Tossing and turning in her bed for the third time that week, Sylvie sat up and glanced at her alarm clock in frustration.
3:37 AM, it read – which meant she had been awake for more than two hours. Again.
Although she’d gone to bed at a decent hour and fallen asleep right away, here she was wide awake, knowing that in a few short hours she’d have to get up, make her way to work, and somehow find the energy to get through that big presentation to the new client that her boss was counting on her to bring in.
Sylvie flopped down on the bed. She was so tired – so why couldn’t she fall asleep?
Sylvie’s experience is not uncommon.
Here in Canada, insomnia is on the rise. A new study conducted by Dr. Charles M. Morin at Université Laval revealed that 40% of Canadians had experienced one or more symptoms of insomnia at least three times a week in the preceding month and only 13% said they had consulted their doctor about it.
“Many people who suffer from insomnia try to treat the problem themselves rather than consulting a healthcare professional,” said Dr. Morin. His survey revealed that Canadians use prescription medicine (10%), natural products (9%), over-the-counter drugs (7%), or alcohol (5%) to treat their sleep problems. “This is not a good idea because we don’t know the risks and benefits of products that have not been approved by government health agencies,” he explained.
What is Insomnia?
Insomnia is a sleep disorder whereby you can’t fall asleep, even though you want to, or you can’t stay asleep long enough. It is generally defined as taking more than 15 minutes to fall asleep, being awake and unable to fall back asleep from periods of 30 minutes or more during the night, and/or sleeping less than five hours per night. Acute insomnia can afflict you for just a few days, or it can become a chronic condition, depriving you of rest for months or even years.
It can also make a person exhausted, moody, irritable, accident-prone, anxious, and less able to think straight or remember things. Over the long term, insomnia is also linked to conditions like obesity, high blood pressure, diabetes, and heart disease.
Insomnia Rates in Canada
Prevalence of Insomnia
Insomnia affects all segments of the population, including children and the elderly. According to a recent survey1, half of Canadian adults have trouble going to sleep or staying asleep. One in five adults do not find their sleep refreshing, and one in 3 have difficulty staying awake during waking hours. Younger adults are more likely to report problems falling asleep, whereas middle-aged and older adults find it harder to stay asleep throughout the night.
Insomnia is more prevalent among women, middle-aged and older adults, and individuals who say they are in poor physical or mental health. It’s also more common among lower-income Canadians. And insomnia is on the rise – the report notes an increase of 42% in insufficient sleep among Canadians from 2007 to 2015.
Insomnia Costs Us All
A recent study2 estimated the total annual cost of insomnia in the province of Quebec alone to be $6.6 billion. This total includes direct costs associated with healthcare consultations and products used to promote sleep (including medications and self-administered aids such as alcohol), as well as indirect costs arising from lost resources (absenteeism and reduced productivity) associated with insomnia.
The study also found that insomnia costs those who suffer from it in particular, both directly and indirectly. The average cost to someone suffering from insomnia is $5,010 annually, which includes indirect costs such as reduced productivity and lost revenue as well as direct costs like medications.
What causes insomnia?
Stress and Worry
Stress and worry are two of the most common disruptors to the sleep cycle – more than half of insomnia cases are caused by a troubled mind. If you are dreading an upcoming event, it can be difficult to put it out of your mind at bedtime. Our dependence on devices such as smartphones may lead us to check work emails right before bed, causing job-related stress that contributes to worry as you try to fall asleep.
Ongoing stress, such as worry about work, school, money or a relationship, can intrude on your sleep on a regular basis. And major life events, such as a job loss, divorce, or the death of a loved one often cause insomnia. People with depression, anxiety, dementia, or mental disorders are far more likely to have sleep problems, including insomnia.
In Sylvie’s case, a recent round of layoffs at work and a new, abrasive boss had her worrying about her job security and financial stability. She was working later hours to demonstrate her worth – and skipping regular exercise, which could have helped her manage the stress better.
Substances and Medications
Sylvie had started having an extra cup or two of coffee in the morning, to shake off the brain fog she got out of bed with most days. To relax after a hard day at the office, she regularly had a few glasses of wine in the evenings as well. Both caffeine and alcohol, however, can affect the ability to fall asleep, stay asleep, and enjoy a restful night.
Caffeine is well-known as a stimulant, but its effects can last for several hours, so the chances of it affecting sleep are significant. Caffeine not only makes it hard to fall asleep, but can also cause you to wake up during the night. Alcohol may have a sedative effect for a few hours, but as it is metabolized by the body it can rouse you from sleep and affect sleep quality as well.
Many medications, such as decongestants or asthma inhalers, are also stimulants and can disrupt sleep. Other drugs that might cause insomnia include allergy medications and those for heart disease, hypertension, thyroid problems, and depression.
On nights when she worked late, Sylvie ordered pizza and ate it in front of the TV before falling into bed. Eating a late dinner or snacking before bed can activate the digestive system and keep you up, and fatty foods can contribute to acid reflux problems or heartburn, especially when you’re lying down in bed. Even drinking water or herbal tea just before bed can require you to wake up and visit the bathroom during the night, disturbing your sleep.
An irregular sleep schedule also contributes to insomnia, as your body becomes accustomed to sleeping and waking at regular intervals. Sylvie would tell herself that she would “catch up” by sleeping in on weekends, and while she did get some much-needed rest, inconsistent sleep patterns made it hard to fall asleep once she was back on her weekday schedule.
To make matters worse, Sylvie was suffering from the shifting balance of hormones caused by menopause. Occasionally, hot flashes — surges of adrenaline that raise body temperature – would make her so uncomfortable that she would wake up drenched in sweat, sometimes several times a night.
Menopause is another contributor to insomnia, which may help explain why insomnia affects middle-aged women more than any other age group.
Sylvie had noticed that she woke up more when she was on her back – a position in which she had been told she sometimes snored in her sleep. Snoring is associated with sleep apnea, a condition where the normal breathing cycle is interrupted, waking you up several times every night.
You may not realize it’s happening, but you feel tired the next day. Fortunately, sleep apnea can be diagnosed with a simple test. Sufferers of sleep apnea report great improvement in sleep after treatment.
What Can I Do to Beat Insomnia?
At Apnea Health, we can help
After yet another sleepless night, Sylvie came to see us for a sleep test. It turned out that she stopped breathing 18 times per hour. One of our respirologists (sleep doctors) met with her to explain that she suffered from moderate sleep apnea and the treatment options available to her.
Sylvie did a trial of CPAP for 3 months where our team was able to eliminate her sleep apnea so that she no longer stopped breathing 18 times per hour. However, after 3 months she was still waking up at night or too early in the morning unrefreshed. After consultations with our therapists and our sleep doctor, we determined that Sylvie also suffered from insomnia. She joined a 4-week cognitive behaviour workshop for insomnia.
Today, Sylvie wakes up refreshed and with more energy. And on weekend mornings, when she used to sleep late, she now spends time exercising or outdoors with her family.
If you are one of the 40% of Canadians suffering from insomnia, contact one of our sleep specialists today to set up a sleep test.
- Chaput JP, Yau ,J, Rau DP and Morin CM, Prevalence of insomnia for Canadians aged 6 to 79, Statistics Canada, December 19, 2018.
- Daley M, Morin CM, LeBlanc M, Grégoire JP, Savard J. The economic burden of insomnia: Direct and indirect costs for individuals with insomnia syndrome, insomnia symptoms, and good sleepers. Sleep. 2009;32(1):55-64.