I can’t fall asleep: what is insomnia and how to restore proper sleep

Night struggle against time. Undoubtedly, all of us at some time in our lives have encountered difficulties falling asleep, as well as maintaining adequate sleep. If this sounds familiar, chances are you've had a bout of insomnia.

Insomnia is a disorder characterized by difficulty initiating or maintaining sleep. Various factors can be closely associated with this disorder. Poor diet, mental health problems, financial problems, depression, anxiety, lack of physical activity, chronic diseases and medications are some of the many factors that can affect the quality of our sleep. Today, together with experts, we will understand what insomnia is, how it occurs and how you can restore proper sleep.

What is insomnia?

Insomnia is defined as persistent difficulty falling asleep, staying asleep, or waking up too early and not being able to get back to sleep. It can be occasional or chronic and is associated with symptoms such as daytime fatigue, irritability and difficulty concentrating.

As Gala Koronovskaya, a somnologist, psychiatrist, psychotherapist, and research director at the Higher School of Economics, explains, based on pathophysiological mechanisms, scientists divide the causes of insomnia into three types:

1. Internal sleep disorders are disorders that develop inside the body:

a) Stress: These are events or “triggers” that typically involve acute or chronic stressful life events, including stress at work, death of a loved one, divorce, changes in work schedule, job loss, or other major life events.

b) Diseases:

• Somatic diseases accompanied by pain (for example, rheumatic diseases, chronic pain syndrome), shortness of breath or orthopnea (cardiovascular or pulmonary diseases), nocturia (congestive heart failure, use of diuretics, benign prostatic hyperplasia, untreated obstructive sleep apnea).
• If we talk about diseases, the causes may be: hyperthyroidism, gastroesophageal reflux disease (GERD), diabetes, coronary heart disease, lung diseases (chronic obstructive pulmonary disease, asthma, sleep apnea), chronic renal failure, premenstrual syndrome, headaches, Parkinson's disease and sleep-related movement disorders (eg, nocturnal myoclonus, restless legs syndrome).
• Mental illnesses: anxiety disorders (PTSD, panic attacks, generalized anxiety disorder, phobias, etc.), mood disorders (depression, mania, bipolar disorder), schizotypal disorder, schizophrenia and psychosis, alcoholism.

2. Sleep disturbances caused by external factors.

a) Environment: Environment with excessive noise, high or low temperature, low pressure, lack of oxygen, bright light can cause insomnia.

b) Poor sleep hygiene: viewing social networks, news, etc., exercise before bed is just as bad for sleep as going to bed late.

c) Use of various substances:

• Medications: Insomnia may be associated with the use or withdrawal of certain medications or substances. Common medications and substances that can cause insomnia include anticonvulsants, anti-anxiety medications, antidepressants, and beta-blockers.
• Psychostimulants: alcohol*, tea, cola, caffeine, energy drinks, narcotic drugs. Alcohol* does help you fall asleep, but it interferes with deeper stages of sleep and usually leads to awakenings at night, which is a type of sleep disorder.

3. Sleep disorders associated with circadian rhythms, in which there is a discrepancy between sleep patterns and desired or social norms for sleep. For example, sleep disorder during shift work, with frequent changes in time zones.

Why does insomnia occur?

Lack of sleep, according to Evgeniy Gibert, a psychotherapist and clinical psychologist, can lead to memory problems, poor concentration, decreased immunity, worsening depression, exhaustion, fatigue and difficulty performing daily activities.

“An adult needs to sleep about 8 hours a day (no less than 6 and no more than 10 hours), preferably from 23:00 to 07:00, because it is at this time that melatonin is produced, which promotes deep sleep and productive rest.

If a person wakes up frequently (every 2-3 hours), this indicates a problem with the genitourinary system. If you have nightmares, this indicates depression or nervous tension. Light sleep or its complete absence at night can be due to cardiovascular diseases or diseases of the respiratory system. Severe mental illnesses such as Alzheimer’s disease, Parkinson’s disease, dementia, schizophrenia, etc. can also cause insomnia,” explains Evgeniy Gibert.

Insomnia can also be caused by:

1. Unsuitable conditions that interfere with healthy rest, for example, too high a temperature in the bedroom, an uncomfortable bed, or uncomfortable bedding.

2. Work or entertainment before bed. You should not take your laptop or phone to bed with you. Bright light awakens people from sleep, and a person cannot fall asleep for a long time at night.

3. Watching horror films and action films before bed.

4. Active physical exercise also does not help you fall asleep quickly. Rapid heartbeat, overexcitement of the body, a person may need several hours to calm down.

5. Heavy, fatty food before bed (especially meat). Drinks containing caffeine (coffee, green tea).

6. Psychotherapist, clinical psychologist, head of the expert council of the International Institute of Psychosomatic Health Sergei Martynov notes that the most common cause of insomnia is the intensity of emotions. He gives an example of a stressful or emotional event that happened during the day.

A person is immersed in it and cannot fall asleep or get enough sleep, as a result of which experiences accumulate and intensify. From a physiological point of view, the expert explains, this state is maintained by the hormones adrenaline and cortisol, which have an “invigorating effect.” And naturally, a person under the influence of these hormones has no time for sleep.

“The thought process intensifies, thoughts begin to run in circles: I want to imagine what he will say, whether he will call or not, or to understand how the exams will go. And the first thing that is important to do is to stop and realize that this state will not help solve anything. Man can control thoughts. He can, through an effort of will, direct thinking in the opposite direction. For example, start repeating to himself: the wedding will go well, you will be lucky in the exam, everything will be fine with the plane. And gradually fall asleep.

There is also magical thinking, when a person decides on his own that he should freak out, not get enough sleep, and then everything will be fine. But this is a self-torturing attitude that has nothing to do with reality. Here, too, it is important to learn how to switch to a resource state with a strong-willed decision,” advises Sergei Martynov.

Ways to restore proper sleep

1 Experts note that falling asleep is regulated by the hormone melatonin, which begins to be produced at nightfall. Hence the first tip: provide complete darkness.

“One of the most basic recommendations is that it is best to fall asleep in complete darkness. If you have problems with sleep, then try to create darkness for yourself,” advises psychotherapist Sergei Martynov.

2. Put away all electronic devices an hour before bed.

“A person will not fall asleep if he spends the whole evening watching TV, on social networks or playing computer games. And if the film caused intense emotions in him, then a sleepless night is definitely guaranteed. Therefore, if you want to sleep in the evening, then it is better not to neglect this state The film and social networks will wait,” he comments.

3. Replace cold light with warm light.

“There are studies that prove that cold blue light has a stimulating effect on the nervous system. At home, it is better to replace cold light with warm light,” explains the expert.

4. Don't overeat at night.

According to the therapist, this is bad practice.

"There are often cases when the cause of insomnia is gluttony. It seems to a person that he sleeps better on a full stomach. But in reality this is not so. Firstly, the body will have to work all night to digest food. Plus, some food can stimulate the production of all the same adrenaline and cortisol. And the person simply won’t have time to sleep,” explains Sergei Martynov.

Clinical psychologist Evgeniy Gibert adds that diet has a significant impact on sleep quality.

Diet also has a significant impact on sleep quality. It is recommended to consume foods that increase melatonin secretion before bed. According to research, such foods include cherry juice, almonds and fruits such as raspberries and bananas. The last time you eat should be 2 hours before bedtime,” he advises.

You can also drink herbal tea before bed.

“Herbal infusions that should be drunk an hour before bedtime will help in the fight against insomnia. Herbs such as lemon balm, chamomile or lavender are well suited for this purpose,” the expert adds.

5. Create a relaxing atmosphere.

It is very important to relax before going to bed. Incorporate evening habits into your daily routine.

“Introduce simple rituals before bed, such as listening to calm music and turning on soft lighting, and practicing relaxation techniques,” says Eugene Gibert.

In addition, in order to ensure healthy sleep, Evgeniy Gibert advises:

6. Go to bed and get up at the same time, avoid long sleep during the day.

7. Designate separate areas for work and sleep.

“The bed should be used only for sleeping, and not for working, watching TV or eating,” notes Evgeniy Gibert.

8. Do not watch movies full of tension or violence before going to bed.

9. Avoid intense exercise immediately before bed.

10. Ventilate the room thoroughly.

11. Avoid difficult conversations with your loved one.

"This can raise your blood pressure and heart rate, making it difficult to fall asleep," the expert explained.

12. Make sure that you have a high-quality mattress, a comfortable pillow and bedding that is pleasant to the touch.

If no advice helps, and insomnia continues to defeat you, it is recommended to consult a doctor.

“If there are any traumatic memories, chronic insomnia, a general depressive state, when no exercise helps, when stress prevails and the situation is not under control, then you need to solve the problem with a specialist and understand the specific situation. Believe me, everything can be solved. And sleep will definitely return,” says psychotherapist, clinical psychologist, head of the expert council of the International Institute of Psychosomatic Health Sergei Martynov.

Thus, it is important to understand the cause of your insomnia and solve it. To make it easier for the doctor to understand your problem, he may need some explanations from you. Somnologist, psychiatrist, psychotherapist, scientific director of the Higher School of Economics Gala Koronovskaya advises preparing for a meeting with a specialist.

Within 1–2 weeks, the patient needs to write down the following answers to the questions in the diary:
1) What time do you go to bed? What time do you wake up?
2) How long does it take to fall asleep?
3) How many times do you wake up at night?
4) What food and drink do you consume before bed?
5) Do you sleep during the day? If yes, how many times do you sleep during the day?
6) Do you feel sleepy during the day?
7) Do you play sports and when?

*Using alcohol, tobacco and drugs is harmful to your health.