Severe Insomnia: Symptoms and Treatments

Approximately one-third of our lives is spent sleeping. But for those who suffer from severe insomnia, it feels like much less than that. We all have those nights every now and then where we don’t get the sleep we need, but what happens when one night of sleep deprivation leads to another, and another, and eventually into weeks without a full night’s rest? What does a severe insomnia sleep pattern look like? Where is the line between a few missed hours of sleep and severe insomnia? What is sleep hygiene and how does it relate to severe insomnia?

Severe Insomnia: Stages of the Sleep Cycle

Let’s take a minute to break down the basics of the sleep cycle, from that first moment when your head hits the pillow to the deepest stages of sleep where we delve into our dreams. There are two major parts of our sleep cycle, non-REM and REM sleep. Non-REM sleep is composed a few different stages:

Stage 1 of the sleep cycle

This is the beginning stage of sleep when your eyes are closed, you may still be relatively aware of your surroundings, and you make be woken up easily. You’re not quite asleep but you’re on your way. This state only lasts a few minutes.

Stage 2 of the sleep cycle

Early light sleep. This is where your heart rate starts to slow down and your body prepares for that long-awaited sleep.

Stage 3 of the sleep cycle

Deep sleep begins to increase at this point in the sleep cycle. Waking up during this stage of sleep might make you feel a bit groggy which may be why you can get plenty of sleep, but still feel a bit drowsier than usual when you wake up in the morning. The length of this stage of sleep tends to decrease with age, so while babies tend to get the most of stage 3 sleep, adults tend to get less and less of it.

REM sleep, or Rapid Eye Movement, is composed of one final stage:

Each REM cycle lasts about an hour and a half to two hours. In this stage, our heart rate increases and our breathing starts to speed back up. REM sleep is also where vivid dreams typically occur and it is the final stage before the process starts all over again. Adults also typically spend less time in REM sleep than children and adolescents.

Now that we know the ins and outs of the human sleep cycle, let’s discuss what happens when this biological mechanism gets tampered with, and the ways in which severe insomnia begins to affect our daily lives.

Severe Insomnia: What is Insomnia?

Insomnia is a common sleep disorder affecting one’s ability to fall asleep (onset) or stay asleep (maintenance). The lack of sleep that comes with insomnia also comes with its negative effects on our lives during the day, creating what can feel like a never-ending cycle of fatigue. Often when we think of the term insomnia we think of the inability to fall asleep completely, but insomnia comes in all different forms. Whether it’s the inability to fall asleep, irregular sleeping patterns such as frequent daytime napping followed by a lack of sleep at night, or waking up over and over throughout the course of the night, insomnia affects millions of people and can be chronic and long lasting, or acute and temporary. From moderate and temporary to pervasive and severe insomnia, it is an issue faced by many, and because sleep disorders are so prevalent, there is a multitude of resources out there to help us all learn how to get a good night’s sleep. It’s common to experience a few nights or poor quality sleep every now and then which can cause you to feel a bit out of sorts the next day, but when does “being a little tired” become more than just a temporary problem? What exactly is the difference between acute and chronic insomnia?

• Acute insomnia can take place over the course of a few nights, or even one night due to a temporary stressor or situation. This can be anything from getting into a fight with your friends to worrying about a big project at work, to a thinking about that next big exam coming up. Approximately one-third of adults report experiencing some symptoms of insomnia, and with the stresses that come with living in today’s society, it’s no wonder so many of us suffer from some sort of sleep deprivation.
• Insomnia becomes chronic when the inability to fall or remain asleep around three nights a week lasts for a period of a month or more. It’s possible for severe insomnia to follow acute insomnia if other psychological or physiological disorders are present, or it can even be exacerbated by poor sleep hygiene or lifestyle changes. Severe insomnia is more than just feeling a bit sleepy during the day. When it comes to chronic, severe insomnia, it can result in behavioral, social, physiological, and psychological changes.

Severe Insomnia: Signs and Symptoms

Insomnia disrupts the lives of so many and its symptoms are by definition exhaustive. Symptoms of severe insomnia typically include general sleepiness and irritability. It’s not uncommon for life’s stressors to affect our sleeping habits every now and then which is why symptoms of insomnia can appear so frequently. Life is full of stress from work, school, finances, and everything else life has to throw at us. Severe insomnia shares some symptoms of acute insomnia; however, these symptoms are longer lasting and are accompanied by even more symptoms. Symptoms of chronic insomnia include:

• Mood changes and irritability
• Worsening of pre-existing disorders like depression and anxiety
• Higher risk of injuries due to a lack of concentration and loss of ability to focus
• Restlessness and inability to fall and stay asleep
• Increased emotional distress
• Negative effects on memory and academic or occupational performance
• Headaches

Causes of Severe Insomnia

Severe insomnia can be caused or exacerbated by pre-existing psychological or medical conditions, poor sleep habits, lifestyle changes, and a series of other factors that so many people are familiar with. Lifestyle changes that can lead to insomnia include:

• Changing from day to night shifts at work
• Constantly sleeping late, which can confuse the body
• Eating foods that cause indigestion before bed

Not only does insomnia worsen pre-existing conditions, but the same conditions can worsen insomnia as well. Sleep apnea and restless leg syndrome are often associated with insomnia, both causing disruptions in the sleep cycle by waking you up through the night. Other common physiological or psychological causes of severe insomnia may be:

• Chronic pain
• Anxiety and ruminating thoughts
• Nightmares or night terrors
• Asthma or other disorders that cause difficulty breathing
• Loss or sadness that may contribute to depression
• Medications including antidepressants

The causes for short-term acute insomnia are typically temporary stressors like an argument, a big project, a problem at work or an illness. These stressors are typically temporary and can be resolved, often leading to a resolution to short-term or acute insomnia.

Severe Insomnia and Sleep Hygiene

Sleep hygiene is simply the practice of good sleep habits that will help you sleep through the night and wake up feeling refreshed and well rested. Keep in mind that these are not total solutions to sleep problems, as some severe insomnia may require certain lifestyle changes or even treatment from a medical professional, but they are simple things you can try to reduce the effects of insomnia and get back into a normal sleep pattern. These healthy sleep habits include:

• Putting a limit on those daytime naps to no longer than 30 minutes. Better yet, avoid naps if they are not absolutely necessary. Napping during the day can mess with a healthy nighttime sleep schedule.
• No caffeine before bed! People drink caffeine to stay awake, not to stay asleep, so avoid caffeine and other stimulants found in coffee, teas, nicotine, and even chocolates to help get that full night of rejuvenating sleep you need.
• Reducing your alcohol intake. It may make you feel tired at first, but your sleep will typically be lighter after drinking, meaning it’ll be easier for you to wake up and disrupt your sleep cycle. This may cause you to get minimal satisfying sleep and wake up still feeling groggy and not well rested.
• Be mindful of your sleep environment. Use your bedroom only for sleep and not for snacking or watching TV. Keep the room at a cool, comfortable temperature and make sure lights are turned off, including any light from cell phones, computers, and lamps. A quiet environment is also ideal to reduce the symptoms of insomnia.
• Avoid looking at the clock wondering how long it’s been since you tried to go to sleep. Checking the time can increase anxiety about how long it is taking to fall asleep and decrease the amount of sleep you actually get.
• Establish a regular sleep pattern. Set your morning alarm for the same time each day and try to go to bed at the same time each night.

Anxiety and Severe Insomnia

It’s also important to understand that worrying about the sleep you are missing can also actually worsen both acute and severe insomnia. Time spent worrying makes it that much more difficult to fall asleep. So here comes another exhausting cycle: you can’t sleep so you worry about not getting any sleep which causes you to get less sleep because you are too worried about not getting any sleep. Even thinking about it is exhausting. Anxiety and lack of sleep often go hand in hand so it’s important to get yourself in a relaxed state before going to sleep in order to reduce feelings of anxiety or stress.

The frequency of Severe Insomnia

It’s reported that about one-third of adults experience some symptoms of insomnia, but the severity can vary drastically from acute and temporary, which can begin at a few days and last for a few weeks, to chronic, where insomnia can last weeks or months. Insomnia affects millions of people, but this sleep disorder is more commonly found in women, adults over 60, chronic pain sufferers, pregnant women, and those suffering from mental health disorders. However, insomnia takes a toll on adolescents as well. A study conducted in 2010 showed that adolescents participating in the study who went to sleep after midnight were twenty-four percent more likely to suffer from depression than those who went to sleep at a set time of 10 PM. It was also found that those same adolescents going to sleep after midnight were twenty percent more likely to report suicidal ideation. Lack of sleep poorly affects people of all ages and does not have one single cause.

Disorders most commonly associated with severe insomnia

Insomnia does not always show due to poor sleep habits or temporary stressors. Lack of sleep takes a toll on the body and the mind, and severe insomnia can be exacerbated by a multitude of other conditions. It can also exacerbate other conditions as well. Some conditions that are frequently associated with insomnia whether they may cause or be caused by it include:

• Depression
• Anxiety
• Restless leg syndrome
• Postpartum depression
• Sleep apnea

Severe Insomnia Treatments

• Practicing good sleep hygiene. As mentioned previously, sleep hygiene can play a significant role in your ability to fall asleep. Take the time to limit light and sound before going to sleep as well as limiting screen time. Another good practice is to set that regular sleep schedule.
• Cognitive Behavioral Therapy (CBT) may be worth trying as well. This approach focuses on the emotional factors contributing to insomnia. When it comes to treating sleep disorders, CBT involves the practice of associating being in bed with sleeping and less with other activities.
• Relaxation is also an important technique that can help those who struggle with falling asleep. From meditation to taking a warm bath, getting yourself into a relaxed state may be the first step to a satisfying sleep.
• Lifestyle changes may help both short-term and severe insomnia. These changes can be dietary, an established sleep schedule, sticking to a regular work schedule, or even adding an exercise routine into your day.
• In cases of severe insomnia, medication may also help as well if you are struggling with depression or anxiety. This is something you might wish to discuss with a medical professional if you feel your emotional and psychological state is taking a toll on your sleep and your daily life and vice versa.

When it comes to severe insomnia there is no single solution. Everyone’s circumstances are different and what works for some may not work for others. What we do all have in common, however, is the fact that we all need sleep to function as best we can, no matter what life throws at us. So let’s practice some good sleep hygiene and get a good night’s sleep!

References

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Stewart, K. (2012, February 7). Overnight Treatment for Chronic Insomnia. Retrieved  September 5th, 2018 from https://www.health.harvard.edu/blog/overnight-treatment-for-chronic-insomnia-201202074207

(n.d.). Retrieved September 5, 2018 from https://medical-dictionary.thefreedictionary.com/Chronic+insomnia

(n.d). Retrieved September 5, 2018 from https://sleepfoundation.org/insomnia/content/what-is-insomnia

(n.d.) Retrieved September 5, 2018 from https://www.nhlbi.nih.gov/health-topics/insomnia

(n.d). Retrieved September 5, 2018 from https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Understanding-Sleep

Gangwisch, J. et al (2010, January 1). Earlier Parental Set Bedtimes as a Protective Factor Against Depression & Suicidal Ideation. Retrieved September 5, 2018 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2802254/

Marisa Smith

Marisa is a recent Binghamton University graduate with a degree in both English and psychology. She is particularly interested in discussing matters of the brain, human behavior, and literature. Marisa enjoys creating informative content to share with others who may be interested in learning more about psychology.