Rest is one of the most important factors for maintaining good health, as during this process the secretion of certain hormones changes, allowing us to recover from daily efforts, among many other benefits. With the arrival of summer, due to high night-time temperatures, many of us begin to experience difficulties falling asleep. We usually refer to this difficulty as “insomnia”, but is it really insomnia in the clinical sense?
To answer this, we need to understand two of the main types of insomnia:
– Acute insomnia: difficulty sleeping lasting less than 3 months, with a variable number of episodes. There is a risk that it may become chronic, meaning it persists over time.
– Chronic insomnia: experiencing at least 3 episodes per week of difficulty falling or staying asleep for more than 3 months.
Not all of us may feel represented by these definitions, but between 10–15% of the population does meet these criteria and experiences this disorder. It has become so prevalent that it was previously classified as a symptom, but in the latest edition of the most important diagnostic guide for mental disorders (DSM-5), it has been classified as a disorder in its own right.
The presence of insomnia can increase the risk of developing certain conditions, such as cardiovascular disease. In particular, people with chronic insomnia may have a 27–45% higher risk of myocardial infarction, as well as a higher risk of type 2 diabetes, gastro-oesophageal reflux, asthma and thyroid-related disorders. In short, rest is key to maintaining good health, as we mentioned at the beginning.
Who is most affected by insomnia? Although insomnia can affect anyone at any age, there are two populations at higher risk: women and older adults (over 65 years of age). In addition, there are several psychological factors that can significantly increase the risk of developing this disorder. The most important psychological factors include work-related stress, night shifts, the loss of a loved one, divorce and domestic abuse. There are also other, more pathological factors that may increase this risk, such as stress, anxiety, substance abuse, road traffic accidents and possibly immune system dysfunction. However, one of the most important factors when it comes to insomnia is our genetics, as genetics accounts for around 40% of its variability. This has even been demonstrated in twin studies (a key feature of high-quality genetic research), such as the study by Madrid-Valero, JJ et al., which highlights the high heritability of insomnia.
All of the above conditions may very well be affecting us right now. In fact, we may even feel identified with this issue of insomnia. However, if we want to take action and improve it…
What can we do to improve insomnia? Where should we start?
There are two main approaches to improving insomnia:– Non-pharmacological therapies: such as sleep hygiene, sleep restriction, stimulus control, relaxation therapy and, above all, the most recommended option, cognitive behavioural therapy for insomnia.
– Pharmacological therapies: involving compounds such as GABA, melatonin, orexin and others, which can significantly help improve sleep.
Which treatment is best for each case?
This question can only be answered in one way: by getting to know ourselves better than ever and identifying the underlying cause of our insomnia. How? By carrying out studies that assess your genetic risk, identifying whether you have markers associated with this disorder that may be affecting you, and, above all, with the help of a healthcare professional specialised in evaluating and deciding which strategy is best suited to your case. ## References
- Bollu PC, Kaur H. Sleep Medicine: Insomnia and Sleep. Mo Med. 2019 Jan-Feb;116(1):68-75.
- Krokstad S, Langhammer A, Hveem K, Holmen TL, Midthjell K, Stene TR, Bratberg G, Heggland J, Holmen J. Cohort Profile: the HUNT Study, Norway. Int J Epidemiol. 2013 Aug;42(4):968-77. doi: 10.1093/ije/dys095.
- American Psychiatric Association – APA. (2014). Diagnostic and Statistical Manual of Mental Disorders DSM-5 (5th ed.). Madrid: Editorial Médica Panamericana.
- Dopheide JA. Insomnia overview: epidemiology, pathophysiology, diagnosis and monitoring, and nonpharmacologic therapy. Am J Manag Care. 2020 Mar;26(4 Suppl):S76-S84. doi: 10.37765/ajmc.2020.42769.
- Riemann D, Baglioni C, Bassetti C, Bjorvatn B, Dolenc Groselj L, Ellis JG, Espie CA, Garcia-Borreguero D, Gjerstad M, Gonçalves M, Hertenstein E, Jansson-Fröjmark M, Jennum PJ, Leger D, Nissen C, Parrino L, Paunio T, Pevernagie D, Verbraecken J, Weeß HG, Wichniak A, Zavalko I, Arnardottir ES, Deleanu OC, Strazisar B, Zoetmulder M, Spiegelhalder K. European guideline for the diagnosis and treatment of insomnia. J Sleep Res. 2017 Dec;26(6):675-700. doi: 10.1111/jsr.12594.
