Insomnia is probably the most common complaint encountered in my past clinical experience. The factors contributing to everyone’s difficulty sleeping are multifactorial. A large portion is societally driven; everyone is juggling multiple duties where there aren’t enough hours of the day to accomplish everything, or those duties themselves require wakefulness during regular sleeptime hours. Jobs, workloads, child-rearing, school, chores, and more. Then the stress of all those duties contribute to anxiety and mood disorders and other conditions that further worsen insomnia. There is also increasing evidence that our use of nocturnal lighting, particularly with modern devices like computer, smartphone, and television screens also mess with our natural circadian rhythm cycles, which further delays or eliminates sleep.

Sleep is crucial to overall health and daily functioning. Increasing evidence has tied lack of sleep to a host of mental and physical disorders, including increased depression, irritability, impulsivity, cardiovascular disease, and more. One study noted that sleep actually functions as a sort of laundry cycle for the brain, where during sleep, blood vessels (and lymphatic channels) in the brain hyperperfuse and flush out metabolic buildup from the day and remove neurotoxins, and distribute components that enhance cellular repair. Some researchers theorize that this process may be impaired when individuals eventually develop the brain plaques that lead to Alzheimer’s dementia over time. And even short-term, a “junky” brain may not function as smoothly with regard to cognitive or emotional processing; hence feeling foggy and cranky after a bad night’s sleep.

Allowing for full sleep cycles may also be important for overall brain functioning; rapid eye movement (REM) sleep is noted to have particular significance for neurorestorative processes.  Slow-wave sleep may also have its own crucial healing processes for the body as well and may reduce inflammatory states.

How can we help improve sleep? Increasingly, first-line treatment focuses more on sleep hygiene, which is a series of steps to train oneself to restore a regular sleep cycle. Steps like setting a regular daily sleep schedule as much as possible, engaging in physical exercise up until early evening, avoiding caffeinated drinks after mid-afternoon, avoiding alcohol (which can alter sleep cycles), “downwinding” towards bedtime by decreased lighting and relaxation techniques/meditation, reserving the bedroom for sleep only, maintaining a consistent bedroom temperature, avoiding “blue light”-emitting devices after sunset may help, although of course reality-based lifestyles may hamper some of these better habits.

Sleep medications are frequently used for insomnia, but have marked tradeoffs, and in most cases should only be reserved for short-term usage. Several sedative-hypnotics can lead to next-morning grogginess and decreased cognitive functioning, and some (such as the benzodiazepines and nonbenzodiazepine GABA-A-receptor modulators) can become habit-forming or addictive over time and less effective, or can interact with other medications or alcohol in a dangerous fashion. If there are underlying mood or anxiety disorders contributing to insomnia, they should be treated primarily as well. Also medical conditions that worsen insomnia such as sleep apnea should be diagnosed and treated.

As a society, we may need to rethink how we treat and prioritize sleep; recent workplace initiatives to permit “power naps” at work, and cultures that allow “siesta” time probably have the right idea. The irony is that many institutions overwork people to maintain productivity, but over time, not building in work-life balance, childcare-friendly initiatives, and promoting sleep will reduce productivity and lead to a tired, unhappy workforce.

All of us need to recognize and respect the physical realities of our need for sleep. Everyone will be better rested and ready for it.   

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