Insomnia is one of the most prevalent sleep disorders in Canada and the United States of America.
Despite the importance of sleep, more than 33% of Americans do not get 7 hours of sleep every night.
It doesn’t stop there, not only is health being compromised but it could cost BILLIONS of dollars every year.
“Insomnia costs the U.S. Workforce 63.2 Billion dollars a year in lost productivity”
On an individual level, this would cost the average US worker 11.3 days or $2,280-$3,274!
For Canadians, the estimated burden of insomnia is $5,010 per person per year.
This is a LOT of money being lost. But how is this possible? Why is no one talking about this?
It’s hard to evaluate the exact amount of money being lost because the money is lost through indirect costs. These indirect costs include work absences as well as reduced work performance.
These lost wages are further inflated by
1. The low proportion of insomniacs that are actively seeking treatment.
2. Treatments not being effective.
3. The high costs of treatment.
The costs to the economy will only grow as insomnia rates increase! On our current trajectory, these costs could rise exponentially!
What is Insomnia?
Insomnia is an individual’s subjective interpretation of sleep difficulty including
1. Getting to sleep.
2. How long they can sleep before waking up.
3. Their sleep quality.
4. Their impairment from fatigue during the day.
In general, insomnia is characterized by difficulties falling asleep, staying asleep, going back to sleep after waking up at night and feeling tired after sleeping.
How is Insomnia Diagnosed?
For short-term insomnia, your doctors look at symptoms such as sleepiness during the day, your mood and if you have issues with concentration.
They will also test to see if you are healthy by completing a physical exam.
After they have completed the physical exam, they may simply ask you to keep a sleep diary.
If the issue persists it is classified as chronic insomnia. Chronic insomnia is evaluated by
1. The presence of significant distress.
2. If you have physical and/or mental limitations due to fatigue.
3. You must have these sleep difficulties for at least 3 nights/week for at least 3 months.
4. Your sleep difficulties must not be linked to any other health disorder.
What is the Prevalence of Insomnia?
In the U.S, 30-40% of adults reported symptoms of insomnia in the year 2020. Short-term insomnia is believed to affect 9.5% or 31.3 million people! Of this 31.3 million, 20% will develop chronic insomnia.
This means that 6.26 million people develop chronic insomnia every year!
Who Is Most Affected By This Disorder
The two largest risk factors for insomnia are age and sex. This means that they do not directly cause insomnia but can increase your risk!
As you get older, your sleep changes. What this means is that you are more likely to wake up during the night from light, sounds or other disturbances. Things that normally wouldn’t wake you up suddenly do now!
When you age you also become at risk for other mental conditions which can contribute to inadequate sleep leading to insomnia symptoms.
Women are more likely to have insomnia compared to men due to their hormones. Multiple hormonal changes happen during their life!
Menstrual cycles and days leading up to a period can lead to insomnia symptoms. Pregnancy, menopause and post-partum depression can also all lead to insomnia symptoms!
This can progress to chronic insomnia!
Overall, the population most at risk for insomnia are older women!
Insomnia has been found to decrease quality of life!
It has been linked to reducing physical functioning, increasing bodily pain, poor social interactions and poor mental health!
Insomnia also poses a large health risk.
“Insomniacs are 2.5-4.5 times more likely to get into accidents”
Insomniacs also have higher rates of absences, poor concentration and more difficulty performing tasks.
“Insomniacs' healthcare expenses are 60% higher than people without this disorder.”
This is a huge financial burden on an individual and the hospital system.
Treatment options are divided into medication and non-medication.
4 classes of medication are prescribed which are hypnotics, antidepressants, melatonin agonists and orexin antagonists.
Hypnotics are the most commonly prescribed because they are cheap and easily accessible. This medication improves sleep quality and reduces the number of times you wake up during the night.
Two major issues with this type of medication are that they can easily cause addiction and tend to not be effective if used for a long period.
When your doctor is thinking of prescribing you medication there are several things they take into account.
1. Do you have difficulty getting to sleep or is it more difficult for you to maintain sleep?
2. How often do you have difficulty sleeping?
3. How long will you be taking this medication?
4. Do you have any other health conditions that could react poorly with the medication?
If you have difficulty staying asleep then your doctor would likely prescribe you a hypnotic or orexin antagonist.
If you suffer from anxiety and depression along with insomnia then your doctor may prescribe you an antidepressant. This antidepressant would counteract your anxiety and/or depression symptoms allowing you to sleep better.
Several strategies can be used depending on the severity of insomnia. For individuals starting to experience insomnia symptoms, initial education and counselling about good sleep practices are helpful.
Good sleep practices can include waking up at a regular time, limiting time in bed to only sleep, creating a good sleep environment, avoiding caffeine and alcohol in the afternoon and avoiding daytime napping.
If these prove to be ineffective then cognitive behavioural therapy for insomnia could be helpful.
This form of psychotherapy identifies and explores the different feelings, thoughts and behaviours that contribute to symptoms of insomnia. It seeks to clarify misconceptions and challenges that act as obstacles to a good night’s sleep.
There are three components to this therapy.
1. Cognitive interventions: Changing misconceptions and thoughts that are not helpful about sleep
2. Behavioural interventions: Promoting relaxation techniques, changing associations of the patient’s bedroom and establishing healthy sleeping habits.
3. Psychoeducational interventions: Providing education about how your thoughts, feelings and behaviours can impact your sleep.
How Covid-19 Increased Insomnia Prevalence
Covid-19 has been the source of worldwide stress and anxiety about employment, finances, social isolation, health and various other issues. This major stressful event can and has impacted many people’s sleep!
The Covid-19 pandemic has caused many psychological symptoms including short-term insomnia.
“Of the 5,641 people in a study published in the Sleep Medicine Journal, 20% of the participants reported clinically significant insomnia”
This is a very high concern as short-term insomnia like we discussed earlier, can progress into chronic insomnia.
The study urges that sleep health education targeting the general population is very important. This education should include illustrating the importance of maintaining regular sleep schedules, getting enough sunlight during the day as well as reducing the barriers to receiving cognitive behavioural insomnia therapy.
“If there is any time in your life to be aware of how important your sleep is, it is NOW”.
What Is Anxiety?
Anxiety is linked to fear and manifests as thoughts that can influence your behaviours. The way it influences your behaviour is because your brain deems an anticipated event or circumstance as threatening. It is an often underdiagnosed mental disorder so the current estimates may not be fully accurate.
Think of anxiety as the feeling you get before a big presentation at work or a fear of doing something wrong CONSTANTLY. It’s a crushing and inescapable feeling.
There are 9 types of anxiety!
To diagnose you, a doctor will perform a physical exam to rule out any health issues that could be the cause of your anxiety. If everything comes back normal then the next step is a psychological evaluation.
Separation Anxiety Disorder is the fear of harm to, loss of or separation from certain people or figures in your life.
Selective Mutism is the consistent failure to speak in social situations where you are expected to speak. If you have watched Big Bang Theory this is what Raj is afflicted with and why he cannot talk to girls!
Specific Phobia is specific objects or situations that cause you to feel intense fear.
Social Anxiety disorder is an intense fear of social situations where you could be embarrassed. This one relates to being embarrassed, rejected, humiliated or offending others.
Panic Disorder relates to individuals that experience recurrent, unexpected panic attacks. This is a vicious cycle as worrying about when or if you have another panic attack can trigger panic attacks!
Agoraphobia is when people are fearful about being in public or enclosed spaces as they are worried about help not being available if they have panic symptoms, embarrassment or that escape may be difficult.
Generalized Anxiety Disorder is excessive worrying about various things in your life such as work or school.
Substance/Medication-Induced Anxiety Disorder occurs when you continually use a certain substance or from the withdrawal of certain medical treatments.
Anxiety Disorder Due to Other Medical Conditions occurs when an individual experiences anxiety symptoms due to a medical condition. For example if someone had heart disease this could be a contributing factor to their anxiety.
How Is Anxiety Treated?
Similar to insomnia, there is short-term and long-term anxiety. For short-term anxiety the treatment is also benzodiazepine (a hypnotic) whereas chronic anxiety involves psychotherapy, medication or sometimes both!
Medications For Chronic Anxiety
There are 6 medications used to treat anxiety (including hypnotics). The treatment that you will receive first before any of the others is selective serotonin reuptake inhibitors (SSRIs).
Selective serotonin reuptake inhibitors (SSRIs)
Now, you are probably wondering, why serotonin is used to treat anxiety? There is a specific receptor called the 5-HT1A receptor which reduces anxiety symptoms. This medication works by preventing your body from taking back the serotonin that it has released. The extra serotonin in your system can then activate this receptor!
Selective norepinephrine receptor inhibitors (SNRIs)
SNRIs prevent your body from taking back norepinephrine (adrenaline) and serotonin. This medication works similarly to SSRIs except they are often used when SSRIs are not effective! This class of medication is very helpful for generalised anxiety disorder.
Anxiety is not just mental thoughts, it can sometimes lead to changes in your behaviour. Your heart can start beating rapidly, you can start to feel dizzy, your hands are sweating and shaking and your voice can start to crack.
Dealing with these symptoms on an ongoing basis is not good for your mental or physical health. This medication is used to control and reduce these physical effects.
They are very helpful for Specific Phobia related anxiety.
These medications are just as effective as SSRIs but are more dangerous. They are typically used when the previous medications do not work! They act on the same targets as SSRIs and SNRIs as well as more!
This medication targets the same receptor as SSRIs but takes longer to activate them. This is really important because what it means is that it can help people who have built up a tolerance!
Building up a tolerance is something that all pharmaceutical companies fear. It can happen with anything because your body is very smart but at the same time very stupid. It can sense the smallest change in your body but the second that that change becomes a recurring thing, your body adapts.
To demonstrate tolerance let’s take a look at coffee.
If you aren’t a coffee drinker then you will notice that if you have one cup of coffee it will give you a TON of energy.
However, if you drink a cup of coffee on a more regular basis. You will need to have more cups of coffee to get a similar boost in energy.
The point is that if you continually expose your body to coffee then you will need a to drink more to get the same effect.
This drug allows people to get the same effect with a less strong dose! Another benefit of this drug is that it does not have the same adverse health effects as SSRIs.
This medication is often used to treat generalised anxiety disorder.
How Does Insomnia Cause Anxiety?
Here comes the big question, does insomnia cause anxiety. In a short answer YES, but also NO. Let me explain.
They both contribute to each other. If you have anxiety, you likely have sleeping problems. On the other hand, insomnia can cause anxiety especially around sleeping and everyday life. It often depends on which one happens first!
In fact, for certain anxiety disorders such as generalised anxiety disorder, part of the definition includes sleep disturbances such as nightmares and insomnia. Furthermore, the prevalence of insomnia for individuals with panic disorder can be as high as 67%!
On the other hand, insomnia can contribute to anxiety symptoms, increase the risk for the development of anxiety and can make anxiety disorders worse!
For individuals suffering from insomnia, going to bed can be a major source of stress. This stress combined with poor sleep quality can contribute to the development of anxiety.
“In a study published in the Sleep Journal that consisted of 25,130 people, reserachers found that chronic insomnia is a risk factor for the development of anxiety disorders”.
If you cannot sleep, your mental health will decline and your natural ability to cope with stress is not as strong.
This can lead to excessive worrying and stress about things in your life that you usually wouldn't think twice about.
Now We Want To Hear From You!
Which statistic shocked you the most?
Are you surprised by the link between anxiety and insomnia? If so, what surprises you the most?
Leave a comment down below!