Chronically sleepless: Why is it so hard to get good shut-eye?

Sleep deprivation has been linked to Alzheimer's disease, diabetes, stroke and even car accidents.

Robin Roberts 7 minute read March 18, 2022
The illustration shows the girl who admires star sky

Insomnia is among the most-researched health conditions and still it’s not fully understood. GETTY

Here’s an eye-opener: Nearly half of Canadians have trouble falling or staying asleep. Beyond making you snippy in the morning, insufficient shut-eye can cause a slew of health problems, some leading to an early grave, if the problem persists. 

Chronic insomnia is defined as sleeping for six hours or less a night, at least three times a week, for more than three consecutive months. It often begins with an event that causes a lot of stress and anxiety, such as a death, divorce, new job, or health crisis (like a pandemic) that upsets your sleep schedule, but continues long after the stressor is gone.

It’s among the most-researched health conditions and still it’s not fully understood. There have been exhaustive studies, theories, therapies and treatments with varying results. Even without the added anxiety of the pandemic, ruefully called “coronasomnia,” which further messed with our slumber, blissful, restful, restorative sleep has been elusive for so many for so long, particularly women, who suffer insomnia twice as much as men.

“Why do some people have deeper sleep than others? That is still a question [to be answered],” says neurologist Dr. Thanh Dang-Vu. And he runs a sleep lab. Dang-Vu founded the Montreal-based Sleep, Cognition and Neuroimaging Laboratory (SCNLab) in 2013 to study the brain mechanisms of sleep disorders and the role of sleep in cognitive health. He’s also a professor in the Department of Health, Kinesiology and Applied Physiology at Concordia University, as well as vice-president (research) of the Canadian Sleep Society, which supports research on the many types of sleep disorders, such as insomnia, sleep apnea, narcolepsy and idiopathic hypersomnia (extreme daytime sleepiness even after a good night’s snooze).

“Our brain’s ability to produce different sleep stages varies from one person to the other and even varies within the same person,” he says on a call from Rome, Italy, where, coincidentally, he’s attending the 2022 World Sleep conference. “We know that as we age, for example, our sleep will become more fragmented and shallow.” 

Sleep deprivation is the same as being intoxicated

Dang-Vu and his team conducted a study of older people with insomnia and found poorer memory performance and more cognitive decline than those in the same cohort who were not insomniacs. “[We’re attempting] to better understand how sleep helps strengthen our memories, and how bad sleep affects brain structure and function,” he says.

Dr. Najib Ayas, associate professor, UBC Faculty of Medicine, and member of the UBC Hospital Sleep Clinic, sees the same in his Vancouver lab. “Sleep helps the body heal itself, as well as regenerates muscles, [but] even after one night of sleep deprivation, you can see cognitive effects,” he says. “[It’s] equivalent to being intoxicated.” 

He says studies with mice have shown that when they sleep, toxins are cleared from the brain. “And it’s thought some of these toxins include [the protein] beta-amyloid and may be why poor sleep or sleep disorders may also contribute to an increased risk of dementia and Alzheimer diseases.” 

Ayas also says getting fewer than 40 winks has also shown a correlation to an increase in car accidents.

“You have to be very alert while driving but it’s a very monotonous activity; it’s difficult to keep engaged. Even during daylight-saving time, that one-hour change, results in a significant increase in crash risk,” he says, adding that occupational injuries, too, increase with poor sleep, and shift workers can be the most adversely affected. 

Older people also tend to have more insomnia — “you lose some of the neurons that are involved in sleep onset as you age” — but they also tend to have more medical problems, such as restless leg syndrome or chronic pain disorders, and may be on more medications, which can affect sleep.

Too much sleep just as bad as too little

Dang-Vu cautions against napping, as it can disrupt nighttime sleep. “For people who don’t have sleep problems, naps can be a powerful tool to restore your brain function and memory,” he says. “[But] make sure it’s not too long, 20 to 30 minutes maximum, and ideally not after 3 p.m.” 

But then, too many Z’s can be just as problematic as too few. “In epidemiology studies, those who sleep nine or more hours per night tend to [also] be at increased risk of heart disease, obesity, depression or other psychiatric conditions,” says Ayas, adding what they don’t know is whether it’s because of the increased sleep time, or if other issues, such as certain diseases disrupt your snooze time, making you sleep more to make up for it. 

Insomnia and having problems with sleep concept

Chronic insomnia is defined as sleeping for six hours or less a night, at least three times a week, for more than three consecutive months. GETTY

Apnea and narcolepsy 

Those with sleep apnea, a potentially serious condition, are usually loud snorers who stop breathing periodically during the night and often gasp for air. As a result, they’re not only drowsy during the day, they’re also at increased risk for car accidents, occupational injuries, heart disease, stroke, diabetes, and Alzheimer’s disease. 

“We usually gauge the severity of sleep apnea by the number of times their airway narrows or closes per hour of sleep,” says Ayas of the subjects in his lab. “Everybody has a bit of instability of breathing at night so anything less than five times an hour we consider pretty normal; anything over 30 times an hour we consider severe.”

As for how common it is, he says that about 10 per cent of the population has sleep apnea, but about 50 per cent of the population snores — essentially, “the vast majority of people with sleep apnea will snore, but a lot of people who snore won’t necessarily have sleep apnea.”

Dang-Vu is also studying narcolepsy, a relatively rare genetic disease where people are overwhelmingly sleepy during the day and may fall asleep suddenly. He says he’s currently comparing research data from people with hypersomnia to those with narcolepsy to fully understand the specifics of their conditions.

Sleep aids 

As for tools to help us sleep, according to Dang-Vu, there have been many new discoveries about how and why we sleep (or don’t), but there is still a lot more to be learned.

“We have more understanding of why sleep is important for the brain, the different chemicals that are involved, [but we’re] still progressing on our assessment of sleep in a real environment,” he says. 

Meantime, both Dang-Vu and Ayas say the best treatment for insomnia is cognitive behavioural therapy (CBT). CBT-I addresses the underlying causes of insomnia and helps reset your relationship with your bed by first, restricting the amount of time you spend there, and then gradually increasing it. “It works for up to two-thirds of people, [with] improvements that they’re able to maintain over time,” says Dang-Vu. 

The problem is that not everyone can access the therapy easily, he explains. First, you have to find a psychologist who is trained in CBT-I, and there are not many of them, then you have to incur the time and cost — four to eight sessions for anywhere from $175 to $250 an hour. And, he says, not all provinces offer coverage or reimbursement for these treatments. “It’s unfortunate because it’s a very important issue that affects mortality and the risk of diseases,” he says. 

For those who can’t afford a psychologist, Dang-Vu says he’s developing online formats of CBT-I. There are also many apps that can help, such as Somryst, which was developed using CBT-I; Muse, which offers guided meditation; or Headspace, which has a free version of its mindfulness program. 

How to get better at sleep

But there are some basic rules that can give you the best shot at getting a satisfying sleep. First, keep a cool room, about 18°C; leave your phone and tablets across — or out of — the room to avoid exposure to the harmful effects of blue light; go to bed and wake up at the same time every day; keep your room as quiet and dark as possible (use a sleep mask or ear plugs, if necessary); exercise during the day but not close to bedtime; don’t consume alcohol or caffeine before bed; and if you haven’t fallen asleep after 25 minutes, get up and do something quiet and calming; and use your bed for sleep and nothing else (except for, maybe, you know).

Sweet dreams, and to all a good night. 

Robin Roberts is a Vancouver-based writer.

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