How does insomnia affect the body?

 Anyone who has had a sleepless night can attest to the fact that they don't feel 100% the next day. However, could lack of sleep be having more effect on the body than just leaving a feeling of tiredness?

The brain is the part of the body that is more dramatically affected by insomnia, and many of its everyday functions are inhibited by insufficient rest. While tests have shown that short-term memory on the whole is unaffected by insomnia, those who suffer from it may have a less active working memory, the part of short-term memory involved with processing and storing information and applying it to a task. fMRI scans showed that those with insomnia had lower activity levels in brain regions involved with this working memory compared with control subjects. As well as impacting everyday thinking, lack of sleep can also result in a slowing of mental processes, reduced concentration and, in cases of extreme sleep deprivation, can restrict the transformation of short-term term memories into long-term memory. As well as reducing the efficienct of the brain, a state of prolonged wakefulness means that activity levels of the emotion-processing part of the brain, the amygdala, rise. This increased activity can cause insomniacs to experience higher levels of frustration and anger throughout the day

Over time sleep deprivation can begin to affect hormonal processes, which can further impact sleep quality. Secretions of the stress hormone cortisol rise, resulting in higher levels of anxiety and a faster heart rate. During normal sleep, a hormone is secreted which suppresses feelings of hunger. When sleep is reduced there is more time for the body to produce ghrelin, the hunger hormone, meaning insomnia patients experience heightened appetite. In order to quickly boost energy levels, the body craves foods with a high sugar or salt content, resulting in an observed link between insomnia and obesity.

As sleep cycles become irregular the body's circadian rhythm is affected, meaning that those suffering from too little sleep are likely to experience more erratic peaks and troughs in their energy levels. It is normal to experience a period of lethargy during the day, however, for insomniacs this period is prolonged, making it harder for them to stay awake in the afternoon. At the other extreme, insomniacs may experience stretches of feeling excessively alert, as they become focussed on the pressures of the day and heart rate and adrenaline levels are maintained at a high level.

In the long term, long periods of limited sleep can have drastic effects on the body and a person's performance during activities. If insomnia persists it is important to see a doctor, who can provide advice or medicinal aid for returning to a normal sleeping pattern, giving the body time to repair and relax.

Sleep Science – The Mechanisms Behind Insomnia

 Everyone is prone to a sleepless night or two, brought on by excitement or stress. However, for some, lack of sleep can last for weeks, sometimes months. Sustained sleep-deprivation is something that is estimated to affect between 20% and 50% of adults. Much work has gone into researching not only how to cure insomnia but also what the mechanisms are that cause it.

The 3 P's of Insomnia

A popular explanation for this sleep disorder looks at three key factors – predisposition, precipitation, and perpetuation. Advocates of the 3-P Model believe that insomniacs have certain characteristics, such as being naturally anxious or being perfectionists, that make them more susceptible to sleep problems. This predisposition, combined with a precipitating event, such as a death of a loved one or job stress, can affect sleep resulting in a period of acute insomnia (short-term sleep loss). The third facet of this model is that anxiety about, and poor attitudes towards, sleep will perpetuate the symptoms of insomnia. This is because, the more uneasiness a sufferer feels about falling asleep, the more active their brain will be, resulting in them actually staying awake for longer.

The Cognitive Processes of Sleeplessness

This idea of perceptions of how one will sleep feeds into the Cognitive Model of insomnia, an idea put forward over ten years ago. The simple concept is that those suffering from insomnia worry about their sleep and what will happen if they don't get enough. These thoughts actually trigger emotional stress and brain activity which causes the individual to search themselves and their surroundings for factors that could interrupt their sleep, such as noise, light, or discomfort. In the process of focussing on these things they actually bring themselves back into a state of full wakefulness, as the brain isn't allowed to wind down. By actively focussing on the act of falling sleep, insomniacs delay it, by maintaining the brain in a state of awareness.

The Brain Chemistry of Insomniacs

Related to the Cognitive Model, but taking a more in depth stance, the Neurocognitive Model of sleep deprivation explores how brain activity may differ between those with regular sleeping patterns and those without. Scientists have observed that those suffering from acute insomnia actually have higher levels of electrical activity in the brain than those who don't suffer sleep problems. The result of this could be that insomnia sufferers may have higher sensory or information processing activity during times when those with regular sleeping patterns don't. This could have drastic effects on a person's ability to fall asleep, as they are more aware of what is happening around them.

The role physiological factors has been more thoroughly researched, as it has come to be believed that insomniacs may have innate characteristics that affect how easily their sleep is disrupted by both external and psychological factors. Elevated levels of brain metabolism have been observed in studies of insomniacs, making it harder for them to switch off at night. Furthermore, it has been seen that patients with insomnia secrete less melatonin at night, the hormone responsible for making us feel tired. This, combined with the observed increased levels of norepinephrine, a hormone similar to adrenaline, in insomniacs have the debilitating effect of making it much harder to fall asleep.

Thankfully, as insomnia becomes better understood, more techniques and medical interventions are being developed to cure it.

Olympic-Level Care With Dr. Gerardo E. Miranda-Comas

This week Mount Sinai is proud to introduce you to Assistant Professor of Rehabilitation Medicine, Dr. Gerardo E. Miranda-Comas. Trained in Physical Medicine and Rehabilitation, Dr. Miranda-Comas has sub-specialized in Sports Medicine, with a clinical focus on a vast range of sports-related injuries. His medical interests include the diagnosis and non-surgical management of musculoskeletal injuries, sport-related injuries, exercise prescription, electrodiagnosis, regenerative medicine, and diagnostic-therapeutic musculoskeletal sonography. With every injury case, Dr. Miranda-Comas believes that the best intervention lies in increasing patient awareness and education, and he aims to aid early return to function, and improvement in the patient's quality of life.

Dr. Miranda-Comas' interest in sports medicine began while completing a fellowship in the field at the University of Puerto Rico School of Medicine. Since then he has been involved in sports medicine at every level, being invited to lecture at scientific meetings at both national and international levels, as well as having published many articles on the subject. His interest in sports stretches beyond his professional life, to his involvement in covering sporting events from high school-level, right through college sports and up to elite-level events.

A true testament to his expertise within the field, Dr. Miranda-Comas was selected to be a member of the medical team at the 2016 Olympic and Paralympic Games in Rio. Only the best physicians are selected to become a member of the Olympic medical team, following a long application process, and are required to have an intimate and expansive knowledge of athletic injuries. However, this is not the only mass participation event that Dr. Miranda-Comas has contributed his medical knowledge to, being present in a professional capacity at both the New York City Marathon and the Pan American Games.

On top of his real-world experience with sports injuries, Dr. Miranda-Comas has earned four board certifications in Physical Medicine and Rehabilitation, Sports Medicine, Electrodiagnostic Medicine, and Musculoskeletal Ultrasound. Holding roles as the Associate Program Director of the Mount Sinai Sports Medicine Fellowship, and as a core member of the of the Physical Medicine and Rehabilitation Program faculty, Dr. Miranda-Comas is extremely qualified to treat a range of sports-related complications. But don't take our word for it – take a look at his customer experience rating of 4.8 out of 5 stars on our website as a true testament to his knowledge and skill in the field!

To book a consultation with Dr. Gerardo E. Miranda-Comas, request an appointment here

Tips for a Good Night's Sleep

There is nothing better than having a good night's sleep at the end of a long work day. However, in the US, 30% of the population suffers from insomnia, with this rising to between 40% and 60% among those above 60. Often it is caused by stress or anxiety, and may be fixed as this stress is removed. However, for those suffering more long-term sleep loss other measures must be taken to improve the situation.

Developing a Sleep Schedule

One important action to take is to implement a sleep schedule. By making sure you go to bed at the same time every night and wake up at the same time every morning your body will get into a cycle, helping you to wake up feeling more rested. While regular sleep patterns are important, they will not be as effective if other factors are not taken into account. Midday naps can actually leave you feeling more tired, as they adjust the body's internal clock. If you must have a nap it should be kept to 10-30 minutes and should be had during mid-afternoon. Similarly, using electronic devices before bedtime can upset rest as the light from them resets the body's circadian rhythm by imitating daylight. In order to get the best sleep possible, all electronics should be turned off an hour before sleep. Furthermore, lights should be dimmed 2-3 hours before bed, as this will stimulate the brain to produce melatonin, the hormone that induces sleep.

Regulating Food Intake and Exercise

It is essential to cut out substances such as nicotine and caffeine before bed, as both are stimulants that will keep you awake. It is also best to avoid having a nightcap as, while alcohol will initially make you fall into a deep sleep, as it wears off you will spend less time in this deep sleep and more in the lighter REM stage of sleep resulting in waking up feeling lethargic.

While it may be a myth that eating cheese before bedtime will give you nightmares, it will definitely make it more difficult to get a good night's rest. Eating just before dinner will cause the body to release cortisol, a hormone involved in the metabolism of food, which decreases secretion of melatonin, thus making you more likely to wake up in the middle of the night. Likewise, it is best to keep late-night exercise to a minimum. Working out in the middle of the day can help to tire you out, and thus help encourage sleep. However, exercising releases energy which, if done just before bed, will keep delay sleep. Light exercise, such as stretching or yoga can be beneficial, as it relaxes the body.

See a Doctor

Often the measures mentioned above are sufficient to restore good sleep, however, occasionally symptoms can persist. If sleeplessness lasts a month or longer it may be necessary to see a doctor, who can ascertain if the cause is related to another health condition, such as acid reflux or asthma. Alternatively it could be an adverse effect of medication you are taking.