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Insomnia – Part 1:
Why Can’t I Sleep?

Insomnia: A Daytime Problem with Night Time Consequences

Woman who can't sleep suffering from insomnia
Trouble sleeping? You are not alone! Occasional insomnia affects most of us at one time or another. Ten percent of the U.S. population suffers from chronic insomnia, lasting 6 months or more. Let’s explore what is insomnia, and how does it affect us. For solutions to insomnia, check out Insomnia – Part 2: Manage Insomnia and Improve Your Sleep.

“Clinically significant insomnia” is defined as insufficient sleep on 3 or more nights per week. Adults need 7.5-8 hours of sleep, while children and adolescents require 9-10 hours.

There are Three Types of Insomnia

  1. Transient, precipitated by life stress. It is situational and usually lasts less than one month.
  2. Sub-Acute, which persists 1-6 months. It can be caused by stress and / or physical conditions such as sleep apnea, Parkinson’s disease, hot flashes, and restless leg syndrome.
  3. Chronic, which persists 6 months or more. It can be caused by stress, physical conditions, or genetics (familial insomnia syndrome).

Most insomnia is not just a disorder of sleep — it has its roots in daytime stress.

In women, hormonal transitions such as postpartum and peri-menopause can trigger sleep problems.

Many of us self-medicate for insomnia, for example with alcohol or other chemicals. But in the long run some of these self-treatments worsen insomnia.

Let’s take a closer look at the type of insomnia most of us experience — stress-related insomnia.

Most insomnia is not just a disorder of sleep — it has its roots in daytime stress. The stress we experience throughout the day, and how we perceive and manage that stress, can create or perpetuate insomnia.

Let’s explore how this works:

Stress activates the body’s emergency system, housed in our brain, adrenal glands, and nervous system — and triggers our stress-management cascade:

  1. You perceive stress from work, family, financial, social situations.
  2. Your brain gets notice: “Attention: Stress!”
  3. Nerve impulses in your brain trigger a gland, the pituitary, in your brain to make stress-coping hormone signals.

The stress-hormone-coping signals travel through the blood stream. The adrenal glands respond by making adrenaline to further arouse the nervous system, and cortisol to adjust our metabolism in ways that help the body cope with stress.

The adrenaline and cortisol “activate” the body’s nerve and metabolic systems. This:

  • increases your heart rate
  • increases your blood vessel constriction producing high blood pressure
  • increases your body temperature
  • increases your body movements before the onset of sleep, leading to physical agitation, such as “restless leg” syndrome
  • changes your metabolism to increase fat deposits around your middle

These physical changes caused by stress during the daytime cause excess arousal, an energy that manifests itself as:

  • delayed onset of sleep
  • frequent awakenings
  • poor sleep quality

Our response to stress and how it causes insomnia is fairly elaborate. Hopefully, now you can see how lack of sleep can have serious long-term consequences such as:

  • weight gain*
  • high blood pressure
  • anxiety
  • depression
  • altered perception of the world, even psychosis

*Sleep deprivation turns on our appetite centers in the brain, and we crave carbohydrates. It also ramps up our stress hormones, contributing to even more weight gain.

Once insomnia is established, it produces physical changes in our bodies that make it self-perpetuating.

Insomnia Produces Fatigue, Not Sleepiness

Ironically, insomnia causes daytime “fatigue,” which may actually inhibit “sleepiness.”

“Sleepiness” is a feeling of physical and mental tiredness associated with a desire and ability to sleep.
“Fatigue” is a feeling of physical and mental tiredness not associated with increased tendency to sleep. Instead, fatigue can produce a sensation of agitated wakefulness.

Insomnia increases our body’s inflammatory response. Normally our “inflammation molecules” peak shortly after onset of sleep. However, with insomnia our inflammation molecules peak in the early evening and remain sustained throughout the night and day, contributing to a sensation of restlessness and fatigue.

Life Transitions Increase Our Vulnerability to Insomnia

Dramatic hormonal transitions such as peri-menopause and post-partum are associated with insomnia.

As we get older our body becomes more “reactive” to similar amounts of stress because we grow more physically sensitive to the stress-modulating hormones.

We’ve explored the causes of insomnia, from daytime stresses and life transitions, and seen how insomnia can cause weight gain, high blood pressure, anxiety, depression, and even an altered perception of the world.

If You Liked This Article:

Be sure to read Insomnia – Part 2: Manage Insomnia and Improve Your Sleep for how to regularly get a good nights sleep.

What’s your experience?

Do you suffer from insomnia? If so, how long has it been going on?
What long-term strategies have you found to successfully reduce your insomnia?

Scroll down to the bottom and Leave a Comment in the box below. Thanks for sharing your experience!

Sources and Resources

Scientific Articles

Morin et al. Cognitive Behavioral Therapy, Singly and Combined with Medication, for Persistent Insomnia: A Randomized Controlled Trial JAMA May 20, 2009—Vol 301, No, 19, page 2005.

Basta, M et al. Chronic Insomnia and Stress System Sleep, Med Clin. 2007 June 2(2): 279-291.

Cognitive Behavioral Therapy, Relaxation Techniques

Bourne, Edmund J. The Anxiety and Phobia Workbook, Fourth Edition New Harbinger Publications, Inc. Oakland, CA, 2005.

Spradlin, Scott E. Don’t Let Your Emotions Run Your Life New Harbinger Publications, Inc. Oakland, CA, 2003.

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{ 10 comments… add one }

  • WarmSocks May 22, 2009, 12:23 pm

    I slept 10:30pm-3am for months. In hindsight, I think it was the stress of knowing I’d have to go back to a doctor I didn’t like. When I finally asked my PCP for a referral to a different rheumatologist, the sleep problems went away – even before I got to see the new rheumy, just knowing that I never had to see the old one again was fantastic.

    • Dr. Shelley Binkley, MD May 22, 2009, 5:30 pm

      Wow WarmSocks! It’s funny how something like that can “stick” in our brains and act as a source of anxiety and rumination. I’m happy to hear it was resolved with a change in situation. Sleeplessness is sometimes a sign our gut is telling us something we need to listen to. Thank you for reading the blog and commenting! – Dr. Binkley

  • shobhika May 24, 2009, 12:30 am

    Doing yogic exercises like sarvang asana the way to do is
    1. Lay on your back
    2.Lift your legs and place your hands at the base of your back. Lift your pelvis and bring your feet behind your head (plow pose). Your legs should be as straight as possible and your torso should be perpendicular to the floor.
    3.With your hands pressing into your lower back lift your knees into the air with your feet hanging towards your buttocks.
    4.Lift your legs into the air. Your heels should be lifting towards the ceiling.
    5.Gaze at your chest, being careful not to move your head from side to side.
    6.You can hold the pose for 30 seconds to three minutes.

    • Shelley Binkley May 26, 2009, 10:54 am

      @shobika thank you for the yogic exercise suggestion!

  • Megan Oltman May 25, 2009, 10:37 am

    Great article Shelley! As a recurrent sub-acute insomnia sufferer, I can see myself in so much of this. I use deep breathing and visualization relaxation techniques to quiet the stress pathways, as you call it. Those of us with Migraine disease are caught in the further problem of the insomnia and lack of high quality sleep contributing to triggering Migraine attacks, and the same relaxation that helps with the sleep helps calm the nervous system and make it less vulnerable to Migraine triggers. I love your explanation here. Worry about not sleeping has indeed kept me up many a night!

    • Shelley Binkley May 26, 2009, 10:54 am

      @Megan thank you for reading and commenting! Yes, sleep deprivation can trigger migraines, as you know. The same calming techniques can effectively alleviate migraines, insomnia, and other stress-related or stress-aggravated symptoms.

  • jose December 22, 2009, 10:44 pm

    well i got very good tips and info but i dont know if i got insomia i dont fell fatigue or weak i just cant seem to foucs on sleeping and sometimes i feel like i closed my eyes and im asleep but i can remenber all the noise’s i heard that night the next day!! almost like im having a dream that feels and sounds so real any one please feel free to givve me feed back on this

  • krys August 2, 2011, 1:35 am

    great article! Im 17 and havent been able to sleep well.. I feel very alert all the time! I dont think i have insomia or maybe i do.. I tried the relaxation.. Even tried not to use my phone laptop tv ect. Before sleeping.. I feel tired! My eyes are tired but once i turn the lights off i feel awake! What can i do?

  • Max Medlow October 7, 2011, 7:33 pm

    Hi there. Recently (within the last two week) I have moved from my quiet house in the countryside to go to uni in a big city. The bed here is uncomfy, there are noisy nightclubs blasting music long into the early hours of the morning, and there is a car alarm which goes off for about 2 minutes every night, at the same time every time! Along with this, I’m not totally happy with the course I have chosen and am feeling quite stressed about the inevitable decision I have to make here, about leaving uni to pursue things that will make me happier.

    Anyone could tell me that all these factors are ruining my sleep (I just CANNOT sleep at night, and only manage to sleep in the day due to utter exhaustion), but I was hoping maybe for an experts advice on whether going back to the countryside and doing things which make me happy are *really* going to help me here. I’m just absolutely terrified that I’m going make massive, and hopefully positive, changes to my life and still be stuck with this horribly depressing sleep problem.

    I noticed that there have been no comments left in the last couple of years on this page, but I really hope you are still around to help me! Thanks

    • Shelley Binkley December 16, 2013, 7:22 am

      Hi Max,

      Have you been able to sleep better?

      Thank you for reading the blog and sharing your experience.

      -Dr. B

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