If you’re wondering Why Is Sleep Important And What Is It Good For? Well, according to the Canadian Medical Association, about one-quarter of Canadians are losing sleep over financial worries.
In fact, over 50% of people who come into sleep clinics complain of insomnia due to financial worries.
Covid-19 anxiety is also taking an emotional toll and affecting the sleep of individuals. There is increased uncertainty of the future and a lack of connection with usual supports. People are struggling with self-isolation financial hardship, worries of oneself or one’s family getting infected and people cannot escape the constant, barrage of news stories on this potential threat. More and more we are being asked to turn to screens to function. Yet studies show increased social media at night increases feelings of anxiety, depression, and low self-worth in adolescents with 90% of these adolescents who struggle with anxiety reporting sleep problems.
Sleep difficulties can be the result of stress or they may be symptomatic of an underlying psychiatric condition. Difficulties with sleep may be a diagnosable condition on there own such as Insomnia, Hypersomnia, Restless Leg Syndrome, Obstructive Sleep Apnea, or Night Terrors. When an individual has trouble sleeping one also has to consider whether the sleep problem is a condition on its own that needs to be treated or is it a symptom of another condition such as a Mood Disorder, PTSD, Substance Use Disorder, or some other undiagnosed neurological condition. Sleep and mental health have a bidirectional relationship. Sleep problems can precipitate or worsen mental health or may cause them.
One thing is certain that sleep difficulties will result in impairments in one’s life by causing daytime fatigue, loss of interest, depressed mood, poor concentration, worry, agitation, and irritability. Studies have shown that the risk of developing major depression is much higher in those who have insomnia and insomnia is the most common symptom that predicts PTSD in U.S. service members returning from military deployment. As well as independent treatment of insomnia in Major Depression improves depression treatment outcomes.
Sleep timing quality and quantity are controlled via a homeostatic drive that builds up during waking and circadian rhythm that is usually linked to the light-dark cycle to promote sleep. Sleep can be disrupted by inconsistent bedtime and wake times, dozing in the evening, spending excessive time in bed, sleep-related anxiety, clock watching, excessive use of night-time screens. Adolescents are known to have a delayed sleep phase because they stay up late gaming and or watching screens. and communicating with others. This leads to difficulty awakening and daytime sleepiness. This is the opposite of the elderly who can have sleep issues because they go to bed too early and wake up too early.
One may wonder why is sleep important for the brain?
Why being deprived of sleep can lead to reduced cognitive function, impaired immune function, feelings of stress, decreased quality of life, obesity, and diabetes. Why being completely deprived of sleep can result in hallucinations and even death. The world record for not sleeping is 266 hours. What is going on in our bodies when we sleep. Functions of sleep include energy conservation and nervous system recuperation. Sleep works with memory consolidation and emotional regulation allowing neuroplasticity in brain development.
Healthy sleep usually involves a period of relaxed wakefulness for up to 30 minutes, and then periods of non-REM sleep and REM sleep. NREM sleep goes through four stages 1-4 with stages 3-4 being marked by slow-wave restorative delta wave sleep. During these periods of slow brain activity, a person is difficult to arouse. REM sleep is marked by increased brain activity and is associated with dreaming. The excessive brain activity during REM sleep is where I believe neurochemicals are being released from synapses. These chemicals stored in vesicles in the neurons build up because of emotional and perceptual stimulation during the day. Thus dreams often can show the events and emotions that have been building up in us and our brains during our days.
In the DSM V Insomnia Disorder or causes of insomnia in males, it requires dissatisfying sleep quality or quantity at least 3x a week for 3 months. Most sleep problems are transient but one in three can last for over a year. Medications are often used when one is having trouble falling or staying asleep. But there are many side effects and risks to medications including abuse and dependence. Even when people use over the counter agents such as gravel, or sedating antihistamines, melatonin, valerian root they are at risk of altering their sleep architecture. Not to mention that when one awakens during the night because of worry or a problem if they are too medicated they will not be able to use their consciousness to think about the issue and perhaps come up with a solution that may benefit them.
Doctors are often quick to prescribe benzodiazepines, melatonin agonists, orexin antagonists, sedating antidepressants, anticonvulsants, and antipsychotics to treat insomnia in their patients. Miscellaneous agents such as prazosin, clonidine, hydroxyzine are also used by psychiatrists to promote sleep. Benzodiazepines such as lorazepam, clonazepam, temazepam, and the Z drugs such as zopiclone, and zolpidem are extremely effective for the short term treatment of sleep problems but ongoing use leads to tolerance escalating doses. This can be followed by physiological and psychological dependence and the risk of synergistic sedation with other sedatives such as alcohol. Benzodiazepines and z drugs, as well as alcohol, stimulate GABA an inhibitory neurotransmitter that the brain uses to lessen neuronal firing. When you use external substances to stimulate GABA the brain stops making it. So, if you stop the pill or the alcohol too abruptly the brain will be GABA deficit, and rebound anxiety and insomnia will result. If a person has been on the substance long enough they can even have seizures from an absolute absence of GABA when they stop their sedatives.
Z drugs such as zopiclone and zolpidem are purported to be safer but even they bring up concerns with complex sleep-related behaviors, increased dementia risks, and increased mortality rates. Sedative use is associated with increased motor vehicle accidents and falls in the elderly, worsened short term memory, and rebound insomnia depend on the dose, and duration of use. Melatonin shows in studies that it does lead to small benefits for insomnia. Orexin is an activating neurohormone that can be blocked by a drug called Suvorexant available in the US to treat insomnia. This drug does not show the same side effect profile of benzodiazepines because instead of increasing Gaba they block the wake-promoting chemical Orexin. Mirtazapine and older antidepressants such as amitriptyline and doxepin are used by doctors to induce sleepiness. They are not abused like benzodiazepines but they cause problems because of daytime sedation, weight gain. Quetiapine is very commonly used in low doses to treat sleep problems. It is quite effective at lessening anxiety but often increases hunger after taken leading to substantial weight gain and emotional blunting.
Cannabidiol or CBD is an active ingredient in cannabis.
It is reported to not cause the high that the THC found in marijuana causes. It is used by people for help with falling asleep and staying asleep. It is also reported to help with pain and inflammation. There are a few studies showing improved sleep in patients taking CBD. My concern would be whether it suppresses REM sleep the same as THC. As I mentioned earlier REM sleep is needed for emotional processing and memory consolidation while sleeping. Regular marijuana use will lead to a lack of emotional development and poor short term memory both deficits could be worsened by THC’s REM suppression qualities. In one study on healthy volunteers, CBD did not affect REM sleep. One must be careful that long term use does not lead to dependency and a diminished effect over time. Sticking to low intermittent use of CBD could minimize this risk.
Alcohol is often consumed socially in the evening or at bedtime.
It can be used as a form of self-medication to promote sleep. It is effects on sleep are dose and time-dependent. Higher doses used near sleep have the greatest impact on sleep. Alcohol acts as a sedative and facilitates sleep onset at the beginning of the night but after the body breaks it down in the liver it results in wakefulness during the night. Alcohol can worsen sleep apnea and it is known to suppress REM sleep early in the night and result in REM rebound later. If alcohol is consumed again during the night to promote sleep, there is a risk of morning impairment and even resultant DUI charges when driving the next day.
Chronic Insomnia requires a thorough evaluation.
One must rule out psychiatric illnesses, medical illness, medication side effects, substance use disorders, issues with poor sleep hygiene. In Major depression insomnia is reported at sleep onset, midnight, and early morning awakening. Depression is also associated with Restless Legs Syndrome. Asleep study for obstructive sleep apnea should be considered when a person has daytime sleepiness, witnessed night-time episodes of not breathing, and refractory hypertension or obesity. Medications known to worsen sleep include antidepressants, stimulants, steroids, bronchodilators, decongestants, and diuretics. Medical illnesses that can worsen sleep include cardiac pain, breathing difficulties, joint pain, diabetes, thyroid difficulties, dementia, and Parkinson’s Disease.
CBT-I is the number one recommended treatment for insomnia.
This involves primarily sleep restriction and reduced time in bed. This increases the sleep drive. CBT-I also uses Stimulus Control to reduce arousal time in bed and advises only going to bed when sleepy. Clinicians work to challenge maladaptive beliefs around sleep and confront catastrophic thinking to make sleep expectations less worrying. Health promotion and relaxation techniques are advocated. To improve sleep hygiene regular exercise and stretching, and breathing exercises, meditation is recommended. Limiting caffeine and alcohol is also important as is keeping the bedrooms dark and quiet and cool. Foods reported to improve sleep include almonds, warm milk, kiwi fruit, chamomile tea, walnuts, tart cherries, fatty fish, barley grass powder, lettuce, calcium, magnesium, B-vitamins, and vitamin D.