insomnia speech essay

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Works Cited

Colten, Harvey R. “Extent and Health Consequences of Chronic Sleep Loss and Sleep Disorders—Sleep Disorders and Sleep Deprivation.” National Center for Biotechnology Information . U.S. National Library of Medicine, 01 Jan. 1970. Web. 03 Nov. 2016. .
“Dangers of Getting Too Little Sleep.” HealthCommunities . N.p., n.d. Web. 03 Nov. 2016. .
“Chronic Insomnia’s Dangerous Side-Effects.” Newsweek . Newsweek, 23 Aug. 2009. Web. 03 Nov. 2016. .
“Chronic Insomnia Linked to Increased Risk of Death.” Mercola.com . N.p., n.d. Web. 03 Nov. 2016. .

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Home — Essay Samples — Nursing & Health — Neurology & Nervous System Diseases — Insomnia

Essays About Insomnia

Insomnia is a common problem that affects millions of people around the world. That's why it's important to write an essay about this topic, to raise awareness and provide helpful information to those who are struggling with insomnia.

When choosing a topic for an essay on insomnia, it's important to consider what type of essay you want to write. For an argumentative essay, you might consider topics like "The impact of technology on sleep quality" or "The relationship between stress and insomnia." For a cause and effect essay, topics could include "The effects of caffeine on sleep" or "The connection between insomnia and mental health." For an opinion essay, you might explore topics like "The best natural remedies for insomnia" or "The role of sleep medication in treating insomnia." And for an informative essay, topics could include "The science of sleep and insomnia" or "The best lifestyle changes for improving sleep quality."

For example, if you're writing an essay on the impact of technology on sleep quality, your thesis statement might be "The use of smartphones and other electronic devices before bedtime has a negative impact on sleep quality." In your , you could discuss the prevalence of technology use before bed and its potential impact on sleep. And in your , you could summarize the key points of your essay and provide recommendations for improving sleep quality in the digital age.

Writing an essay about insomnia is an important way to raise awareness and provide helpful information to those who are struggling with sleep. Whether you choose to write an argumentative, cause and effect, opinion, or informative essay, there are plenty of topics to explore and examples to draw inspiration from.

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Reasons and Solutions to Sleep Difficulties

The impact of alcoholism on insomnia and other sleep disturbances, sleepless nights: hypersomnia and insomnia, the effects of milk collected at night in treating anxiety and insomnia, the effects of sleep deprivation, relevant topics.

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127 Sleep Essay Topics and Essay Examples

🏆 best sleep topic ideas & essay examples, 👍 good sleep topics to write about, 💡 interesting sleep topics, ❓ research questions about sleep.

Problem of Sleep Deprivation This is due to disruption of the sleep cycle. Based on the negative effects of sleep deprivation, there is need to manage this disorder among Americans.
Effects of Sleeping Disorders on Human On the other hand, Dyssomnia relates to sleep disorders that develop as a result of lack of adequate sleep. In some cases, antidepressants have been used to cure sleep disorders that are as a result […]
Cross-Cultural Sleeping Arrangements in Children The aim of this paper is to study the different sleep patterns such as solitary or co sleeping in the United States of America and different cultures around the world.
How Sleep Deprivation Affects College Students’ Academic Performance The study seeks to confirm the position of the hypothesis that sleep deprivation leads to poor academic performance in college students.
Insomnia: A Sleeping Disorder Type Causes of insomnia can be classified into two; factors contributing to acute insomnia and chronic insomnia. Chronic insomnia can be as a result of emotional stress.
The Effect of Sleep Quality and IQ on Memory Therefore, the major aim of sleep is to balance the energies in the body. However, the nature of the activity that an individual is exposed to determines the rate of memory capture.
Sleep-Disordered Breathing and Acute Ischemic Stroke In this case study, the investigator focused on ischemic stroke, one of the most common types of stroke in the world.
Sleep Apnea, the Heart and the Brain in the Elderly They should get the necessary treatment of heart diseases and neuromuscular disorders Be attentive to yourself and live a full life!
Sleep Deprivation Impacts on College Students Additional research in this field should involve the use of diverse categories of students to determine the effects that sleep deprivation would have on them.
Sleep Stages and Disorders A more elaborate look into understanding sleep take a look at the two aspects of sleep which is the behavior observed during sleeping periods as well as the scientific explanation of the physiological processes involved […]
Sleepwalking Through Life In this case, there is a large context of life that people can be part of which should be understood. All in all, there is a lot that can be done to ensure that people […]
Effects of Sleep Deprivation While scientists are at a loss explaining the varying sleeping habits of different animals, they do concede that sleep is crucial and a sleeping disorder may be detrimental to the health and productivity of a […]
Psychology of Sleep: Article Study The field of sleep and sleep disorders has been an integral part of psychological investigations: a number of scientists find it necessary to contribute sleep education and offer the ideas which help people improve their […]
Sleep and Its Implication on Animals This paper is set to synthesize the evolution sleep in animals, its benefits and the recent knowledge that is linked to this natural phenomenon of near unconsciousness.”A Third of Life” addressed what is sleep and […]
Sleep and Sensory Reactivity in the School-Aged Children The interaction of these elements should be considered in therapies expressly designed to improve sleep disruptions or sensory processing difficulties in children as a possible negative determinant that may adversely affect children’s health and normal […]
Stages of Sleep, Brain Waves, and the Neural Mechanisms of Sleep As sleep is extremely important for a person’s well-being, I believe it is essential to pay attention to the mechanisms of sleep and how they work.
The Issue of Chronic Sleep Deprivation The quality of sleep significantly impacts the health and performance of the human body. These findings point to significant promise for the use of exercise in the treatment of sleep disorders, but a broader body […]
Sleep-Wake, Eating, and Personality Disorders Treatment On the other hand, treatment with prazosin and mianserin was effective; for example, the drug mianserin benefits patients suffering from sleep disorders. Psychotherapy approaches like Cognitive Behavioural Therapy for Insomnia and Imaginary Rehearsal Therapy are […]
How the Modern Life Has Affected Sleep Czeisler mentioned in the DW documentary about sleep: “The electric light to which we are exposed in terms of resetting our internal clock is like light on steroids”. That is why we should affect the […]
Sleep and Meditation Can Predict an Individual’s Satisfaction With Life This aim of this study is to investigate the effects of quality sleep and mindfulness on life satisfaction. In a nutshell, life satisfaction depends on the quality of sleep and meditation.
Water Consumption and Sleep Hygiene Practices First, I will discuss that safe and sufficient water facilitates the practice of hygiene and well-being and is a critical determining factor for health.
Depression Associated With Sleep Disorders Y, Chang, C. Consequently, it directly affects the manifestation of obstructive sleep apnea, restless leg syndrome, and periodic limb movement disorder in people with depression.
How Technology Affects Sleep in Adolescents The critique will focus on the various sections of the article, where the strengths and weaknesses of each are outlined and discussed. The title of the article excellently reflects the essence of the research.
Sleep Disturbance in Children Any disorder that alters the craniofacial or pharyngeal anatomy predisposes the child to obstructive narcolepsy is considered a medical problem associated with sleep disturbances in children. Central Sleep Apnea is the repeated cessation or decrease […]
ADHD and Problems With Sleep This is because of the activity of a person in the middle of the day and the condition around them. The downside of the study is that the study group included 52 adults with ADHD […]
Solving the Sleep Problem through TQM Principles The initiative to address the lack of sleep among employees and consequently improve their performance and the quality of services requires teamwork optimization.
Effects of Lullaby Music on Quality of Sleep in Adults With Insomnia Insomnia consists of deprivation of the duration and quality of sleep, which affects the psychological and physical condition of people. In addition, the main limitation may be the unreliability of the information provided by the […]
Eat, Sleep, and Console: Narcotic Abstinence Syndrome in Infants The choice of the quantitative design is justified by the necessity to prove the superiority of the proposed solution to the one that is currently deployed as the alternative way of managing the needs of […]
The Importance of Sleeping and Dreaming Finally, I would not take this pill since I love seeing dreams and realize that this “miracle medicine” will cause too many negative consequences.
Hippocampus-Dependent Memories During Sleep The smell was chosen because it was not necessary to interrupt the integrity of the subjects’ sleep to introduce it into the experiment.
The Influence of Sleep Deprivation on Human Body It contradicts living in harmony with God, as when the person is irritated and moody, it is more difficult to be virtuous and to be a source of joy for others.
Programs in Family Sleep Institute She explained to me the sleep cycle of the child and the adult, how many hours my child is supposed to sleep, the bedtime routine, and the method that we had to adopt during the […]
Sleeping Habits & Physical Health: Students’ Perception Using the survey as the data collection tool, the investigators state that most students do not have appropriate sleep habits, although they agree that their academic success and physical health suffer because of the lack […]
Sleep Deprivation and Insomnia: Study Sources The topic of this audio record is a variety of problems with sleep and their impact on an organism. They proved the aforementioned conclusion and also paid attention to the impact of sleep deprivation on […]
Sleep Problems Among Student-Athletes Despite the importance of the topic under study and the conclusions reached, the work raised additional questions and had some limitations.
Excessive Sleepiness May Be Cause of Learning, Attention, and School Problems The information in the article “Excessive Sleepiness May Be Cause of Learning, Attention, and School Problems” by Calhoun and Fernandez-Mendoza is used to show that heavy daytime sleeping may be a cause of attention, learning, […]
Sleep Hygiene Intervention Plan for Young Adults The main goals of this plan are to develop a list of guidelines for nurses on how they can offer a kind of educational program to their patients based on which young adults can understand […]
Neurocognitive Consequences of Sleep Deprivation The CNS consists of the brain and the spinal cord while the PNS consists of all the endings of the nerve extensions in all organs forming the web that extends throughout the entire organ.
Sleepiness Level and Degree: Research Instruments A sum ranging from 0 to 24 of the score on the eight items makes the total score of the ESS.
Evolutionary Biology: Sleep Patterns in Mammals This synthesis addresses the question of the origin of sleep in mammals and traces this phenomenon by studying the evolution of the mammalian brain and suggesting possible external factors that affect sleep patterns.
“Childbirth Fear and Sleep Deprivation in Pregnant Women” by Hall To further show that the information used is current, the authors have used the APA style of referencing which demand the naming of the author as well as the year of publication of the article/book […]
African Sleeping Sickness Using the various forms of detection and diagnosis it was discovered that African sleeping sickness is a major problem in Sub-Saharan Africa.
The Use of Sleephormone in Children With Neuro-Developmental Disorders For the better management of the data that are planned to be retrieved from the clinical trial procedures, the following list of the definitions and acronyms used in the trial process is given.
Sleep Deprivation and Learning at University It is a widely known fact that numerous people face the problem of lack of sleep. Second, sleeping is essential for increasing the productivity of students in the context of learning.
Communication Between Sleep, Behavior and Obesity The purpose of the study seeks to evaluate the association between nighttime media use with sleep behaviors and variation in weight status for first-semester college students.
Obstructive Sleep Apnea and Heart Diseases In children with Down syndrome, incidence rates of hypertension and sleepiness are high, and the problem is compounded in the presence of OSA.
Sleep is a Vital Stage of a Day Cycle in Humans During the first stage of sleep, the EEG shifts to theta waves, with a frequency of 4 7 Hz. There are numerous sleep disorders, which can affect the well-being of a person.
“The Effect of Nursing Quality Improvement and Mobile Health Interventions on Infant Sleep Practices” by Moon The following analysis is related to the article, “The effect of nursing quality improvement and mobile health interventions on infant sleep practices” by Moon et al.
Sleep Deprivation: Biopsychology and Health Psychology Another theory that has been proposed in relation to sleep is the Circadian theory which suggests that sleep evolved as a mechanism to fit organisms into the light dark cycle of the world.
Study of the Sleeping Process The paper entails a comprehensive analysis of the sleeping process in addition to evaluating the factors that affect the sleeping process.
Sleep Disorders: Sleep Deprivation of the Public Safety Officers The effects of sleep disorders and fatigue on public safety officers is a social issue that needs to be addressed with more vigor and urgency so that the key issues and factors that are salient […]
Sleep, Satisfaction With Life and Cognitive Function Sleep is the state of the mind involving temporary loss of consciousness leading to the resting of the mind. Sleep is one of the most important requirements in individuals so as to ensure the well-being […]
Sleep Versus Social Demands in Students The effects of has been exhibited more greatly in animals through studies and all animals have been shown to sleep in different forms.
Sleep Deprivation: Personal Experiment As I had been perplexed, I did not take a step of reporting the matter to the police neither did I inform my neighbors.
Sleep Patterns and Memory Performance of Children The article presents the essence, the methods and the results of the experiment which had to show the influence of TV and computer games on German children’s sleep.
Recuperative Versus Circadian Theory of Sleep The Recuperative theory of sleep is based on the premise that humans require sleep to rejuvenate and recoup spent energy during the waking period.
Biology. Adolescent Sleep Pattern The habit of sleep is very individual specific therefore a study of the pattern of sleep of a group needs to be evaluated to get an understating of the pattern of sleep.
Non- and Rapid Eye Movement Sleep Non REM sleep represents 75% of sleep duration and occurs in four stages and REM sleep represents stage 5 of sleep.
Main Information about Sleeping Disorders In the introduction part the paper provides an overview of sleep and sleep disorders. This led to the conclusion that instead of being a quite and peaceful period of rest and resuscitation as everyone would […]
Memory Consolidation and Reconsolidation After Sleep The memory consolidation of the visual skill tasks is related to the REM sleep and the short wave component of the NREM.
Sleep Disorders: Narcolepsy, Obstructive Sleep Apnea, Insomnia An important aspect of the pathogenesis is the autoimmune lesion of the orexin neurons of the hypothalamus, which leads to a decrease in the level of hypocretin-1.
Sleeping Sickness Transmission and Control Measures Most of the cases of sleeping sickness are usually recorded in the Democratic Republic of Congo, Central African Republic, northern parts of Uganda, Sudan, Angola, Zambia, Uganda, Tanzania, and Malawi.
Blue Light Effect on Human Sleep The introduction is comprised of a thesis statement and a description of the critical thoughts of the paper. At the end of the paper, recommendations on how to reduce the adversarial effect of the blue […]
Electronic Devices Use and Sleep in US Adolescents During the process of data collection, the authors discovered that most of the participants tended to go to bed very late, which affected the quality of their sleep and their ability to normally function over […]
The Role of Sleep in Humans’ Well-Being Each of the speakers in the videos focuses on a different characteristic of sleep, but all of them agree that without enough sleep, one does not perform to the fullest potential.
Sleep Helps to Repair Damaged DNA in Neurons The researchers found that the chromosomes in the fish’s neurons would often change shape while their owners slept, enabling the repair of the damage accumulated in periods of activity.
Co-Sleeping Impact on Child Development At the same time, it is crucial to pay attention to the phases of sleep and the cycles of awakening. It will help to facilitate the process of sleep in the future and eliminate any […]
Adolescent Sleep and the Impact of Technology Use Particularly, the authors of the study explain why there is the need to know the answer to the question by providing a profound background to the case and stating that innovative technology has a profound […]
Sleeping Patterns Within Infants Infant A is put to sleep in the bassinet, and the parents use the sleeping bag in order to make the infant’s sleep more comfortable.
Sleep Deprivation: Research Methods The purpose of the research will be to determine sleep deprivation, what causes it, the effect, and why sleep is important.
Coffee Effects on Sleeping Patterns: Experiment Consumption of coffee before going to bed will cause individuals to have difficulty falling asleep The amount of coffee the subjects drink before going to bed The time after going to bed that subjects fall […]
Sleep Disruptions in Healthcare Professionals First of all, the sleep disruption may lead to a lack of coordination in the team because some members would be fatigued during the working hours, which would interfere with their functioning and concentration in […]
Sleep May Be Nature’s Time Management Tool by Carey The author states that no one knows why sleep exists therefore setting the context for the article in which she advances the numerous theories that are advanced as to the role that sleep plays.
Physical Activity and Sleep Health in Adults In the introduction to the analysed study, a substantial scientific background for the problem of improving physical activity and sleep in adults is presented.
Insomnia and Narcolepsy: Sleeping Disorders Besides, it was established that people with insomnia are inclined to overestimate the negative effect of sleeping disorder and underestimate the total time of sleep.
Sleep Patterns’ Impact on Academic Performance Because some university classes begin as early as 7 o’clock in the morning and finish in the evening, the only option for such students is to reduce the length of night-time sleep in order to […]
Prevalence of Sleep Disorders among Medical Students Nightmares and dreams arise in the course of REM sleep as it is linked to desynchronized and quick brain waves, deferral of homeostasis, and failure of muscular tonus.
Emotions Clusters and Sleep Failure Earlier critics had argued that PANAS was not suitable for children, and this led to the development of specific PANAS-C for children.
Sleep Deprivation and Specific Emotions The purpose of this study is to develop an understanding of the relationship between sleep deprivation and emotional behaviors. The study looks to create a link between the findings of past researches on the emotional […]
Sleep Disturbance, Depression, Anxiety Correlation The above imply that many questions are still unanswered with respect to the kinds of sleep complaints affecting undergraduates and the impact on their psychological health.
Relationship Between Depression and Sleep Disturbance It was emphasized that persistent disturbance, its severity, and the intermittent nature of the sleep were not associated with depression and its recurrence in the following years. The sleeping disturbance is a risk factor that […]
Sleep and Psychopathology Relationships – Psychology Generally, available evidence shows that feelings of negative emotions such as anxiety are characterized by the dysfunction in cognitive and interpersonal spheres.
Sleep Disorder Consequences on the Immune System Consequently, the research question for this paper is: what are the consequences of sleep disorder on the immune system? The primary goal of the study is to determine the effects of sleep disorder on the […]
Importance of Sleep – Psychology Precisely, most of the organs of the body are at rest during sleep. It is during sleep that the body encodes the information it obtains during the day into the memory.
Dream and Sleep Cycle Dreams occur in any of the phases of sleep, nonetheless, the most concise, clear, vivid and memorable dreams are observed in the last phase of sleep (known as the rapid eye movement REM sleep.
Changes of Sleep in the Course of One Night Furthermore, voltage generated by eye rotation in their sockets and electrical activities of the muscles all help in the study of the cycles of sleep in the course of one night.
Relationship Between Sleep and Depression in Adolescence Using SPSS for data analysis, the results indicate the presence of a correlation between elements of depression and sleep duration and quality.
Ethical Issues in Treating Obstructive Sleep Apnea with Exercise Independently The approaches should ensure that necessary preventive and curative measures are put in place to facilitate the process of eradicating the disease that is causing immense sleep related complications.
The Eight Hour Dilemma: Sleeping Time Reduction. When a Single Hour Makes a Difference While reducing the amount of sleeping hours to seven and less can possibly lead to sleep deprivation and the further changes for the worse in a human body, eight hours are no longer the borderline […]
Infant Sleep Disturbance (ISD) The uniqueness of this study stems from the fact that it would provide a clear understanding of the most effective intervention/basis for physicians and parents to pursue in the management of sleep disorders among infants […]
Underlying Issues Associated with Sleep Disorders and Stress Of fundamental importance to this research paper is the realization that the amount of sleep that an individual gets is one of the internal factors that influence his or her own capacity to handle stress.
The Consequences of Poor Sleep Conducting a research devoted to human sleep habits in children and feeling the affect on their confidence as adults, the existing data should be evaluated and the conclusions are to be drawn in the sphere […]
The Role of Melatonin in Determining the Sleep-Wake Cycle Melatonin plays a significant role in the circadian control of sleep as well as in restraining the development of malignant cells.
The Phantom Menace of Sleep-Deprived Doctors This is one of the problems that should be addressed by hospital administrators. Therefore, it is vital to develop strategies that can improve the work of medical institutions.
The Biological Basis of Sleep The authors suggest that it needs more accurate measurement of sleep and wake pattern by the use of the electrooculogram, the recording of the movement of the eye, EEG and electromyogram, the recording of the […]
Sleep and Dreams: How Do They Work? During sleep, the brain is at rest while the rest of the body system is in active state. Thus, to prevent most of the body disorders in human both psychiatrists and health experts recommend sleep.
Sleep Disorders with Children and Adolescences This study is important in terms of understanding of the effectives of empirical and theoretical research in the field and attracting the scientist’s attention to the problem so that appropriate and effective treatment to be […]
Sleep Process Research There are said to have five sleep stages, which are divided in to two: the rapid eye movement and the non rapid eye movement during which the dreams occur.
A Day in the Sleep Clinic: Culture and Health The third aspect of the PEN-3 Model looks at the cultural issues and health beliefs. For instance, the Sudanese family belief in superstition may not affect the health outcome in the hands of the doctor.
Using Depressants During Sleep Time The paper also holds up the notion that, today it is important to control the sleeping patterns, to conform to the lifestyle demands. The drugs are mainly used generally to reduce the sleep delays, thus […]
Sleep Improves Memory It is possible to replace a traumatic memory with a pleasant one then take a brief moment of sleep to reinforce the pleasant memory.
How Much Sleep Do You Need by Age?
What Is an Sleep?
What Is the Purpose of Sleep?
What Is Good Sleep?
Why Is Sleep Important for Health?
What Happens if We Don’t Sleep?
Why Is It Called Sleep?
What Causes Lack of Sleep?
What Age Gets the Most Sleep?
What Is the Most Healthy Time to Wake Up?
Why Do Older People Need Less Sleep?
How Much Sleep Is Healthy?
What Are Interesting Facts About Sleep?
What Happens During Sleep?
Why Should We Drink Water Before Sleeping?
How to Fall Asleep Fast Within 5 Minutes?
Which Foods Make Sleepy?
What to Drink to Sleep Faster?
What Are the Sleep Tricks?
What Part of the Brain Causes Sleep?
How Can I Get Better Sleep?
Which Oil Helps You Sleep?
Does Warm Milk Help You Sleep?
How Can I Relax When I Can’t Sleep?
At What Time Is the Body Ready for Sleep?
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Insomnia and Its Impact on Physical and Mental Health

In contrast to the association of insomnia with mental health, its association with physical health has remained largely unexplored until recently. Based on findings that insomnia with objective short sleep duration is associated with activation of both limbs of the stress system and other indices of physiological hyperarousal, which should affect adversely physical and mental health, we have recently demonstrated that this insomnia phenotype is associated with a significant risk of cardiometabolic and neurocognitive morbidity and mortality. In contrast, insomnia with normal sleep duration is associated with sleep misperception and cognitive-emotional arousal but not with signs of physiological hyperarousal or cardiometabolic or neurocognitive morbidity. Interestingly, both insomnia phenotypes are associated with mental health, although most likely through different pathophysiological mechanisms. We propose that objective measures of sleep duration may become part of the routine evaluation and diagnosis of insomnia and that these two insomnia phenotypes may respond differentially to biological vs. psychological treatments.

Introduction

The prevalence of insomnia in the general population ranges between 8-40%, depending on the definition used. While 20-30% of the general population has poor sleep (i.e., insomnia symptoms of difficulty initiating or maintaining sleep, early morning awakening, or non-restorative sleep at any given time), another 8-10% of the population suffers from chronic insomnia. 1 , 2 Also, about 4% of the population use sleeping pills in a regular basis. 3 However, the connection of insomnia with significant medical morbidity has not been examined until very recently. This has led to view insomnia and its associated mental and physical health complaints as a minor problem from a public health perspective.

A factor that may have contributed to this lack of firm association between insomnia and significant medical morbidity is the definitions used for this disorder and the lack of validated objective/biological markers. Sleep disorders were included for the first time in the Diagnostic and Statistical Manual of Mental Disorders (DSM)-III-R 4 in 1987 and provided overall diagnostic criteria for “insomnia disorders” based on the subjective complaints of difficulty initiating or maintaining sleep or of non-restorative sleep, occurring at least 3 times a week for at least 1 month, and associated daytime functioning complaints. The DSM-IV-TR eliminated the overall diagnostic criteria for “insomnia disorders” as well as the frequency criterion, maintained the diagnoses of “primary insomnia”, “dysomnia NOS”, insomnia “related to another mental disorder”, “due to a general medical condition”, and introduced “substance-induced insomnia”. 5 The DSM-5 has eliminated the different insomnia diagnoses in DSM-IV-TR to reintroduce overall diagnostic criteria for “insomnia disorder” with specification of comorbid mental and/or physical conditions, so that no causal attributions between insomnia and the physical/mental condition are made, and has extended the duration criterion from 1 month to 3 months. 6 The latter change is an acknowledgement that chronicity is what differentiates insomnia as a disorder vs. insomnia symptoms, i.e., poor sleep due to underlying, identifiable physical, emotional, or drug-related factors.

The International Classification of Sleep Disorders (ICSD), and its revised form ICSD-R (1997), also defined insomnia based on subjective sleep and daytime functioning complaints but, in contrast, attempted to identify subtypes based on “intrinsic” factors such as etiology (i.e., “psychophysiological”), age of onset (i.e., “idiopathic insomnia”), degree of discrepancy between objective sleep findings and subjective perception of sleep (i.e., “sleep state misperception”) or “extrinsic” environmental factors such as “inadequate sleep hygiene”, “food-allergy” or “altitude insomnia”. However, these subtypes, even when refined in the ICSD-2, 7 have not proven to be clinically useful and the reliability and validity of DSM and ICSD diagnoses is at best modest. 8

Although the objective sleep of insomniacs is different than that of normal sleepers, PSG variables are not required or recommended for the diagnosis of the disorder. In fact, PSG criteria have not proven to be useful in terms of differential diagnosis or severity assessment and are not currently used in clinical practice. The sleep laboratory is useful for the evaluation of patients with sleep-disordered breathing (SDB), the diagnosis of narcolepsy, and the differential diagnosis of idiopathic vs. psychogenic hypersomnia, 9 , 10 as well as the study of the initial effectiveness, continued efficacy or tolerance, and potential withdrawal effects of a hypnotic drugs. The validity and clinical utility of sleep lab testing for diagnosing insomnia has been evaluated in large studies 11 , 12 that have shown that PSG measures such as latency to sleep onset, total sleep time, number of arousals and awakenings, sleep efficiency, or sleep stages, are not useful in the diagnosis or differential diagnosis including subtyping of insomnia, except to confirm or exclude other sleep pathologies when there is reasonable evidence from clinical history (e.g., SDB or periodic limb movements). The current consensus is, therefore, that PSG is not recommended for routine, differential diagnosis, or severity assessment of insomnia in clinical practice. 13

In this review paper, we present evidence that objective measures of sleep are useful in predicting the medical severity of insomnia (i.e., cardiometabolic and neurocognitive morbidity and mortality) and that should be considered in the new classification of insomnia.

Insomnia and the Stress System

In the last two decades, several models have been proposed to understand the etiology and pathophysiology of insomnia and most of them have emphasized the importance of the joint effect of stress and psychological factors in the pathogenesis of insomnia. 14 The characteristic psychological profile of patients with insomnia, consisting of cognitive-emotional hyperarousal (i.e., obsessive, anxious, ruminative, and dysthymic personality traits) and emotion-oriented coping strategies, 14 - 16 is thought to be present pre-morbidly and play a key role in the etiology of the disorder. 14 , 17 - 20 Insomnia is associated with precipitating life events 21 and cognitive-emotional arousal14 and is perceived by the patient as stressful on its own. Thus, insomnia should be expected to be associated with activation of the stress system.

Stress has been associated with the activation of the hypothalamic-pituitary-adrenal (HPA) and the sympatho-adrenal-medullary axes, whereas corticotropin-releasing hormone (CRH) and cortisol (products of the hypothalamus and adrenals, respectively), and catecholamines (products of the sympathetic system) are known to cause arousal and sleeplessness to humans and animals. On the other hand, sleep and particularly deep sleep appears to have an “anti-stress” effect as it is associated with an inhibitory effect on the stress system including its main two components, the HPA axis and the sympathetic system.

While the majority of early studies reported no difference between subjectively defined “poor sleepers” and controls in the levels of cortisol secretion, 22 - 24 later studies found that 24-h urinary free cortisol, norepinephrine, and catecholamine metabolites levels were either increased in patients with insomnia with objective sleep disturbances as compared to controls or were correlated with PSG indices of sleep disturbance in insomnia patients. 25 - 31 The few exceptions might be related to the fact that the objective sleep of patients with insomnia was very similar to that of controls 32 or to lack of statistical power and controls not being carefully selected. 33 , 34 In addition, it was shown that middle-aged healthy individuals were more vulnerable to the sleep disturbing effects of the stimulating hormones of the HPA axis, i.e., CRH, which may explain physiologically the increased prevalence of insomnia in older subjects. 35 Furthermore, other studies have demonstrated that this type of insomnia is associated with increased nocturnal heart rate and impaired heart rate variability, 36 , 37 increased overall oxygen consumption (VO2), a measure of whole-body metabolic rate, 38 , 39 and increased pupil size, indicative of sympathetic system activation, 40 but not in insomnia defined only on subjective measures. 41 , 42

Another paradox with patients with insomnia who typically complain that they are fatigued and sleepy during the day is that during the Multiple Sleep Latency Test (MSLT) they have either similar or increased daytime sleep latencies when compared to controls. 42 - 45 In fact, several studies have shown that, within patients with insomnia, those with shorter objective sleep duration show longer sleep latencies in the MSLT 44 , 46 - 48 and are more alert in vigilance tests. 38 , 39 , 46 This is in contrast to normal individuals who after sleep deprivation experience significantly reduced sleep latencies on the MSLT and decreased alertness in vigilance tests, i.e., physiological sleepiness. 49 , 50 Thus, long latencies in the MSLT may represent a reliable marker of physiological hyperarousal in insomnia patients.

Finally, evidence about the presence of central nervous system hyperarousal in insomnia comes from studies in human subjects using neuroimaging, 51 , 52 and spectral, 53 , 54 arousal, 55 and event-related 56 electroencephalography analyses as well as from studies on the neural circuitry of stress-induced insomnia in rats. 57 Increased cortical arousal during sleep is present to a variable degree in all patients with insomnia 53 - 56 and may explain why they perceive their sleep as wake and as non-restorative. 58 , 59

Insomnia and Cardiometabolic Morbidity

Until recently, chronic insomnia has not been linked firmly with significant medical morbidity, such as cardiovascular disease. Several surveys have shown a significant relationship between difficulty falling asleep or poor sleep with cardiometabolic outcomes such as hypertension 60 - 62 and diabetes. 63 - 66 For example, persistent complaints of difficulty initiating or maintaining sleep were associated with an increased risk of hypertension,61 acute myocardial infarction, 62 and incident type 2 diabetes. 63 - 66 However, these studies showed relatively small effect sizes and did not include a PSG evaluation so as to control for SDB or other sleep pathology. The findings of these early studies were dismissed as methodologically flawed by many clinicians and researchers alike. 67 , 68 In fact, at least one report showed a reduced mortality rate for those individuals complaining of sleep difficulties after 6 years of follow-up. 69

Given the well-established association of hypercortisolemia with significant medical morbidity, (i.e., hypertension, diabetes, metabolic syndrome, osteoporosis, and others), 25 - 31 we hypothesized that insomnia with objective short sleep duration is associated with significant cardiometabolic morbidity and mortality. A series of recent epidemiological studies from the Penn State Adult Cohort,1 that used in-lab PSG, have shown that insomnia with objective short sleep duration is associated with a high risk of hypertension, 70 , 71 diabetes, 72 and mortality. 73 For example, compared to normal sleepers who slept ≥ 6h per night, the highest odds of hypertension or diabetes was in patients with insomnia who slept ≤5h (OR = 5.1 and OR = 2.95, respectively) and the second highest in patients with insomnia who slept 5-6 h (OR = 3.5 and OR = 2.07, respectively), while patients with insomnia who slept ≥ 6h were not at significantly increased risk of hypertension or diabetes (OR = 1.3 and OR = 1.1, respectively). Recent longitudinal data from the same cohort has shown that patients with insomnia who slept < 6h were at a significantly higher risk of incident hypertension (OR = 3.75),71 suggesting that insomnia precedes the onset of hypertension. Interestingly, in a recent longitudinal study we found that non-obese chronic insomniacs, despite sleeping objectively shorter than controls or poor sleepers, did not have a significantly increased risk of incident obesity; in fact, they were less likely to become obese than controls or poor sleepers. 74 These data indicate that insomnia with objective short sleep duration may be linked to medical morbidity such as hypertension and diabetes through mechanisms other than weight gain and obesity (i.e., activation of the stress system and inflammation process). Furthermore, other longitudinal research showed that mortality risk in men was significantly increased in patients with insomnia who slept < 6 h compared to normal sleepers (OR = 4.00), and that there was a marginally significant trend toward higher mortality from insomnia with short sleep duration in men with diabetes or hypertension (OR = 7.17) than in those without these comorbid conditions (OR = 1.45). Thus, the impact of insomnia with short sleep duration was much stronger in those with diabetes and hypertension at baseline versus those who were healthy. 73 In women, mortality was not associated with insomnia with short sleep duration, most likely related to the fact that women were followed-up for a shorter time period.

Consistent with the findings of these population-based studies, other recent studies have shown (1) higher nighttime systolic blood pressure and reduced day-to-night systolic blood pressure dipping, 75 (2) impaired heart rate variability, 76 (3) lower cardiac pre-ejection period, 77 and (4) poorer indices of glucose metabolism 78 in patients with insomnia. Cumulatively, these data suggest that objective short sleep duration may predict the medical severity of chronic insomnia. 59

Insomnia and Neurocognitive Morbidity

Patients with insomnia typically complain of difficulty concentrating, memory problems, and difficulty focusing attention. However, studies using objective neuropsychological testing have produced inconsistent findings. This has led some researchers to question the existence of true cognitive impairments in insomnia 79 and attribute the daytime complaints to excessive attention to the expected consequences of poor sleep. 14

The role of objective sleep measures in the association of insomnia with cognitive impairment has been addressed in a recent study from the Penn State Adult Cohort. 80 This study showed that patients with insomnia, based solely on a subjective complaint, did not differ significantly from controls on either PSG variables or neurocognitive performance. However, significant interactions between insomnia and objective short sleep duration (i.e., < 6h) on specific neurocognitive tests were found. Specifically, patients with insomnia with objective short sleep duration showed poorer neuropsychological performance on tests of processing speed, switching attention, and number of short-term visual memory errors and omissions compared to control groups with normal or short sleep duration. In contrast, patients with insomnia with normal sleep duration group showed no significant deficits when compared to controls. Based on these findings, it seems that insomnia with objective short sleep duration is associated with deficits in switching attention, a key component of the “executive control of attention”. 80 Importantly, the presence of a group of good sleepers with short sleep duration allowed to demonstrate that deficits in executive attention were associated with underlying physiological hyperarousal, a characteristic of chronic insomnia, rather than to short sleep per se. 80 Another recent study by Edinger et al, 81 examined the association between physiological hyperarousal, as measured by the MSLT, and response accuracy on reaction time tasks among 89 individuals with primary insomnia as compared to 95 well-screened normal sleepers. Interestingly, the authors found that individuals with MSLT mean onset latency > 8 min showed lower nighttime sleep efficiencies and increased wake after sleep onset, suggesting 24-h physiological hyperarousal particularly in the primary insomnia group. Importantly, they found a significant interaction between insomnia and increased MSLT mean onset latency so that individuals with primary insomnia and with MSLT mean onset latency > 8 min showed greater error rates in switching attention tasks than normal sleepers with MSLT mean onset latency > 8 min, who showed no significant deficits. The authors concluded that physiological hyperarousal in insomnia may lead to increased daytime alertness yet dispose these individuals to higher error rates on tasks of switching attention, 81 a finding consistent with those of a study by Fernandez-Mendoza et al., in which physiological hyperarousal was ascertained by objective short sleep duration. 80

A recent meta-analysis has shown that individuals with insomnia exhibit performance impairments of small to moderate magnitude in several cognitive functions, including working memory, episodic memory, and some aspects of executive functioning. 82 However, an important factor that has been neglected in meta-analytic research of the neurocognitive literature is the role of the degree of objective sleep disturbance in this association. As we have recently reviewed, 59 most studies have shown that cognitive performance is impaired in patients with insomnia with objective sleep disturbances or that it correlates with objective markers of sleep disturbance in patients with insomnia, whereas those studies in which performance was not significantly impaired established insomnia diagnoses using solely subjective criteria. 59

Cumulatively, the data from these studies indicate that objective short sleep duration may predict its effect on cognitive functions. Future studies should examine whether insomnia with objective short sleep duration may be a premorbid risk factor for mild cognitive impairment (MCI) and dementia.

Insomnia and Psychiatric Morbidity

Many studies have established that insomnia is highly comorbid with psychiatric disorders and is a risk factor for the development of depression, anxiety, and suicide. 83 However, the mechanisms by which insomnia precedes the development of psychiatric disorders, e.g., depression, are unknown. In a recent study from the Penn State Adult Cohort, insomnia with objective short sleep duration was associated with a psychological profile consistent with depressed mood, fatigue, concerns about health and physical functioning, somatically focused anxiety, and poor health status, which is typical of medical outpatients. 58 In contrast, insomnia with normal sleep duration was associated with sleep misperception (i.e., the underestimation of time asleep and overestimation of time awake during the night) and a psychological profile consistent with depressed mood, rumination, anxiety, intrusive thoughts, and poor coping resources. 58 These data have led us to suggest that both insomnia subtypes are associated with (or are at risk of developing) psychiatric disorders but that different pathophysiological mechanisms may account for such an association. 59 For example, it is possible that biological mechanisms, i.e., hyperactivity of the HPA axis, may play a role in the development of depression in insomniacs with objective short sleep duration, while psychological mechanisms, i.e., poor coping resources and ruminative traits, may play such a role in insomniacs with normal sleep duration. However, these hypotheses need yet to be tested.

Natural History of Insomnia: Chronic Insomnia vs. Poor Sleep

As mentioned in the introduction, about 20% of the general population has poor sleep (i.e., insomnia symptoms at any given time) and about another 10% has chronic insomnia. Natural history studies have shown that chronic insomnia is a highly persistent condition, whereas the course of poor sleep is more variable and has a higher remission rate. 17 , 19 , 20 , 84 , 85 This suggests that insomnia is a disorder while poor sleep is a symptom of underlying mental and physical health problems. 19 , 20 , 85 Furthermore, objective short sleep duration has been shown to be a risk factor for poor sleep evolving into the more severe form of chronic insomnia 20 as well as of chronic insomnia becoming persistent.85 These latter findings suggest that objective short sleep duration may be a biologic marker of genetic predisposition to chronic insomnia 20 and of the severity and chronicity of the disorder. 85

As a result of the above-reviewed literature we have suggested two phenotypes of chronic insomnia. The first phenotype is primarily associated with physiological hyperarousal (i.e., short sleep duration and activation of both limbs of the stress system), significant medical sequelae (e.g., hypertension, diabetes, cognitive impairment, increased mortality), and a persistent course. The second phenotype is associated with cognitive-emotional and cortical arousal, but not with physiological hyperarousal (i.e., normal sleep duration and normal activity of the stress system) or significant medical sequelae, and is more likely to remit over time. Furthermore, the first phenotype is associated with a psychological profile typical of medical outpatients, whereas the second phenotype is associated with sleep misperception, anxious-ruminative traits, and poor coping resources. 59 Table 1 summarizes the findings of key studies, while Figure 1 depicts a heuristic model of the underlying pathophysiological mechanisms and clinical characteristics of the two insomnia phenotypes.

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The common characteristics of the two phenotypes are presented in the overlapping area, while their unique characteristics are presented in the areas of each phenotype that do not overlap. Reprinted from Sleep Medicine Reviews, 17(4), Vgontzas AN, Fernandez-Mendoza J, Liao D, Bixler EO [59], Insomnia with objective short sleep duration: The most biologically severe phenotype of the disorder, 241-54, 2013, with permission from Elsevier.

Insomnia with short sleep duration: association with physiological hyperarousal, cardiometabolic morbidity, neurocognitive impairment, and a persistent course

Our proposed model for the two insomnia phenotypes may have an impact on how we diagnose and treat chronic insomnia. As we have stated earlier, previously proposed subtypes of insomnia are based on subjective tools such as clinical interviews, questionnaires, and specific scales and their diagnostic reliability is, at best, modest. The data reviewed here suggest that objective measures of sleep can be useful in detecting the most severe form of insomnia. Thus, we propose the inclusion of objective sleep duration as a criterion in future diagnostic manuals for insomnia in order to differentiate these two clearly different and clinically relevant subtypes of insomnia.

Further, our data suggest that objective measures of sleep, in addition to a thorough clinical evaluation, should become part of the standard diagnostic procedures for insomnia. 59 Although our studies have focused on the utility of sleep duration, other studies suggest that other variables of sleep efficiency and continuity or of physiological hyperarousal (i.e., MSLT) may also serve as markers of the biological severity of the disorder. 20 , 26 , 81 , 86 - 88 However, a potential disadvantage of biomarkers such as stage 1, SWS, or MSLT is that they require a full PSG study or daytime laboratory assessment, whereas sleep duration perhaps could be obtained with simpler methods, e.g., actigraphy. In this regard, several studies suggest the potential usefulness of actigraphy to assess sleep patterns for a period of days or weeks in the “habitual home environment”, to characterize the severity of the insomnia disorder. 88 A similar amount of home sleep monitoring with PSG would be difficult and impractical for clinical venues. However, several problems associated with the use of actigraphy, such as lack of an industry standard for the sleep algorithms used in different actigraphic devices and the propensity to over- or underestimate sleep time, make its current use limited. Future studies using cost-effective methods should examine which variables, i.e., sleep duration vs. night-to-night variability, and which methods, i.e., actigraphy, salivary cortisol, peripheral measures of sympathetic activation, are better predictors of cardiometabolic and neurocognitive morbidity.

Finally, our findings may affect the way we treat chronic insomnia. The insomnia phenotype with short sleep duration may respond better to treatments that primarily aim at decreasing physiological hyperarousal and increasing sleep duration, such as medication or other biological treatments. 30 Previous studies have shown that sedative antidepressants such as trazodone or doxepin, used at low dosages, down-regulate the activity of the HPA axis, decrease cortisol levels, and increase sleep duration. 30 , 89 , 90 Needless to state that biological treatments should be part of a multidimensional approach that combines behavioral changes, i.e., sleep hygiene, and psychological interventions, i.e., cognitive-behavioral therapy (CBT), when indicated. The second phenotype, i.e., insomnia with normal sleep duration, may respond better to treatments that primarily aim at decreasing cognitive-emotional arousal, changing sleep-related beliefs and behaviors, and altering sleep misperception, such as CBT. 91 Psychotherapeutic medication may be indicated based on the presence of comorbid psychiatric conditions, i.e., anxiety or depressive disorders. The differential treatment response of these two phenotypes should be tested in future placebo-controlled clinical trials. In any event, the treatment of insomnia with objective short sleep duration should become a priority given its severity and its effects on physical health. Finally, in the prevention of chronic insomnia, our strategies should focus on (1) those with premorbid cognitive-emotional hyperarousal and short sleep duration, (2) stress-related poor sleep with short objective sleep duration, and (3) a family history of sleep problems. 18 - 20

Acknowledgment

This paper was supported by National Institutes of Health grants R01 51931, R01 33 40916, and R01 64415 to Alexandros N. Vgontzas.

Compliance with Ethics Guidelines

Conflict of Interest

Julio Fernandez-Mendoza and Alexandros N. Vgontzas declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Recently published papers of particular interest have been highlighted as:

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Home / Essay Samples / Health / Sleep Disorders / The Importance of Sleep Informative Speech Outline

The Importance of Sleep Informative Speech Outline

Category: Life , Health
Topic: Healthy Lifestyle , Sleep Disorders

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Introduction

Importance of sleep.

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