Department of Psychiatry
Penn Behavioral Health

PAH Outpatient Behavioral Health Clinic

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Newsletter: April 2011

The Causes of Insomnia

Jordana Cooperberg, MA

Insomnia, we’ve all used the term, but what does it really mean? Some people would say it means a lousy night of sleep. Insomnia literally means “no sleep” or the inability to sleep. The clinical definition of insomnia is a problem initiating and/or maintaining sleep, early morning awakening, or the complaint of nonrestorative or unrefreshing sleep.  These all lead to a complaint of distress about sleep or daytime impairment. At least one of these sleep problems should occur at least 3 nights a week before you think about treatment. Not getting enough sleep is only classified as insomnia for individuals who have adequate opportunity for sleep. It’s not insomnia if you can’t sleep because you don’t allow yourself enough time for sleep.

Insomnia is a very common problem, with 50% of adults reporting insomnia sometime in their lives.  According to the National Institute of Health, insomnia affects 70 million Americans and 1 in 10 adults report chronic insomnia.  Insomnia complaints increase with age usually because the number of awakenings increases with age. The more you wake up, the greater chance you have of not being able to fall back to sleep.  Additionally, women report more insomnia than men (although older men show more disrupted sleep on polysomnography than women).  But what actually causes insomnia?  Theories on causes of insomnia

Is it biological?

  • Hypersecretion of cortisol, a stress hormone, secreted in higher levels during the body’s “flight or fight” response, may be responsible for your poor night’s sleep. Cortisol is produced by the adrenal gland and the highest levels are found in the early morning and lowest at night. Levels of cortisol have been found to be higher at night for insomniacs than for people without sleep trouble.

Or is it that poor sleep is caused by the thoughts that keep us awake?

  • The 3P Model of insomnia feels that some people have:

 Predisposing Characteristics. These are characteristicsfound within people that make them susceptible to insomnia, for example being highly anxious/agitated, perfectionistic, having a high need for control, high energy/high intensity, physiological or cognitive hyperarousal.

Then there is some Precipitating Event, whichis a situational factor usually outside of one’s control and can throw your waking life as well as your sleep out of balance, for example birth of a child, death of a loved one (or any major loss), work related stress, or health issues.

There are thenperpetuating attitudes and practices that develop in response to insomnia and serve to maintain it. These practices often come into play as an attempt to deal with insomnia. Each night of insomnia triggers shifts in confidence about being able to sleep as well as causing changes in behaviors around sleep, like staying in bed too long, napping, or becoming anxious that you won’t be able to sleep.

Or is there another cause for the poor sleep?

  • Poor sleep can also be caused by other problems, like sleep apnea or periodic limb movements during sleep. If you think that might be the problem it is important to be evaluated further at a sleep clinic.

Besides being tired, why worry about insomnia?

Research shows that insomnia can cause depression, but if you treat the insomnia early, you can actually prevent depression. Insomnia also increases the risk of panic disorder and/or anxiety, alcohol abuse, headaches, GI upset and serious accidents, injuries, and falls. Additionally, insomniacs may self medicate and use alcohol to help them sleep. Although alcohol will help you fall asleep, it causes fragmented sleep and more awakenings later in the night. Tolerance also occurs very quickly so that it takes more alcohol to get the same effect. One drink may have helped on Sunday night, but later in the week, by Friday night, you may need 5-6 drinks to get the same effect.

What can I do to help my insomnia?

While it may seem like you are destined for a poor night’s sleep, a few simple changes can help improve your sleep.  Below are some books that you might find helpful.  Otherwise a sleep therapist can help you with achieving better sleep hygiene or other therapies such as stimulus control and light therapy.  If you are having trouble improving your sleep on your own, make an appointment at a local sleep center to have your sleep evaluated further.

Recommended readings:

Glovinsky, P., & Spielman, A. (2006). The insomnia answer.  New York:  Berkley.

Perlis, M.L., et al. (2005).  Cognitive behavioral treatment of insomnia.  New York:  Springer