Why didn’t I sleep a wink tonight either?
Getting to know insomnia
What is INSOMNIA
Insomnia is a quite frequently psychosomatic sleep disorder defined as defined as chronic dissatisfaction with sleep quantity or quality, accompanied by difficulty falling asleep, numerous overnight awakenings and/or early awakenings that prevent restorative, good-quality sleep. The noun insomnia was borrowed from Latin “in” (no) and “somnus” (sleep) and was first described by Johann Heinroth in 1818 who highlighted the existence of several close bidirectional relationships between mental and sleep disorders [1]. It is a condition present in 15-20% of the Italian population, a percentage that doubles if people over 65 years are included [2], with higher rates found in the female gender since particular stages of life, such as pregnancy and menopause, are more frequently associated with the onset of this disorder. Sleep quality plays an essential role in overall well-being. Not getting enough high-quality sleep can impact on both mental and physical health and quality of life.
How to classify INSOMNIA
Insomnia is classified according to the duration, following DSM-5 (Diagnostic and Statistical Manual of Mental Disorders- 5th edition) [3] and ICSD-3 (International Classification of Sleep Disorders- 3rd edition) guidelines [4]. We speak of acute (occasional) insomnia when symptoms persist for a short period of time (few days/some weeks), while to talk about chronic (long-term) insomnia, which is a more complex condition than occasional insomnia, it is essential that some symptoms occur for at least 3 months. Stress and environmental factors (noise, light, temperature, and abuse of excitatory substances) play an important role in the onset of Acute insomnia, in contrast Chronic insomnia occurs in comorbidity to other medical conditions such as hypertension, heart and mood disorders, diabetes, and cancer.
Symptoms
The symptoms that characterize Insomnia can be divided into:
- Nighttime symptoms or indicators: difficulty falling asleep or difficulty maintaining sleep (frequent and early awakenings), non-restorative or poor quality sleep.
- Daytime symptoms: asthenia, anxiety, irritability and mood disturbances, cognitive difficulties, difficulty in social, occupational functioning, headache, nausea and muscle pain.
In order to speak of Insomnia, these symptoms must occur at least three nights a week for at least three months.
Sleep over the life span
The amount of sleep a person needs depend on various factors including: age, lifestyle, health conditions, and (seasonal) times of the year.
- Infants need 16 to 20 hours a day over 24 hours
- School-age children (ages 6-13) from 9 to 13 hours
- Teenagers from 8 to 10 hours
- Young people and adults, need 8 hours of sleep although a change can be observed due to work rhythms and daily stress [5].
The causes of insomnia: 3 P’s model
To explain the causes of insomnia, one can refer to one of the etiological models of insomnia, the “3P MODEL” also known as the Spielman model (1987), which is based on the interaction of three factors: predisposing, precipitating and perpetuating factors [6]. Predisposing factors include older age, gender, familiarity, and individual characteristics. Precipitating factors are the actual cause of the onset of sleep disorder especially for those with a genetic predisposition; they can be related to stressful and/or traumatic events (loss of a loved one), problems related to health, work and social relationships. When the first symptoms of insomnia occur, the perpetuating factors that fuel this disorder come into play. These factors include the dysfunctional behaviors (straining to sleep, taking daytime naps) that the individual engages in to try to sleep, negative beliefs about one’s sleep quality that induce and fuel anxiety and fear with respect to sleep deprivation (apprehension about facing the day due to unrestorative sleep).
Circadian rhythm and sleep stages: non-REM and REM
Sleep regulation occurs through the activation of the physiological process known as the “circadian rhythm or biological clock,” which regulates sleep/wake alternation based on stimuli from the external environment (light/dark succession). The circadian rhythm determines the production and release of melatonin (a hormone secreted by the pineal gland), which improves the quality of sleep, reduces stress and induces relaxation; this is why it is used as a medication in the treatment of insomnia. The human body goes through two stages of sleep: sleep with non-rapid eye movements (non-REM) and sleep with rapid eye movements (REM). During the non -REM phase, sleep gradually becomes deeper and deeper and the body regenerates. During the REM phase, on the other hand, there is an increase in heart and respiratory rate and dreaming. The body goes through the two phases about 4-6 times each night [7].
Insomnia and related disorders represent a real social and health problem as sleep deprivation results in impaired daytime performance by impairing attention and concentration. In most cases, insomnia is underestimated by the patient himself and consequently not diagnosed in a timely manner.
In order to solve the problem, it is appropriate to become aware of it. How about you, do you have problems with insomnia? Take the test!
[1] Steinberg H, Hegerl U. Johann Christian August Heinroth on sleep deprivation as a therapeutic option for depressive disorders. Sleep Med. 2014 Sep;15(9):1159-64 [2] Proserpio P, Biggio G, Ferri R, Girardi P, Agostoni EC, Manni R, Minervino A, Palagini L, Plazzi G, Nobili L, Arnaldi D. Insomnia in primary care: a survey conducted on Italian patients older than 50 years-results from the “Sonno e Salute” study. Neurol Sci. 2022 Nov;43(11):6487-6494 [3] American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, DSM-5. American Psychiatric Publishing, Washington, DC, 2013 [4] American Academy of Sleep Medicine. ICSD-3-International Classification of Sleep Disorders. American Academy of Sleep Medicine, Chicago, 2014 [5] Chaput JP, Dutil C, Sampasa-Kanyinga H. Sleeping hours: what is the ideal number and how does age impact this? Nat Sci Sleep. 2018 Nov 27;10:421-430 [6] Perlis, M., Shaw, P. J., Cano, G., & Espie, C. A. (2011). Models of insomnia. Principles and practice of sleep medicine, 5(1), 850-865 [7] Institute of Medicine (US) Committee on Sleep Medicine and Research. Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem. Colten HR, Altevogt BM, editors. Washington (DC): National Academies Press (US); 2006.
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