Insomnia is a lonely and often neglected problem. This disorder may be found in 10-30 percent of the population, and perhaps higher among the elderly, females, and people with medical and mental disorders, according to the review by Bhaskar, Hemavathy and Prasad. But chronic insomnia may be neglected by family practitioners or treated inadequately. The insomniac cannot call their medical care provider at 2 or 3 a.m. after (once more) lying awake for hours and ask for the doctor for help the way one would if experiencing a medical problem during the day. Nor is waking someone up to relieve the 3 a.m. loneliness a good idea; it’s likely that the person awakened would not be good company. Moreover, since almost everyone has faced sleepiness at some point due to muscle pain, jet lag, a barking dog, or worry, we who suffer from insomnia sporadically may not realize how debilitating this condition can be when it is chronic.
Some occupations are vulnerable to sleep deprivation, either because their jobs don’t give them enough time to sleep, or because they have trouble falling asleep. Shift workers are prone to insomnia, and it may worsen when their sleep-wake cycle changes on their days off or when moving into a new work cycle. One consequence is a significantly greater occurrence of depression among shift workers compared to other groups, according to an analysis published a few years ago.
Despite the many symptoms associated with insomnia, the consensus seems to be that it is a disorder which is under-recognized and under-treated. This may be because sleep habits are not queried by the health provider, and complaints are not offered by the patient unless linked to an obvious cause for sleeplessness, such as pain, hot flushes, reflux, sleep apnea, or medication. Health providers may have neither the time nor the expertise to treat the disorder, assuming it is not related to an obvious cause . . . such as sleep apnea. Or, they may rely on pharmacological interventions to induce sleep, even though these drugs have side effects and/or limited efficacy. Sleep clinics may detect the underlying cause(s) of the sleep disturbances, but usually do not offer long-term therapeutic help.
Support groups for insomniacs exist and may provide information and help if this is not available from health providers. A.W.A.K.E., which stands for “alert well and keeping energetic,” is a national organization started years ago by the American Sleep Apnea Association to provide support for people using a new device, the PAP (positive airways pressure) machine, for sleep apnea. Currently the A.W.A.K.E program has expanded its outreach to anyone in the community with sleep problems. Other support groups helping those with specific problems that interfere with sleep, such as restless legs, are also listed on Internet sites and found throughout the country. But these groups are only as good as the information offered. Someone with serious psychological side effects from lack of sleep probably won’t find anyone in these support groups with the expertise to deal with their problems. However, one benefit may be no longer feeling isolated and lonely when sleep is elusive. Perhaps these groups, at the very least, give the insomniac the name of someone to talk to at 3 a.m.
Medical residents are another group that has been identified as vulnerable to impairments in mood and performance because of sleep deprivation. Their sleep needs are not met, because their work schedules require being “on-call” all night, after working all day. The numerous television hospital dramas with their interpersonal catastrophes fail to mention that the hospital staff may be suffering from depression, impairment of performance, and difficulties with interpersonal relationships because of inadequate sleep. The cognitive deficits associated with restricted sleep are not emphasized in these programs either, but are also a well-researched side effect.
However, emotional, cognitive, and physical impairments potentiated by sleep deprivation are not restricted to these two groups. In an article describing the results of a multi-site study testing an intervention to improve sleep, Freeman and his co-workers link a lack of sleep to clinical depression and suggest that many insomniacs experience general mental distress at their continuing failure to achieve restful sleep. Their study targeted university students whose insomnia caused paranoia and hallucinations, side effects that are probably not well known as a consequence of insomnia. The authors used an online cognitive-behavioral intervention over several weeks and compared the effects to conventional treatments for insomnia, such as medication, and suggestions about avoiding caffeine, regular bedtimes, and relaxation techniques. Despite the fact that no therapist was present in the experimental intervention, the online treatment was effective. Their intervention significantly reduced insomnia, paranoia, and hallucinations after 10 weeks, decreased depression and anxiety, and improved general well-being. What is striking about their results is that the improvements in mental and cognitive function were accomplished without drugs, and the therapy and the educational and cognitive interventions were carried out online.
“Prevalence of chronic insomnia in adult patients and its correlation with medical comorbidities,” Bhaskar, S, Hemavathy D and Prasad S, J Family Med Prim Care, 2016 Oct-Dec; 5(4): 780–784.
“Night Shift Work and Risk of Depression: Meta-analysis of Observational Studies,” Lee A, Myung S-K Cho J, et al, J Korean Med Sci, 2017 32(7): 1091-1096.
“Sleep Deprivation and Depression,” Al-Abri M, Sultan Qaboos Univ Med J, 2015; 4: 4-6.