I have spoken about sleep before, a few times. I am a nagger though, repetitiveness is often the name of my game, so here I am again rambling on about napping…
Napping is often what we do at night, rather than sleep. Just take short naps and then awake, fighting to return to our sleep, or fighting sleep… or nightmares… or night terrors, that awakened us so cruelly.
Insomnia is very common, there are many things that can cause it.
Waking quickly, our bodies locked in a ridged state, totally unable to move, a night terror having just ripped through our mind, leaving us in a very aroused state, panicking. We can have panic attacks whilst sleeping also, and then awake so quickly, wanting to escape, to runnnnnnnnn… but our bodies are locked, paralyzed, our minds are so confused.
Does this sound like a scary movie?
Unfortunately it is not.
Sleep can be very elusive and when it starts to hide from us we suffer.
Depression and insomnia carry strong ties. Though a lack of sleep may not cause depression, it will deepen it considerably. Over longer periods the likelihood of this happening increases considerably.
Mental Disorders, though may not cause insomnia, in round about ways contribute to it. ADD/ADHD, Bipolar, OCD/Anxiety disorders, being prime examples, and of course PTSD. But insomnia can also weaken us and studies now lead to the possibility of longer periods of insomnia increasing our chance of developing a disorder.
Get a snack, this will be long….
Mental disorders though are certainly not the only link to insomnia, they often co-exist. Sleep/wake disorders though are a part of our DSM 5. (This somewhat large book classifies and defines disorders)
This is not to say though, that insomnia is a sleep disorder, there are so many causes. From an annoying dog that barks every night through stress and a mind with no off switch. The list of things to keep you awake can be as long as the DSM 5.
Insomnia is often a symptom we look at, what is actually keeping you awake, perhaps it is an indication of something else. Often we have poor sleep habits, this is something too, that can be hard to change as any habit is hard to break.
Napping in the afternoon or evening is a common problem. The body works hard to develop a rhythm to follow, we even have a name for this, the circadian rhythm. Our body clock. We even have a part of our brain dedicated to be that “clock”. Located in/by the hypothalamus, this is called the suprachiasmatic nucleus or SCN for short. Without boring you more, light is the trigger for the SCN, this light travels through our optic nerve. We are still linked to day -night, light – dark to govern our cycle. Though interestingly enough, even when cut off from light our clock continues to work.
So why bother you with the SCN? A basic understanding of how we sleep and stay asleep answers questions. The SCN is linked to controlling our body temperature, urine output, blood pressure and hormone production. The SCN helps trigger sleep with decreased light signals. Fairly basic.
All very important parts of our sleep cycle.
Travelers and shift workers often have great difficulties with their sleep. Shift workers that constantly rotate schedules with a two week on two week off nights routine have, as a group, elevated heart problems, higher than normal depression issues and of course digestion issues. The body is not designed nor does it function well on this sort of schedule.
Are you bored yet? Don’t fall asleep please, not until bed time.
Ok, now to tie some things together. In my previous post I explained a bit about sleep. Sleepy Time
Lets look at what makes us want to sleep.
The first is the bodies production of hormones, we produce quite a few. One being adenosine. To put this in a very uncomplicated format…. this makes us sleepy. So often when we have the need to stay awake for various reasons, we take something that combats this hormone. Stimulants. Caffeine in coffee as an example, and before you nod and show me your tea cup, there is caffeine in many teas but tea can also contain Theophylline , Theobromine and L-theanine. Big words huh? Ok so I am used to stumbling over words with too many syllables, basically these are stimulants. They stimulate the heart or brain, depending on which one you are looking at, stimulation is not conducive to sleep.
Back to adenosine, this is produced all day and the levels continue to rise. With the intent of making us drowsy for our regular sleep time. An item worthy of note, when sleep eludes us over a long period, the levels of adenosine continue to build, it has been discovered that this large increase of adenosine combats anxiety/stress. Many people with anxiety disorders will notice that stress and anxiety almost vanish in this situation, when they go a long period with no sleep. Unfortunately trading off a few days of sleep to combat anxiety is not the way we want to cope.
So the adenosine is one of the hormones that help to put us into our sleep state, the body metabolizes the adenosine as we sleep over our normal sleep cycle, as the levels are gradually reduced we gradually wake. This is not the only hormone that helps us sleep or that wakes us up though.
Isn’t this fascinating?
Many of us have heard of Melatonin. Sleeping pills often contain this. The body produces this as well to make us drowsy. We produce large amounts, much more than are found in sleeping meds. Many studies are and have been done on the actual effect of Melatonin as a supplement and its effectiveness. Light is related to the bodies production. If we darken our surroundings the body will produce more. conversely of course, bright lights will cause the body to produce less. Yes I know that is quite simple, bright lights though, as an example, is the monitor you are staring at right now….. Our evening activities can be detrimental to sleep. Watching T.V. , spending much time on the computer… playing video games, these things are not helping us obtain sleep. Even your alarm clock display can disrupt the production of melatonin.
Cortisol, another hormone helps to wakes us up. The body produces it as the sun starts to peek in our rooms. It is also produced during a night terror. Night terrors also release adrenaline. Stress and anxiety increase cortisol levels. As cortisol will awaken us, obviously this is why stress and anxiety can be a cause of insomnia. PTSD sufferers will attest to how elusive a nights sleep is with their mind revisiting a traumatic event each night. Though this is not the only cause for night disturbing dreams.
This leads us to Parasomnia, sleep disorders that encompass night terrors (not to be confused with nightmares) bed wetting, sleep walking, sleep paralysis, nightmares and some other issues such as confusional arousals… waking up in a confused state, almost as if drunk.
Night terrors are much more vivid than a nightmare. You may awaken screaming, terrified, fearing for your life, confusion when you awaken, unlikely to communicate or even move. These occur during deep sleep. You may awaken with bruises as you could be thrashing about.
Sleepwalking can be dangerous as the sleepwalker can get themselves into some situations that will cause injury, you may awaken them, they will be confused. It is not amusing to follow them about the house to see what they get into.
Sleep paralysis is when you awaken and are unable to move anything, breathing is not effected, though patients will often feel they are suffocating. Hallucinations may occur that can be terrifying. The period is short, only minutes, but they can feel an eternity. This short period of struggling to cry out, or move causes strong anxiety, thus releasing hormones that will awaken you, such as adrenaline. This condition can be attributed to stress, anxiety, medications or may be a symptom of Narcolepsy.
So now we move to Narcolepsy. A normal sleep cycle includes the REM state after about 90 minutes or so, with Narcolepsy, we enter that state almost right away, this is when we dream. The body also protects us during this state by paralyzing us. During dreams we can’t really thrash about much our bodies are restricted. Day time sleepiness is one of the symptoms of narcolepsy. Hallucinations also. Depression and narcolepsy can be, or more likely, are linked.
Mental disorders can mess with your sleep greatly as well, unfortunately this complicates or exacerbates symptoms of the disorder considerably. The body needs its sleep. Without it depression and anxiety can be greatly increased. This becomes a vicious circle.
Insomnia is not an uncommon thing for us to suffer with, we will all have nights that may rob us of some sleep. Up to 20% or so of the population will deal with sleep problems on a more serious basis, not just a night or two of tossing and turning. Those dealing with disorders may run at 80% dealing with chronic sleep issues.
Certainly the lack of sleep complicates symptoms and can even cause a misdiagnosis, as symptoms can be intertwined with those caused by days/weeks/months/years of insomnia.
Normal sleep cycles are approximately an hour and a half, the body moves from a deeper sleep to REM sleep every 90 minutes or so during our long nap. Deep sleep is when our body restores itself, our immune system is recharged.
During REM our body is more awake, the mind doesn’t truly sleep, it is active during the night sorting out our day. During REM our body has an increase of heart functions, breathing. It too is an important cycle, as we learn more about what sleep does for us, we find during REM our cognitive functions increase, memory and learning, as we sort out our experiences during the day. It keeps us healthy mentally as well.
Insomnia messes up these cycles that are so important to us, to our bodies to our minds health. Hormone production can be disrupted.
The most basic thing is, we need our sleep to keep our health.
There are numerous sleep disorders. Far too many to cover in a month of posts.
Insomnia and depression are so strongly linked, one causes the other, both make symptoms worse and deepen both conditions. The longer the insomnia continues the harder it is to treat.
Medications that treat disorders, are often to blame for sleep disruptions. When this occurs, feedback with the prescribing doctor is necessary, dosage changes, time of the dose or a med change may solve the problem for you. You won’t know until you try and the doctor won’t know if you don’t provide feedback.
So after all this rambling and a bit of knowledge to fill your minds with, what is the message?
If you are not sleeping well or at all, you really need to speak to your doctor. Help is more than likely available to help sort out what is keeping you from a good sleep. The longer you put this off, the harder it becomes to treat. As with any issue, you always have to take the first step. It may be as simple as correcting poor sleep practice, either way, without the first step there is no help.