2. Nine Clear-Cut Signs of Insomnia
What would make someone fear the night? Is it that character from the latest horror film
they have watched? Maybe it’s the darkness because our minds can play tricks on us
when our eyes aren't used to the gloom of the night. Perhaps it’s the notion that there’s
someone out there, either an unknown or known entity ready to pounce on you during
your weakness. For the insomniac, it’s none of these things, because their fear of the
night comes from the sleeplessness itself.
When your body is tired but your mind is awake
That’s the true nature of insomnia. When you want to give in to the night, but your mind
fails you. It’s a difficult and poorly understood disorder, diagnosis is uncommon. It can
occur by itself or in the presence of other symptoms, as in a medical condition. It can be
acute or chronic. But the symptoms remain the same, an unexplained fatigue during
daytime, racing mind during night time and a blur of everything in between. The problem
with insomnia is, especially when it occurs on its own without any determinable other
medical condition, it’s hard to treat.
Explaining the difference between symptoms and signs
In our previous blog post, we have discussed about the symptoms of extreme insomnia.
You can click on the link for further information about it. So in this blog post, we’re focus-
ing on the signs of insomnia instead. You might be wondering what are the differences
between the two.
Symptoms are subjective to the patient, they are experienced and felt by the insomnia
sufferer himself. For example, tiredness or fatigue is a feeling that only the person expe-
riencing it can explain. Similarly, mood changes are something that can be determined
by the person experiencing them. It’s true that as a spectator you can also notice these
3. symptoms in an insomniac. But only the insomniac can explain the true nature of the
feeling of tiredness or mood changes that they have.
Clinically, signs are objective manifestations of the condition or disease. They can be
felt or not felt by the insomniac. What separates them from symptoms is that they can
be easily seen or tested for by another person. For example, whenever you go to the
clinic to have your yearly check-up, what does the nurse or physician do to see your vi-
tal signs? That’s right, monitor your blood pressure, listen to your heartbeat or palpate
certain parts of your body. So if it can be seen by another person, not necessarily a
physician or medical personnel, we can categorize it as a sign instead of a symptom.
Onto the signs of insomnia…
In this blog post, you would learn more about the signs that tell that you have insomnia.
You may or may not have all of these symptoms. It varies from person to person, but the
higher your score is, the higher the likelihood of you having the sleeping disorder. By no
means does this list equal that of the diagnosis of a trained medical professional. But if
you have that inkling in your mind that you’re perhaps suffering from insomnia, you can
use this list as a reference.
1.You have difficulty falling asleep
The generally accepted average time for someone to fall asleep is seven minutes. If you
want to be more specific about it, the CDC, under the National Health and Nutrition Ex-
amination Survey, conducted a survey about the average time an American falls asleep
each night. The result was that most of the respondents answered below 59 minutes,
with the range of 5 to 34 minutes as the median. You can find out more about this inter-
esting survey in this link.
4. For an insomniac, the average time to fall asleep differs greatly. In the book, The Sleep
Instinct, written by Meddis, the author highlighted how complicated it is to know the av-
erage sleep latency of insomniacs. This is because most of the time, insomniacs over-
estimate their sleep latency and at the same time over-estimate their sleep duration. For
insomniacs, anything beyond an hour can be considered as late-sleep latency or late-
sleep onset. For the extreme cases, there could be episodes of insomnia where sleep
latency occur for four hours or more, sometimes not at all.
2. You have difficulty maintaining sleep
Insomnia doesn't just exist at the onset of sleep, it can also exist in the midst of a sup-
posed healthy sleep. What can be the causes of waking up whilst sleeping? There are
plenty like the need for urination, uncomfortable temperature or even a crying baby. But
for the insomniacs, they have difficulties maintaining sleep with or without these rea-
sons. The problem with frequent waking up during the night? Your brain won't be able to
complete the sleep cycle and thus, recovery won't be as smooth as compared to a full
night’s sleep.
The scenario highlighted in this case study of Ms. F perfectly captivates this sign of in-
somnia. Her insomnia is chronic, causing her to wake up several times a night, staying
awake for 30 minutes before being able to sleep again. As the researchers have pointed
out, sleep-maintenance insomnia can occur simultaneously with sleep-latency insomnia.
Usually though, the latter occurs earlier in the diagnosis and the former occurs much
later in the course of the disease.
3. You are waking up too early
When we stay up too late to watch a movie on a weekday, we sometimes regret it the
next day when we have to wake early for our job. Now insomniacs have the same
dilemma, only they don’t do it on purpose, they can’t sleep early in the night and then
they wake up early in the morning. It can also be that the insomniac is able to sleep
5. easily during the night but wakes up at odd hours during the morning. The early-morn-
ing waking can be gruesome, especially since you know you still have time to sleep yet
you cannot go back to sleep.
This type of insomnia, or perhaps this sign, is more common amongst older adults. Like
in this study, the insomniac reported to going to bed each night at around 9:30. But then
he wakes up at around 3:00 or 4:00 in the morning of the next day. He remains in bed
for an hour and a half possibly trying to get some more sleep. The frustration is there
because he knows he hasn't had enough sleep yet. If this is typical to your situation,
then continued reading as there are more signs that can help you diagnose your insom-
nia.
4. You have a short-sleep duration
So how do we define a short-sleep duration? There have been many claims and studies
about the optimum amount of sleep a person should be getting each night. If we want to
be more clinical about it, here’s a link to the recommended sleeping duration by the
CDC. For adults aged 18 years and above, the average sleeping duration recommenda-
tion is 7 to 9 hours every night.
Now ask a colleague of yours how much sleep he had last night. What did he answer?
Ask another colleague and compare their answers with yours. The truth is, sleep dura-
tion varies from person to person. Even more varied is the functioning of each person
despite their sleep duration. So if your sleep duration is within 6 to 8 hours each night
and you feel refreshed after waking up, then chances are, you are getting enough sleep.
But if your sleep duration is around 3 to 5 hours each night and you feel grumpy or tired
after waking up, you could possibly have insomnia.
5. You have problems with your thyroid gland
6. If you have thyroid hormone imbalance, insomnia can occur. It is therefore an important
aspect of the diagnosis of insomnia and most medical personnel require a test of the
thyroid to rule out its relation to the disorder. Your thyroid hormones need to be bal-
anced because both hyperthyroidism and hypothyroidism can cause insomnia. This
might come as a surprise to many since usually it is just the former that is associated
with insomnia.
Hyperthyroidism can cause insomnia because it elevates the production of thyroid hor-
mones. When it does so, it can cause increases in temperature, heart rate and even
breathing. The overall hyper arousal of the nervous system can induce a sleep-latency
insomnia. On the other hand, hypothyroidism can cause disturbances in sleep quality or
even sleep maintenance. In this study, the researchers found that those with hypothy-
roidism experienced a decreased stage three and stage four in the sleep cycle. Patients
with hypothyroidism can sleep more yet feel tired and groggy upon waking.
6. You can’t concentrate during day time
If someone tells you that you seem distracted and far away most of the time, then it’s
highly likely that you have insomnia. The impact of sleep deprivation on attention and
memory has long been studied. You see, our brain, though very complex, is a working
and functional model of our capacities. It needs enough sleep every night in order for it
to recuperate and recover. But without optimal sleep, the brain can dysfunction and the
usual easy tasks you do might seem harder to complete.
Just how bad can insomnia affect our concentrating abilities? In this experimental study,
the researchers tested the cognitive performance of participants. They were subjected
to normal sleep, 24 hours of sleep deprivation and 35 hours of sleep deprivation. The
result was that the areas of the brain called the superior parietal regions and thalamus
was activated less during the sleep-deprivation parts of the task. So what does this
mean? Simply that the brain can be affected by short-term sleep deprivation, more so
by long-term sleep deprivation caused by insomnia.
7. 7. You often get frustrated with simple problems
Insomniacs often feel frustrated even with simple issues, like a traffic jam or a crying
child. The frustration is frustrating in itself because you know in reality that the specific
causal event shouldn't be affecting you. If you have petty arguments with your husband
all the time, you might want to look back and check whether you have the other signs as
well. If you often get irritated with problems instead of solving them, you might be suffer-
ing from insomnia.
In the previous blog post, we have discussed the part of the brain stimulated during irri-
table situations, which is the anterior cingulate cortex. This study focused on the com-
parison of this part of the brains of children with bipolar disorder and those without the
disease. Turns out, along with the prefrontal cortex, this part of the brain organizes be-
havior during irritable situations. Yet those patients with bipolar disorder exhibited differ-
ent brain patterns during irritable situations as compared to the non-bipolar children.
Perhaps future studies can tap into the brain patterns of irritated insomniacs versus irri-
tated non-insomniacs.
8. You have an elevated night-time blood pressure
As our body gets into deep sleep, it’s normal for our blood pressure to decrease. Clini-
cally, this is termed as nocturnal dipping and is a part of the natural circadian rhythm of
the body. The night-time blood pressure is usually around 10% to 15% lower as com-
pared to the day-time blood pressure. Medical personnel would usually measure your
day-time temperature and then night-time temperature to make the diagnosis.
The problem with elevated night-time blood pressure is that it doesn't just signify insom-
nia, it can also be a sign of a risk for hypertension. If you look in this study, the re-
searchers were able to confirm that patients insomnia with elevated night-time tempera-
tures are at higher risks of developing hypertension. In another study, researchers found
8. that night-time blood pressure was a better predictor of cardiovascular morbidity and
mortality as compared to day-time blood pressure.
9. You have other sleeping disorders or medical conditions
Ah, the chicken and egg dilemma… Which came first, your insomnia or your sleeping
disorder? Which came first, your insomnia or your depression? Well, it doesn't really
make sense to find out which came first. A better question would be, do you have other
underlying conditions? Because if you do, then insomnia might just be one of the symp-
toms of this health condition.
For instance, sleep apnea is a common sleeping disorder wherein the affected person
experiences pauses in breathing whilst asleep. Sleep apnea can cause one to wake
during different times of the night due to the obstruction in breathing. And so, your
sleep-maintenance insomnia could be just a symptom of this underlying condition. Other
conditions like anxiety or depression can also induce insomnia in a person.
Do you fear the night?
Do you often feel like sleep won’t come at all? Do you fit in most of the signs mentioned
above? If you answered yes to these questions, it might be time to go to a sleep center
or a psychiatrist to help you get the sleep you truly need. Perhaps with some therapies,
you can change your sleep patterns and hopefully, treat your insomnia. There are also
some medications that only certified psychiatrists can prescribe to insomniacs.
