BY: WWW.UNINSOMNIA.

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Insomnia: The Disease of Sleeplessness (Or Is It?)

The clock is ticking and you’re there eyes wide awake. Your husband is snoring loudly
beside you, seemingly unaware of your predicament. Around the house everything
seems quiet enough. Even the children who were always restless have dozed off. Yet
you can’t sleep, you have done your household chores, caught up with deadlines at
work. But your mind just won't shut and you feel so tired already. This has been going
on for weeks now, sleeplessness just won't leave you alone.

Prevalence of sleeplessness around the world

The Centers for Disease Control and Prevention (CDC) investigated on the prevalence
of healthy sleep amongst adults residing in the US. In their 2016 Morbidity and Mortali-
ty Weekly Report, it was found that 1 in 3 adults sleep less than 7 hours per night. The
optimal amount of sleep is 7 hours or more. Anything less than this amount can lead to
an unhealthy sleep, plus irritability and drowsiness during day time.

Dreams UK also conducted their own investigation about the quality of sleep of Euro-
peans. They interviewed over 15,000 respondents from various regions of Europe in-
cluding London, England, Scotland, Northern Ireland and Wales. The results were in-
teresting as over 63% of the respondents reported that they were unhappy with the
quality of sleep that they’re getting. In addition, females are more likely to feel unhappy
with their quality of sleep than men.

Similarly, in Asia, researchers have also studied the prevalence of sleeplessness in var-
ious regions. While the overall prevalence of sleeplessness is lower as compared to
Western regions, it still exists in a significant percent of the Asian population. In China,
for example, a recent 2017 study found that around 15% of the population suffers from
insomnia. In Malaysia, this study found that around 28% of the population suffers from

chronic insomnia and experiences day time disruptions due to their sleeplessness.

The sleep cycle along with its stages

Sleep is such a complicated process, it is important but many aspects of it are still not
deciphered well. Essentially, we go through four stages during our normal sleep cycle.
In the book The Insomnia Workbook: A Comprehensive Guide to Getting the Sleep You
Need by Silberman, she had highlighted these four stages comprehensively, including
the importance of each.

The first stage is called NREM1 or Non-REM 1, the lightest and shortest phase in the
sleep cycle. It usually accounts for not more than 10% of our sleep cycle. During this
phase, the person might experience muscle jerks and twitches. It is also very easy to
wake a person from this stage since the sleep quality is still light.

The second stage is called NREM2 or Non-REM 2, a deeper and longer phase in the
sleep cycle. Adults usually spend around 35% to 55% of their sleep in this phase. It is
harder to wake a person from this phase of sleep as he or she is mostly unaware of the
surroundings. Compared to the other phases, this stage is long and comprise the most
of the sleep cycle.

The third stage is NREM3 or Non-REM 3, the deepest and most restorative part of the
sleep cycle, accounting for around 5% to 23% of it. In an ECG, this phase can be rec-
ognized by the bursts of delta waves, which are significantly slower than the other
waves. Since this is the deepest part of the sleep cycle, the chances of the person re-
membering his activities while in this phase are very low.

The last stage is called REM, a light but the most active phase of the sleep cycle, ac-
counting for 15% to 25% of it. It is active in the sense that bodily functions such as
heart rate, temperature regulation and even breathing are more intense. It’s very easy
to wake someone if he or she is in this phase of the sleep cycle. And the chances of
remembering activities, like dreams, after being awaken from this stage are higher.

So how do we define sleeplessness then?

Sleeplessness or insomnia can be defined as an acute or chronic difficulty of falling

asleep or maintaining sleep. Those who wake up the next day with a heavy feeling, as if
they haven't slept well despite the hours, can also be considered as suffering from
sleeplessness. For instance, if you have trouble falling asleep, you might have issues
with the NREM1 phase of the sleep cycle. If you have trouble maintaining sleep, then
you might have issues with the three other phases of the sleep cycle.

The clinical term for it is insomnia and there are various causes for it. You can refer to
our previous blog posts, linked below, for further information about the various causes
of insomnia. In a nutshell, sleeplessness can be caused by poor sleeping habits (exter-
nal stimuli) or medical conditions (internal stimuli). It can be short term, usually caused
by both internal and external stimuli, though more on the latter. It can also be long
term, usually caused by internal stimuli, like mutations in your DNA or pathogens in the
body.

Sleeplessness as a disease

When we refer to sleeplessness, or insomnia, as a disease, what does it mean? Simply

put, sleeplessness occurs as the primary problem. In the case we mentioned above,
the housewife suffers from sleeplessness alone. She doesn't have any other medical
conditions or psychological issues. She doesn't take medications or substances that
can contribute to her insomnia. She has adapted to her little lifestyle, racing thoughts
prior to sleeping, that blocks her body’s ability to succumb to sleep.

Sleeplessness can definitely be a disease on its own. If the person doesn't have any
other related disorder that can contribute to the sleeplessness, then it can be catego-
rized as a disease in itself. If the person has no trouble falling asleep during the day, in
mundane tasks or while doing other things, then sleeplessness can be a proper diag-
nosis for him or her. The person suffering from sleeplessness as a disease has condi-
tioned himself or herself to be more active before bedtime. Thus, any attempt to sleep
becomes futile and the insomnia persists chronically.

Sleeplessness as a symptom

Sometimes, sleeplessness can occur as a symptom of other diseases. In such cases,

sleeplessness is not the primary issue, rather it is just a secondary sign that something
is wrong. Let’s look at the case of Maria, a 50-year old woman who recently underwent
hip replacement surgery. She is still on the hospital and suffers from pain after the
surgery. As a consequence, she has difficulty falling asleep because of her pain. In this
situation, sleeplessness occurs because of another condition and not in itself as a dis-
ease.

In psychological diseases such as depression and bipolar disorder, sleeplessness is a

co-occurring symptom along with others. It is not known whether sleeplessness occurs
because of the conditions or from the conditions themselves. In a recent study, re-
searchers found that lesions in the left dorsomedial prefrontal cortex can contribute to
a symptom of sleeplessness as well. Thus, neurological issues can also have a symp-
tom or secondary sign of sleeplessness.

Sleeplessness as both a disease and a symptom

In very rare cases, sleeplessness can both be a disease and a symptom. You might
remember our previous blog post about a certain type of rare insomnia called the fatal
familial insomnia. The prions of those suffering from this condition have a mutation
which lead to late-onset insomnia by their middle ages. Though the mutation won't
manifest at birth, its late onset can lead to adverse chronic insomnia, then to hallucina-
tions and an eventual death of the person.

Another disease called the sporadic fatal insomnia has the same symptoms. But the
onset can be earlier and what’s scary is that it can affect anyone because it occurs
without any mutations in the prion of the diagnosed patients. The usual symptoms of
chronic insomnia, memory deterioration, attention deficits and blurry speech can be
detected in a patient suffering from sporadic fatal insomnia.

With these cases, sleeplessness is the primary issue, which cost the lives of the pa-
tients although there are also other symptoms. Usually, genetic mutations can be the
cause of the chronic insomnia, wherein the patients face problems falling asleep. With
the prolonged sleeplessness, the brain goes into overdrive and the samples of the pa-
tients’ brains reveal such condition. Neuronal death, increased astrocytes and mi-
croglia in the brain indicate that the pathology is of sleeplessness.

The takeaway on sleeplessness

Sleeplessness, or insomnia, is a worldwide problem. It can be a primary issue or the

disease itself, wherein the patient doesn't seem to have any condition that contribute
to the sleeplessness. In such cases, it is important to understand the lifestyle and
sleeping patterns of the individual. If the sleeplessness is already chronic, the person
might have already adapted to his or her unhealthy sleeping habits.

On the other hand, if sleeplessness occurs secondary to another condition, then it is

called a symptom rather than a disease. Conditions of the body like pain and psycho-
logical issues can contribute to sleeplessness. Damaging stimuli or mutations in the
prions of brain, particularly in the thalamus or left dorsomedial prefrontal cortex, can
lead to sleeplessness as both a disease and a symptom.

Hopefully, this post helped you distinguish between sleeplessness as a disease, as a

symptom or as both. It is important to understand their differences, so that we can
learn about the proper treatments for each type. So what type of sleeplessness are you
suffering from? You can share them in the comments section below.