Insomnia and physical health

Melissa Reeinsomnia, Blog

insomnia and physical health

The Connection Between Insomnia and Your Health: Is worry about sleep an important link?

As clinical psychologists working with Insomnia at Sleep Matters, we often encounter clients who are deeply concerned about how their insomnia might affect their long-term physical health. While there is a growing body of research exploring this connection, findings remain mixed and often stem from studies with methodological limitations. 

Here, we look at the research investigating the relationship between insomnia and physical health outcomes, the possible mechanisms at play, and the importance of addressing sleep-related worries.

What is Insomnia?

Insomnia Disorder is not just the odd night of poor sleep, it’s a chronic difficulty falling asleep, staying asleep, or waking too early without the ability to return to sleep. Insomnia can lead to significant daytime impairment, including fatigue, irritability, mood disturbances, reduced productivity, and cognitive deficits. 

How might Insomnia be linked to Physical Health?

  1. Sleep Duration 

    Long-term short sleep duration (average sleep below 5.5hr) is linked to poor physical health outcomes. Much research treats short sleep duration and insomnia as the same thing. This isn’t correct because, as surprising as it sounds, short sleep duration doesn’t apply to the majority of insomnia cases. It is typical, however, that people with insomnia perceive that they get less sleep than they actually do, compared to sleep recorded by overnight sleep studies. People with insomnia commonly feel that they have slept 1-2 or more hours less per night than an objective recording of sleep measures. This underestimation of sleep may be due to higher levels of EEG-measued brain activity during sleep in those with insomnia. Check out the interesting research by Francesca Siclari if you’d like to delve deeper into the technical research on the perception of sleep.
  2. Sleep Variability

    While very short sleep duration may not be the norm in insomnia cases, high variability in sleep patterns is common.  New research suggests that this can be detrimental with studies indicating that inconsistent sleep schedules may lead to negative health outcomes. Sleep-wake variability may be a relevant risk factor in insomnia for poor health outcomes. Thankfully, improved regularity of sleep-wake schedules can often be achieved. Indeed this is something we focus on in Insomnia treatment using Cognitive Behaviour Therapy-Insomnia (CBT-I).
  3. Worry About Sleep

    The relationship between sleep disruption and health is complex and likely bidirectional. Poor sleep can lead to increased stress responses and emotional distress, which in turn can further disrupt sleep patterns. This interplay suggests that anxiety about sleep may contribute to both poor sleep and negative health outcomes, creating a feedback loop.

    A significant aspect of insomnia involves hyperarousal and anxiety about sleep. This worry can elevate sympathetic nervous system activity and increase allostatic load—essentially the wear and tear on the body due to chronic stress—which has been linked to various health issues. Again, this is often effectively addressed by insomnia treatment with CBT-I. Research suggests that people who identify as having insomnia are at risk of worse health outcomes, regardless of how they actually sleep.

Limitations in the insomnia-physical health arena

  • Many studies linking insomnia with poor health outcomes fail to account for confounding variables such as lifestyle factors (diet, exercise) and other sleep disorders. 
  • Studies continue to show some conflicting findings.  For example, one recent study linked shorter sleep duration with a small increase in dementia risk in older adults, whilst another found that sleeping less than 4.5hr a night or more than 6.5hr a night was associated with increased risk. Clearly, there is a lot for science to unpack here.
  • Furthermore, in large studies that investigate sleep-health links, self-reported sleep (rather than objectively measured sleep) is sometimes used. This is a problem because self-reported sleep and objectively measured sleep are not the same thing and do not correlate well. So, such studies tell us about the link between the perception of sleep and poor physical health rather than actual sleep and health outcomes. 

This might suggest that believing you slept poorly can lead to poor physical health outcomes…….

The Role of Cognitive Behavioral Therapy for Insomnia (CBT-I)

At Sleep Matters, we emphasise the importance of CBT-I as a first-line treatment for insomnia. This therapeutic approach helps our clients to develop healthier sleep habits while addressing unhelpful thoughts about sleep. By reducing worry about sleep quality, we can potentially mitigate the possible long-term health risks associated with insomnia.

Take Away messages

While concerns about the long-term physical health impacts of insomnia are understandable, it is crucial to differentiate between insomnia as a disorder versus short sleep duration. The evidence suggests that while insomnia can contribute to various health issues through mechanisms like stress-induced hyperarousal, change in health behaviours such as engaging in exercise, it does not appear to uniformly increase mortality risk. Understanding the complexities of this relationship can empower those affected by insomnia to seek help and adopt strategies that promote better sleep and overall well-being.

Individuals experiencing insomnia should be reassured that effective treatments are available and that managing their condition can lead to improved quality of life without undue worry about long-term health consequences. 

Effective treatments like CBT-I can help alleviate symptoms and reduce anxiety surrounding sleep, ultimately supporting better overall health.

As we continue to explore this complex relationship between insomnia and physical health, it is essential for clients to seek guidance from health professionals who can provide evidence-based strategies for improving sleep quality without succumbing to unnecessary worry.

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