Abstract
This paper focuses on the broad term of insomnia and its effects on a healthy functioning of a human brain. Studying differences in a brain of an individual with insomnia and without insomnia is crucial when making decisions about a diagnose. First, this paper lists possible causes for insomnia, such as depression, war and combat experience, and genetics. Later on, the paper talks about the brain structure of a patient suffering from insomnia and how white matter changes over the course of time in these patients. The list of physiological changes in patients with insomnia then continues in this paper naming some important findings in the brain and body of these individuals. The last part of the paper focuses on serious negative effects of insomnia on a human brain and ways to treat this disorder. Many more research studies are encouraged to be done to discover more on this interesting topic and something many people struggle with on daily basis.
Impact of Insomnia on Physiological Development
Sleep disorders have become one of the leading reasons people seek psychological help from mental help professionals due to some serious impact it has on the physiological well-being of an individual (Skaer & Sclar, 2010). It was found that between 35% and 40% of all American adults experience difficulty either falling asleep or being sleep deprived during the day which results in high numbers of morbidity and mortality (Skaer & Sclar, 2010). Lack of sleep can cause a serious impact on the physiology of an individual. In many cases, the insufficient amount of sleep can negatively impact healthy functioning of the neurocognition (Skaer & Sclar). It can also increase levels of blood pressure, evening cortisol and cause glucose intolerance and obesity in sleep deprived individuals (Skaer & Sclar, 2010). Sleep medicine is a fairly recent discipline, but we already know that there are many types of sleep disorders, such as insomnia, obstructive sleep apnea, excessive daytime sleepiness, fatigue, and restless legs (Skaer & Sclar, 2010). The goal of this paper is to focus on insomnia specifically as one of the leading sleep disorders.
There is not a permanent definition of insomnia that applies to all people who suffer from this sleep disturbance disorder. Insomnia is a broad term and varies from individual to individual when it comes to symptoms people experience. However, recent research shows many different causations of insomnia and also how this disorder has power to influence mental health of a patient. It was found that one of the leading causes of insomnia and sleep disturbances is experiencing depression symptoms (Vargas, Friedman & Drake, 2015). It only makes sense that individuals who struggle with depression symptoms also struggle with insomnia due to the feeling of hopelessness and being constantly overwhelmed. Also, this could be because sleeping decreases the level of serotonin in our brain which is negatively correlated with depression symptoms. As we know, low levels of serotonin increase depression symptoms. Unfortunately, insomnia can in response elevate the levels of depression symptoms among people with this disorder (Vargas, Friedman & Drake, 2015).
It is no surprise to reveal that war and negative experience associated with it increase a chance of post-traumatic stress disorder which is directly correlated with sleep disturbances and insomnia specifically (Maher, Rego & Asnis, 2006). It was found that approximately 74% of combat veterans diagnosed with a PTSD disorder also suffered from insomnia on a persistent basis (Pigeon, Campbell, Possemato & Ouimette, 2013). Unfortunately, insomnia is a sleep disorder that is not able to be resolved on its own and further psychological help is required (Pigeon, Cambell, Possemato & Ouimette, 2013).
Lastly, genetics could also be a leading factor for insomnia, though much more study needs to be done on the subject topic. For example, one twin study showed that insomnia is a disorder influenced by genetics and its heritability can be up to 0.61 for lifetime insomnia (Wing et al., 2012). Genetics is a fairly new field of study and it is difficult to confidently speak about effects of genetics on insomnia. However, MEIS1 gene was found to be highly associated with insomnia and also the involvement of both residual phenotypic overlap and pleiotropy (Hammerschlag et al. (2017). Further research on this topic has been encouraged.
Different Types of Insomnia
When looking at patients suffering from insomnia, it is necessary to look at the brain structure of the individuals with insomnia and compare the differences to the individuals without insomnia. In a recent study, 22 patients diagnosed with insomnia were asked to go through polysomnography and an MRI and then consequently fill out a questionnaire and neurocognitive tests to measure their spatial planning (Kang et al, 2018). It was found that there is an interruption in the integrity of white-matter in the left thalamus-pars triangularis tracts and the inferior frontal gyrus among individuals who suffer from insomnia (Kang et al, 2018). This lack of integrity was associated with feelings of sleepiness during the day and overall effects on cognition of an individual suffering with this disorder (Kang et al, 2018). Interestingly, the MRI scans of the individuals who were sleep deprived showed lower functional connectivity in their parahippocampal area and their left inferior frontal gyrus (Kang et al., 2018). This finding proves the earlier statement that insomnia has a negative effect on a cognitive functioning of an individual.
As mentioned earlier, insomnia is a sleep disorder that does not have one definition used for all patients suffering from it. Therefore, when talking about insomnia, it is important to differentiate between different types of insomnia and ways it’s perceived by an individual suffering from the disorder. Objective insomnia is measured by PSG sleep time, primary insomnia is a broad term for sleep disorders that meet the criteria for psychophysiological or idiopathic insomnia (Bonnet, Burton & Arand, 2014). There is also subjective insomnia and it is measured by a questionnaire in which patients report to suffer from insomnia (Bonnet, Burton & Arand, 2014). Lastly, patients may also indicate sleep disturbances and an abnormal amount of time spent awake during sleep time by filling out a questionnaire and being diagnosed as a sufferers of poor sleep (Bonnet, Burton & Arand, 2014). It makes sense that when diagnosing someone with a sleep disorder or a specific type of insomnia, it takes time to choose the correct diagnoses due to the specific and very individual sleep disturbance a patient may be experiencing.
Perlis et al. (2001) found that patients who suffer from primary insomnia have higher levels of beta power compared to the group of individuals who do not suffer from this disorder by using EEG and watching its activity in the particular study. As learned in class, beta waves serve us in our wake stage and help with alertness in times when use of cognition is needed. Our brains naturally know when it is time to use these waves and when it is time to give our brains rest.
In a different study, Rodenbeck, Huether, Rüther and Hajak (2001) compared a group of individuals suffering from primary insomnia with a group of individuals without insomnia and found that hourly blood cortisol levels were significantly higher in patients with insomnia. As mentioned earlier, insomnia and depression tend to go hand in hand and this could be one of main explanations. As we know, people who suffer from depression have elevated levels of cortisol in their bloodstream and therefore it makes sense that patients may suffer from depression and insomnia simultaneously.
Influence on Brain and Distress
Insomnia is a disorder that may cause a lot of distress in patients suffering from this disorder due to lack of sleep and inability to use proper cognitive functioning. Bonnet, Burton and Arand (2014) once concluded that there is an increase in a heart rate of a patient suffering from insomnia and also suggested that it may be directly correlated to the increased activation of sympathetic nervous system which is responsible for action oriented tasks such as fight or flight response.
The serotonin named GABA+ is highly associated with sleep patterns, but unfortunately, there has not been a correlation found between altered GABA+ levels and insomnia (Spiegelhalder et al., 2016). Many people might think that differences in GABA+ levels are predictors of insomnia, but that has not been confirmed yet. However, Spiegelhalder et al. (2016) found and suggested that levels of GABA+ are associated with sleep duration and levels of Glx could show increase in arousal levels in patients suffering from insomnia. All these findings are very important in diagnosing someone with insomnia and many times brain scans are necessary. Unfortunately, there are also some negative outcomes of insomnia when not treated early enough.
From the physiological perspective, insomnia has some serious consequences on the neuroscience of our brain. Lack of sleep affects the structural plasticity of the brain by having effect on the spine and morphology which in response alters brain functions such as mood, alertness and cognition (Raven, Van der Zee, Meerlo & Havekes (2017). This is an important piece of information and early treatment of insomnia is necessary. There are many different types of treatment and many times treatment varies depending on severity and type of insomnia.
The integrate treatment or 2NITE protocol was found to be very effective in treatment of insomnia due to its effectiveness on decrease in insomnia and an overall increase in quality of life (Colvonen, Drummond, Angkaw & Norman, 2018). This treatment was developed by creating an overlap of cognitive-behavioral therapy(CBT) and psychoeducation(PE) where patients first went through cognitive-behavioral therapy and then were added to the psychoeducation treatment to overlap CBT until it effectively ended and in vivo exposures began (Colvonen, Drummond, Angkaw & Norman, 2018).
Sandlund, Hetta, Nilsson, Ekstedt , and Westman (2018) found that group treatment is also effective with insomnia symptoms. In her study, Sandlund et al. (2018) used techniques of CBT -I in a group therapy of patients suffering from insomnia and found positive effects on daytime functioning, overall decrease of fatigue and improvements of mood stability. This finding confirms the high effectiveness of CBT in patients suffering from insomnia.
Conclusion
Lastly, there is an evidence of certain sleep medication which acts as benzodiazepine receptor agonists being helpful in treatment of insomnia. However, medication, such as Zolpidem is effective in treatment of insomnia only when combined with a cognitive-behavioral therapy (Morin et al., 2017). Also, it was found that Zolpidem as a psychotropic treatment is only effective the first couple of weeks when combined with cognitive-behavioral therapy and then it is encouraged to stop the intake and focus solely on the cognitive-behavioral therapy (Morin et al., 2017). This knowledge is an important example of how many times medication is not the only solution to psychological disorders. Many times, combination of medication and psychotherapy is required to see positive outcomes.
There has been many studies done in the past decade on the topic of insomnia and sleep disturbances it causes in an individual suffering from the disorder. Many new techniques of treatment have been implement, though much more research needs to be done on the broad topic of insomnia. Recent research on insomnia suggests more in depth research on topics, such as genetic influence, the effect of GABA+ neurotransmitter on insomnia and the effects of comorbidity of insomnia with other psychological disorders, such as depression.
