Sleeplessness and Mental Health
The Realm of the Insomniac
Between those late hours of the night when we tell ourselves we’ve simply stayed up a little late and the early hours of the morning when we realize it’s going to be a long, miserable day, is the realm of the insomniac. Some only visit here for a short time as they deal with a particular stressful situation. Others live here, night in and night out, month after month, even year after year.
I’ve been in that sub-dimension of time where everyone around me lies in sweet somnolence while I lie to myself that I can go on indefinitely with little or no sleep. This type of sleeplessness, which is characterized by the apparent absence of a cause, is a sleep disorder known as idiopathic insomnia.
Sleeplessness and Cognitive Impairment
Even though I was able to continue writing, it was clear that my cognitive abilities in other areas had suffered as a result of a sleep disorder. The simplest mental tasks became difficult. The only way I was able to continue working was to take extra precautions to eliminate errors. In medical terms, this is known as cognitive impairment. What is cognitive impairment? According to the Center for Disease Control,
Cognitive impairment is when a person has trouble remembering, learning new things, concentrating, or making decisions that affect their everyday life. Cognitive impairment ranges from mild to severe. With mild impairment, people may begin to notice changes in cognitive functions, but still be able to do their everyday activities. Severe levels of impairment can lead to losing the ability to understand the meaning or importance of something and the ability to talk or write, resulting in the inability to live independently.
Other Causes of Sleeplessness and Cognitive Impairment
In addition to idiopathic insomnia, two other causes of sleeplessness which lead to daytime drowsiness and cognitive impairment are sleep apnea and Restless Legs Syndrome which was recently renamed Willis-Ekbom Disease by the American Medical Association. Both of these require medical attention. Air pressure changes from moving to a higher altitude can cause sleeplessness in some people. There can also be psychological causes of sleeplessness, such as depression.
I want to share my own experience, so I will leave some of these issues for others. My experience has been with idiopathic insomnia, Restless Legs Syndrome/Willis-Ekbom Disease (RLS/WEB) and sleep apnea, specifically, central sleep apnea.
Polysomnography, a Sleep Study
Willis-Ekbom Disease, Formerly Known as Restless Legs Syndrome
When a person is suffering from daytime sleepiness and cognitive impairment, a sleep study, called Polysomnography, is used to record brain waves, oxygen level in blood, heart rate, breathing, eye movement and leg movement while the patient is sleeping. The result of this sleep study might be the diagnosis of RLS/WEB and/or sleep apnea.
First, let’s get a good understanding of the terribly misunderstood condition known as RLS/WEB. It is not the involuntary movement of the legs. That is a different condition. RLS/WEB is characterized by pain, or intense neurologic sensations primarily in the lower legs. Some, such as myself, have this condition in our arms and even in our gums and tongue. For the legs, the person must get on their feet and walk. They can’t ignore this pain. Little children who suffer with this are restless, unable to sit for long periods of time. My parents would take me out of church services and spank me for being so squirmy, not realizing I could not help myself. And I wasn’t able to explain it. RLS/WEB disrupts sleep for many and leads to cognitive impairment.
What can be done for RLS/WEB? The first line of treatment is Magnesium. Many say that chelated magnesium is the most readily absorbed form of this mineral. This means that the magnesium is chemically bound to negative ions which allows it to be more easily absorbed out of the intestines into the body’s cells. Chelated magnesium is more expensive, but reportedly works much better.
Another form of treatment for RLS/WEB is the use of drugs designed for Parkinson’s Disease patients. One such drug is Pramipexole (Mirapex). I have been using this drug for several years and it is effective. One of the side effects can be compulsive behavior, something to watch for if you choose this option. Another drug used for RLS/WEB is Requip (Ropinirole HCL)
Restless Legs Syndrome/Willis-Ekbom Disease
Central Sleep Apnea and Obstructive Sleep Apnea
Central sleep apnea, which can also lead to cognitive impairment, is caused when the brain fails to send messages that control breathing. The person with this condition will simply stop breathing during sleep for extended periods. Central sleep apnea is different than obstructive sleep apnea which is caused by a blockage of the airway. People with obstructive sleep apnea cannot breath. Those with central sleep apnea can breath, but don’t. Both of these conditions can lead to sleeplessness and cognitive impairment.
Following the polysomnography, a patient will be prescribed the appropriate form of treatment. The treatment for obstructive sleep apnea is a device known as a CPAP (continuous positive airway pressure). This is a mask that is worn during sleep and provides oxygen to the airway. The treatment for centralized sleep apnea is a BiPAP (Bilevel Positive Airway Pressure) which gently forces oxygen into the airway.
Nighttime Sleeplessness and Daytime Drowsiness Go Hand in Hand
Cutting sleep from 7 to 5 hours or fewer per night doubled the risk of death by all causes (British study)
Negative Outcomes of Sleeplessness
Cognitive impairment is one consequence of sleeplessness. Here is a list of other negative outcomes of insomnia.
- Daytime drowsiness
- Decreased alertness
- Errors in judgement
- Minimize or ignore the effects lack of sleep is having on them.
- Death-A British study revealed that cutting sleep from 7 to 5 hours or fewer per night doubled the risk of death of all causes.
- Poor health-Heart disease, heart attack/failure, irregular heartbeat, high blood pressure, stroke, diabetes, obesity
- Automobile accidents-The National Highway Traffic Safety Administration (NHTSA) estimates that drowsy driving is responsible for more than100,000 auto accidents, 71,000 injuries, and 1,550 deaths per year.
- Quality of life-Too tired to do the things one loves
- Less interest in sex
- Decreased release of cortisol by body leading to unhealthy skin
- Decreased release of human growth hormone affecting muscle, skin and bone health
- Long term memory loss
- Stress on relationships
- More than doubles the risk of occupational injury
- Attention Deficit Disorder
Coffee and Sleeplessness
A Proactive Strategy to Overcoming Sleeplessness
A proactive strategy is essential to overcoming insomnia and might incorporate the following:
- Deal with the source of the problem-RLS/WEB, sleep apnea, emotional stress
- See your personal physician
- See a professional counselor
- Allow yourself to fall asleep only in your bed
- Don’t read, watch TV or use a laptop in bed
- Practice some sort of relaxation technique, e.g. Meditation/Yoga
- Consider natural, non-narcotic sleep aids such as melatonin or Gamma-aminobutyric acid (GABA) which is a vegetable based, over-the-counter supplement and is a potent sleep aid.
- Avoid these top ten foods that promote insomnia-Taken from an article on medicaldaily.com (See complete article for full explanations).
- Dark chocolate
- Greasy/fatty foods
- Red meat
- High carb/sugary foods
- Spicy foods
- Ice cream
Evaluating the Quality of Your Life
I want to ask those who are suffering with sleeplessness a few questions. My goal is that by answering, you will begin to truly evaluate the state of your life.
1. At what level are you functioning in your personal life regarding the following?
A. Cleaning and maintaining your home and property.
B. Maintaining your automobile
C. Maintaining relationships with family and friends
D. Maintaining a healthy lifestyle with diet and exercise
E. Personal hygiene.
2. At what level are you functioning at work?
A. Have you received warnings regarding the quality of your work?
B. Do you use more sick time than those around you, or more than you used to use?
C. Has your employer threatened you with the loss of your job?
I know about the hopeless feeling that so permeates our minds that we simply sit back in our recliners and watch the clock tick off the hours until another day begins.
The First Steps Back into the Mainstream of Life
Do your answers suggest a happy, healthy person who is living life to its fullest every day, or do they reveal a mere existence, a life barely being lived? At some point, we who suffer with sleeplessness must honestly answer these kinds of questions.
Here are two suggestions one might use to begin moving toward a normal lifestyle regarding sleep. Either one could be taken first.
- Make an appointment with your physician to discuss your sleeplessness.
- Make an appointment with a professional counselor to discuss your sleeplessness.
Your doctor and the counselor will have different ways of handling the issue, so don’t hesitate to take both of these steps.
I can relate to those who suffer with sleeplessness. I know about the hopeless feeling that so permeates our minds that we simply sit back in our recliners and watch the clock tick off the hours until another day begins. But life does not have to go on like this. There is help available if you will take the first step, then the second and third, until you have walked back into the mainstream of life.