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#26: Insomnia - Part 1

#26: Insomnia - Part 1

The Matt Walker PodcastGo to Podcast Page

Matthew Walker
11 Clips
Jul 18, 2022
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Episode Transcript
Hi there, it's Matty and welcome
back once again to the show. Now in the next several episodes were going to be talking all about the most common sleep disorder, which is
insomnia. Now, many of you have asked me to speak about the science behind different Sleep disorders and we will, we'll continue to do that in this podcast and that will include things such as the
The Sleep Disorder, sleep apnea, as well as something called restless leg syndrome. But for the next several episodes, it's going to be all about insomnia. So, what is the objective of this miniseries? Well first, let me tell you what it is not. I'm not a medical doctor. I'm not a clinician. So these episodes are not designed to be a guide to diagnosing. Your
Insomnia, no designed to even offer any medical or clinical advice at all. Now, don't worry, we will still discuss how insomnia is diagnosed, and we'll still discuss how different clinicians make treat insomnia using different methods. But I just want to give you that information because I think it's important to State up front. I also feel as though, it would not be responsible in my Public Communication duties.
How to avoid those things for you as well. I think what I'm trying to say is that when we discuss these things here, they will be describing a set of General descriptions of how people think about insomnia treatment and that's very different to me. Providing you prescriptive information or advice and that wouldn't be appropriate. So with all of that said, what is the overall objective?
Of this miniseries on
insomnia. Well, I'm really excited to actually cover six specific topics, one topic per episode, and here's what we'll discuss first. We're going to go over what insomnia is and also what insomnia is not, and it will speak about how we think about the different features in the difference of the flavors of insomnia that there are. And then we'll speak about some of the more peculiar
Specks of insomnia. Then second we're going to discuss exactly how it is that someone receives a diagnosis of insomnia. In other words, what the process through which you will go through to receive that clinical diagnosis of insomnia and there will talk about what we do. And also, what we don't do to make that diagnosis. Third, we're going to discuss why you in particular may be
Used to insomnia will speak about what the triggers are of insomnia. And will also speak about once you've developed insomnia, what are the things that are only going to be hurting you? In other words, what are the things that are only going to make it worse and keep you locked in that prison of insomnia. Fourth will then discuss what the underlying empowerment's are that we've discovered within your body that have been linked to in.
Insomnia to give us a sense of mechanism, to give us a sense of what insomnia is caused by. And then once we've spoken about the body, in the fifth episode, we'll go upstairs and we'll talk about the underlying brain or the neurological changes that are linked to insomnia. And then, finally, in the sixth episode will speak, all about the different ways that science and clinical medicine has previously tried. And now,
Currently uses in terms of approaches to treating insomnia but let's get back to today's episode. And the first topic, what is insomnia? What are the different types of insomnia? And when is insomnia not insomnia.
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And one of the things I really like about Fiore is that they fit this commitment as the offset, their carbon footprint completely. And I mean, 100%, including the use of sustainable materials and avoiding harmful Plastics, if you like the sound of them, for any, one of these reasons head on over to V or e.com that is, vuo are i.com forward slash. Matt Walker. So the or e.com forward slash Matt Walker.
And if you go there and use that link, you will get 20% off your first purchase full. Fifth off your first purchase. Okay, let's get back to the podcast. I'll start with a calming reality.
Everyone can have a bad night of sleep. Everyone can even have several bad nights of sleep. Indeed. Even I am not immune to
Ravages of
having bad sleep now, and then this is not insomnia, this is nothing to be concerned about, It's Perfectly Normal and coming back to those sort of times when you have a bad night or a bad couple of nights, the can be lots of different reasons for having those occasional bad nights of sleep, they usually fall into three buckets. The first is psychological issues where you just have some mental stress going on. Maybe stress in a relationship or your workplace.
Place. The second is what we call pathophysiological triggers which is just a fancy medical term, meaning a biological basis for bad sleep. Such as you know, you had a migraine that night and hence you didn't sleep very well and then the final thing our environmental factors. So on we've spoken about these before having too much alcohol, or your bedroom being too hard drinking, too much caffeine, or excessive noise around you. Those are all things. Those three categories that can
Each you two having a bad night of sleep or bad few nights of sleep, that isn't insomnia. So, that's the first, I think really important. Take-home message is that insomnia isn't a single bed night of sleep, or a string of bad nights of sleep, as will see it's very, very different. The next important thing for us to appreciate is that insomnia is far more common than you, probably realize, how common is it in terms?
Of a medical disorder. Well, we estimate that at least one out of every three people. Listening to, this podcast will experience some form of clinical insomnia during their lifetime and depending on the studies that you look at and the different criteria that are used to define clinical insomnia, at any one moment in time about ten percent of the population will be suffering from the Affliction of in
The that is staggering one out of every 10 people. You walk past on the street or you drive past in. Your car has clinical grade insomnia. And what's particularly staggering about that fact is how stringent the diagnostic criteria are which will get to for you to actually receive the label of having chronic insomnia disorder just to give you a little context here in the US.
Us. The epidemiological studies have suggested that insomnia disorder is as prevalent as the massive epidemic of obesity, which if you look across all age ranges is around 10.5%. All of, which is to say that first insomnia is a significant. It's a large societal problem and it is the most common sleep disorder second. There is a reasonable statistical probability that you or someone very close to you.
Suffering from insomnia right now or at least will suffer from insomnia during your lifetime. So that's why I want to make these podcast series and really go into detail across these different episodes because it really is quite an alarming prevalence. But what exactly is insomnia then well insomnia has a number of different features or there's a number of different sort of subtypes is how some people think of it and
This way, it's perhaps not too dissimilar to the concept of cancer. There is not just one form of cancer, but there are numerous different types of cancers. Well, there are numerous different flavors of insomnia and different clinical criteria around the world. They have their own different set of definitions and even though it's a perhaps a little bit more complex than this summary that I'm going to give one way that scientists and doctors have thought about
Insomnia is on the basis of three different features. The first is difficulty falling asleep or what we call Sleep onset insomnia. So there, the patient would come into the clinic and say, look, I just can't fall asleep. That's sleep. Onset insomnia. The second of the three is difficulties staying asleep. And that's what we call Sleep maintenance insomnia. So the
Are the patient would come in. Say look, I fall asleep, just fine, but then I wake up and I can't get back to sleep. That's sleep maintenance insomnia. That's different to difficulties initially, falling asleep. And in fact, the actor and the comedian Billy Crystal has once described his own battles with insomnia as saying, I sleep like a baby. I'm awake every hour and that's a caricature, of course, that's an extreme version but gives you a
Sense of what we mean by Sleep. Maintenance insomnia, the third feature or flavor type as it were of insomnia, is that you don't feel refreshed or restored by your sleep? The next day. And so you may be able to fall asleep, just fine and you maybe even able to stay asleep. But when you wake up the next day, you don't feel refreshed by that sleep and as a consequence, it truly empowers. Your daytime
Functioning and that's what we call, non restorative, or unrwa storeit of sleep. So those are the three main sort of features of insomnia. I can't fall asleep. I can't stay asleep. Or when I wake up, I'm just not restored by my sleep and they're not mutually exclusive. You can experience one of them, you can experience two of them, you can experience all three of them and at this point, you may be asking well, what is
Mobile and not so normal when it comes to falling asleep or waking up in the middle of the night. And I bring that point up because first, we all naturally, take some time to fall asleep. You know, I often think of sleep. It's not like a light switch. It's a little bit more like Landing a plane. You just got to gradually descend down and that takes, you know, a healthy amount of time. And then all of us will typically wake up during the night. Sometimes, we don't,
Member those Awakening. Sometimes we do and we have to go to the restroom and come back. These are all perfectly normal, they're all part of ordinary sleep. But in terms of what we think of, as non-normal sleep, when it comes to insomnia, is something that clinicians will often call the 3033 rule. So 3033 now I say rule, I'm using it lightly here.
Really more of a rule of thumb rather than agreed-upon medical definer, but the 3033 rule means the following that. It either takes you at least 30 minutes to fall asleep at the beginning of the night or it takes, you 30 minutes to get back to sleep after you've woken up during the night. And finally, the three part comes in the fact that it is happening at least three nights a week.
Distantly and that's despite you doing all of the obvious things where you've got good sleep, hygiene that we've previously spoken about. So that's the 3033 Rule and so that's how we sort of think about a loose rule of thumb in trying to firstly Define what is normal in terms of sleep and what is perhaps less normal? Now, while we're on the topic of time, there is another absolutely key thing for
You to appreciate when it comes to insomnia and what insomnia is and what it is, not what I mean here is that there is a big difference between being sleep-deprived and having insomnia being sleep deprived is not insomnia sleep. Deprivation is considered as having a perfectly normal ability to sleep, but you just don't give yourself the chance for an
Equit opportunity to sleep, meaning that sleep-deprived individuals have no problems in generating the sleep that they need. If only, they would give themselves the appropriate time to do so, so sleep. Deprivation is a sufficient ability to generate sleep, but insufficient opportunity to get sleep, that sleep deprivation insomnia.
Is actually the opposite of this, you suffer from an insufficient ability to generate good quality or quantity of sleep. Despite you allowing yourself, adequate and sufficient opportunity, time to sleep. Does that make some sense? So, in other words, people suffering from insomnia, they can't generate the Sleep quantity or the Sleep Quality and it can be either of those that they need.
Even though they're giving themselves plenty of time in bed, even though they're giving themselves, plenty of opportunity to sleep, they just can't generate sleep. They don't have the ability to create sleep, that's an important
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Okay? That is a fair amount of information, download to digest and just to summarize in terms of what we've learned today, we've gone over how common insomnia is which is very common. We've gone through the different flavors or features of insomnia.
Falling asleep, difficulty staying asleep, or having unrestricted sleep, that leads you to be impaired the next day. And finally we've spoken about what insomnia is but also critically what it's not. The last thing I want to point out is an important distinction insomnia can be a standalone condition in its own right? Or it can be a secondary symptom of something else. What this practically means for you as the
The patient is that you can be classified as having what we think of, as primary, or the Standalone condition of chronic insomnia. But to do that, the clinician, has to be sure that there aren't any other things that are creating that insomnia and therefore the insomnia is not primary. It's not the main thing. That's the issue its Downstream. It's a consequence. It to secondary symptom of something else. So a good example,
Here would be chronic back pain. See you may actually experience all three of those different flavor types of insomnia and you could be experiencing them for weeks, if not months, but it's all due to the fact of you being in physical pain. And if we treat the pain, then the quote-unquote insomnia goes away. Then it's clear that the insomnia was simply a symptom of having something else. In this example, untreated back pain.
And so, just keep that in mind. Doctors and clinicians. Will first rule out to make sure there isn't anything that's actually producing your bad sleep and therefore by removing those away in excluding those things, we leave the only viable candidate which is true chronic insomnia. And at that point, it's classified as a primary disorder as the main feature as chronic insomnia. I hope that makes some sense to oh, and I
Dope. By the way. Keep in mind that some medications can also be causing insomnia, like symptoms. And you may not realize it, and that's depending on what the type of medication can be and what time of day that you're taking it. So, as you go and see a sleep clinician or a doctor, they will walk you through some of those things. And just check that there are medications that could also be triggering these insomnia symptoms, when in fact you don't really have insomnia, okay?
So that is what insomnia is, what insomnia is not and what the different types of insomnia are. Please join me in the next episode as we continue to unpack the different reasons and the causes of insomnia. But for now I will simply say good night. I will wish you good sleep. I will see you next time. Bye for now.