There is a fair bit of misunderstanding of what exactly constitutes insomnia. In this article, I’ll attempt to shine some light on this subject as it affects a lot of people in some very irritating--and sometimes serious--ways.
To start off, it’s quite normal to experience a few days or a couple of weeks of poor sleep once in a while. Often, it’s brought on by some psychological or physical trauma of some sort – a death in the family, a bankruptcy, a looming deadline – anything.
Once the event passes or the shock wears off, the sleeplessness goes away. We’d call this transient or acute insomnia. If it lasts much longer than about three weeks, we transition into chronic or long term insomnia.
Yet what exactly constitutes insomnia, as opposed to any other sleep disruptions or disorders?
Insomnia is generally interpreted to be a positive or yes answer to either of these questions:
Do you have difficulty falling asleep at night?
Do you have difficulty staying asleep at night?
If you’ve answered yes to either or both of these questions (as it is with me), then you have to ask yourself the question:
Do I really have a hard time falling or staying asleep?
How do I know?
This second question is really important as it’s been shown that people are very poor judges of their own sleep quality and quantity.
However, I believe that, if you can’t actually measure the insomnia (i.e. how many times you woke up and how long you were awake for), the better subjective attitude would be:
How do I feel the next day? Am I unfocused, tired, confused, otherwise compromised?
Some people really suffer with this, and the effects of insomnia are basically an inability to function. They may hallucinate, have difficulty doing simple tasks (like driving or cooking) – it generally ruins their quality of life.
Now that we’ve defined insomnia, it’s important to differentiate between the two types: primary and co-morbid (or secondary).
Primary insomnia is basically the condition you have when no other “causes” for the sleeplessness are there, or can be found. Once all the other medical, medication, substance or sleep disorder (sleep apnea) causes are eliminated, this is what’s left. If the insomnia was “caused” by some depression or anxiety without a real medical issue present – than this is what you have.
Co-morbid or secondary insomnia is a type that is brought on or amplified by the use of some other factor – and it could be almost anything. Medications, nicotine, caffeine, alcohol, illicit drugs, pain, stress, rheumatoid arthritis, hyperthyroidism, brain trauma, anything. It’s important that we get these medical issue resolved first, or the insomnia issue may never go away.
The important lesson here is to find out whether the cause of your insomnia has got a third-party contributor – something that can be controlled. I’d say that things like “jet lag” are pretty hard to control, and so that would be considered short-term, primary insomnia. Something like taking amphetamines or your arthritis causing pain all night would be co-morbid.
In 2002, the Government of Canada conducted a study on insomnia. I was really surprised when I started to look at these statistics, and when I started to talk about my sleeping problems; seems that this issue is a lot bigger than I ever imagined.
Based on the responses of the 36,984 randomly selected respondents, the study reported the following:
Most of their conclusions from the study reinforce many of the things about sleep that we’ve been told -in particular the fact that what you do during the day affects your sleep at night. As they say it better than I ever could – here it is:
Physical and psychological problems can interfere with sleep. Painful conditions such as arthritis, migraine and fibromyalgia were associated with insomnia, as were anxiety and mood disorders and stressful life events. As well, alcohol and cannabis use were significant factors. Obesity, too, was related to having problems with sleep.
Even allowing for a series of physical, mental, lifestyle and socio-economic factors, insomnia was related to some adverse situations. Relatively large percentages of insomniacs had difficulty coping with day-to-day demands and unexpected problems. They were also more likely than other people to have had a recent disability day and to express overall dissatisfaction with life. As well, a significantly large proportion of people in the prime working age range who suffered from insomnia were not employed.
Some less obvious factors were associated with insomnia. When physical and mental health status, lifestyle, and demographic and socio-economic variables were controlled for, being female, middle-aged, widowed, and having a low education were significantly related to insomnia.
On the other hand, moderate physical activity and a bit of work stress were protective. The lack of a positive association between work stress and insomnia may reflect the relatively large proportion of insomniacs who do not work.
So there you have it – some things about sleep you may not have known! Hopefully this information will help you assess your own sleep quality. In my next post, I'll go into more detail about some of the (natural) things you can do to help lessen or relieve any insomnia symptoms.