# RKS: 💤 SLEEP (II) - Insomnia aka Sleeplessness

    

# RKS: 💤 SLEEP (II)

INSOMNIA aka SLEEPLESSNESS

RKS / 2025-2026 / Ser 7 / Blog 2

1st May 2025

INSOMNIA - A PAIN OR A GAIN?

THE INSOMNIA OUTBURSTS

Dear Reader,

The word "insomnia" is derived from the Latin words "in-" meaning "not" and "somnus" meaning "sleep". There are 237 million (mn) insomniacs in the world today and there is a widespread consumption of medication for sleep disturbances including sleeping aids.

In the context of global prevalence of insomnia, the top 10 countries by rank include:

1. Brazil (31%)
2. China (24%)
3. South Korea (24%)
4. France (22%)
5. Germany (15%)
6. United States of America (USA) (13%)
7. United Kingdom (UK) (11%)
8. Australia (11%)
9. Japan (10%)
10. Netherlands (5%)

One in 4 Indian is suffering from India and 1 in 20 people awake even at 4 a.m. is an Indian! Is the poor sleep voluntary or involuntary is indeed intriguing and makes an interesting study particularly with respect to our country folks.

INSOMNIA CLASSIFICATIONS

DEPENDING ON CAUSE

1. PRIMARY: Insomnia can be troublesome without any particular reason.
   
2. SECONDARY: Alternatively insomnia could be the outcome of  medical or mental disorder, or use / abuse of addictive substances. 

97% of insomnia are primary since there is no any reason for their occurrence.

DEPENDING UPON THE PRESENTING SLEEPLESSNESS FEATURE

• Difficulty initiating sleep.
• Difficult maintaining sleep.
• Waking up too early.
• Non-Restorative Sleep (NRS) or poor quality of sleep (overall).

DEPENDING ON THE CONTROLLABLE / UNCONTROLLABLE FACTORS

Aging and diseases definitely are responsible for insomnia. But the GenXt cause of sleep deprivation are the digital sleep demons.

1. Use of phones before bedtime: 88%
2. Scrolling & binge watching: 54%
3. Gen X up late doomscrolling: 42%

Doomscrolling refers to act of habitually consuming distressing news and social media content and being susceptible to the negative impacts of excessive news imbibing and social media engagement.

INSOMNIA CAUSES

• MELATONIN: In humans, melatonin production start at 3-4 months of age. Levels increase progressively during childhood, peaking between the ages of 8 and 10 years. Melatonin synthesis decreases dramatically during puberty and the aging-related decline affects the sleep's circadian rhythm. 

• CORTISOL: During inflammation states (which is a feature of all illnesses), the pro-inflammatory chemicals [tumor necrosis factor-alpha (TNF-alpha) and interleukin (IL)] released in brain stimulate the pituitary gland to liberate the adrenocorticotrophic hormone (ACTH). In turn, the ACTH stimulates release of cortisol from the suprarenal glands and this is responsible for sleep deprivation since it counters melatonin.

Aging is definitely the cause of insomnia but the disturbed sleep in any illness is because all diseases precipitate inflammation whose outcome counters melatonin and its actions. 

INSOMNIA SUFFERINGS

• Fatigue
• Moodiness
• Irritability or anger
• Daytime sleepiness 
• Anxiety about sleep
• Lack of concentration
• Poor concentration
• Poor memory
• Poor quality performance at school or work
• Lack of motivation or energy
• Headaches or tension
• Upset stomach
• Mistakes at work
• Accidents whilst driving

Being awake for at least 18 hours is the same as someone having a blood alcohol content (BAC) of 0.05%. Being awake for at least 24 hours is equal to having a BAC of 0.10%. In India, the legal limit for BAC while driving is 0.03% or 30 mg of alcohol per 100 mL of blood! So beware when has not slept sufficiently and has to drive - the reflexes will be equivocally slowed.

GRADING INSOMNIA

Pittsburgh Sleep Quality Index (PSQI) ranges severity of insomnia from 0 to 21:

1. 0 - 5: Normal sleeping habits
2. 6 - 8: Mild sleep disorder
3. 9 - 11: Moderate sleep disorder
4. >12: Severe sleep disorder

Insomnia Severity Index (ISI) is a scale that also measures the intensity of insomnia:

1. 0 - 7 score: Indicates no clinical insomnia
2. 8 - 14 score: Indicates subthreshold insomnia
3. 15 - 21 score: Indicates clinical insomnia of moderate intensity
4. 22 - 28 score: Indicates clinical insomnia of severe intensity

SLEEP DISORDERS

INSOMNIA VARIANTS

SLEEP DEPRIVATION: Here the individual does not have the opportunity to get a full night’s sleep (sleeping time up to 60% less than the usual state for 1 month).

SHORT SLEEPERS: A small percentage of people who have trouble sleeping are actually short sleepers who can function normally on only five hours of sleep or less.

ABNORMAL SLEEP DEVIATIONS

SLEEP APNEA: When there is excessive daytime drowsiness as proper, efficient sleep has not been obtained during the night. The commonest variety is obstructive sleep apnea (OSA) which has an occurrence rate of approximately 30% in elderly individuals. The reason for apnea or temporary cessation of breathing is on account of the collapse of the airway passages. Whilst 1 in 5 have mild OSA, 1 in 15 are inflicted with severe disease.

REM SLEEP DISORDER: When the temporary muscle paralysis occur during REM sleep, the latter is disturbed. There is then possibility to physically act out (often unpleasant) dreams with vocalizations and sudden limb movements. Such a presentation is referred to as REM sleep disorder.

NARCOLEPSY: Herein there is persistent daytime drowsiness accompanied by brief episodes of muscle weakness. Individuals with narcolepsy straight plunge into the REM phase of sleep, bypassing the NREM stages, and have dreams even during short naps.

SOMNABULISM: Sleepwalking occurs during NREM (N3) sleep phase and is typically associated with normal behaviors such as dressing, eating and urinating.

PARASOMNIAS: In this, since there are abnormal movements, talk or emotions at night, the partner feels his / her companion is wake!

SLEEPING BEAUTY SYNDROME: Also referred to as 'Kleine-Levin syndrome (KLS)' this rare sleep deviation disorder is characterized by recurrent episodes of hypersomnia of varying degrees and presence of hyperphagia (excessive eating), cognitive disturbances and hypersexuality.

CONCLUSIONS

Some of the most successful people in the world not only work extremely hard in the hours they have, they create more of them by forgoing sleep. Some people are genetically wired to wake up earlier or sleep less. Others seem to thrive on less sleep only through sheer determination. 

• 33% of adult population have significant insomnia.
• Near 50% of the elderly are insomniacs.
• Around 70% of those questioned have responded they slept for less than 6 hours daily.
• 58% of Indians go to bed after 11 p.m.

Table: Personalities and their sleep pattern vs personality type.

Employees who experience work overload are more likely to develop sleep problems. A recent study unveiled that this may be due to a lack of support from co-workers and higher-ups. Another research, however, noted a direct link between poor sleep and job dissatisfaction. Poor sleep leads to decreased performance and higher need to take sick leave. Such individuals take longer time to finish work that could have been more efficiently managed with optimal sleep patterns. Make sure each one adopts a hard stop time to leave work for the day.

30-50% of adults suffer from short-term insomnia at some point in their lives. When the suffering persists for more than 3 days per week for more than 3 months than the sleep disturbance is termed chronic insomnia. To counter insomnia there is widespread usage of sleeping aids globally.

The third and concluding part of the '💤 Sleep' blog will dwell on how optimal sleep can be facilitated and measures to tackle insomnia. 

DR R K SANGHAVI

Prophesied Enabler

Experience & Expertise: Clinician & Healthcare Industry Adviser

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