January 25, 2022 6:06 pm

Insomnia. Why we sleep worse and worse and what is the new disorder that worries the experts

Google is a whistleblower. Between 3 and 5 in the morning, Argentines look for a word that distresses us: insomnia. Only those who have spent days and weeks awake knows the despair of facing each night with a conviction that haunts: “I will not be able to sleep.”

“Coronainsomnia” is one of the most devastating consequences of the pandemic in terms of both mental and physical health. Preliminary data from a survey conducted by the Argentine Association of Sleep Medicine which is in the process of being published reveal that 51% of the population considers to have slept poorly in 2020. Far from improving, the situation worsened in 2021, something that draws the attention of experts: 59% of the people surveyed said they had problems getting a night’s rest.

“In April 2020, 44% of those surveyed had anxiety and 21% had symptoms of depression. Last year, after repeating the survey, anxiety and depression decreased, but sleep disorders did not ”, summarizes Dr. Stella Valiensi, president of the association.

These findings are replicated in the rest of the world. The American Academy of Sleep Medicine (AASM) conducted a first survey in 2020 that found that 20% of Americans had trouble sleeping from the pandemic. But when they renewed the study 10 months later, in March 2021, the numbers skyrocketed: almost 60% of the people indicated this condition.

“Many people thought that our sleep should improve because we can see the light at the end of the tunnel, but now it is worse than before,” AASM spokesperson Fariha Abbasi-Feinberg told The New York Times.

The number of people who have trouble sleeping increases year after yearShutterstock

An agenda of varied concerns and emotional factors unleashed the Perfect storm of insomnia during the pandemic. “The main enemy of sleep is stress and we are in a time of tremendous uncertainty,” explains Diego Golombek, a biologist specializing in chronobiology.

After the outbreak of the coronavirus, especially in the extensive quarantine, habits were revolutionized. Two in the morning became the new 23, we gained weight, drank more alcohol, and erased the lines that separate work and private life: a summation of variables that impairs sleep.

When the limitations were relaxed and life began to look somewhat like what it used to be thanks to vaccination, the sequelae related to insomnia did not dissipate. Daniel Pérez Chada, sleep expert and adjunct professor of medicine at the Austral University, attributes it, among other factors, “to employment and financial concerns”.

Experts advise leaving aside all electronic devices at the time of rest, but concerns often prevent disconnection
Experts advise leaving aside all electronic devices at the time of rest, but concerns often prevent disconnectionShutterstock

A survey of Adecco Argentina carried out in mid-2021 among 1226 participants showed conclusive figures: 65% of those surveyed said they went to sleep with concern about the coronavirus and about work.

“Economic uncertainties had a sustained growth and transcend the pandemic. What was a precipitating factor for insomnia, became perpetual for many people ”, adds the psychiatrist Joaquín Diez, director of the Pan American Institute of Sleep Medicine.

Children and adolescents they are also victims of the problem. “In my personal experience, the proportion of young people with difficulties falling asleep and the tendency to fall asleep later has increased, as well as insomnia as a manifestation of high levels of anxiety,” explains María Elena Mazzola, head of the Fleni’s Sleep Medicine Unit.

Only 8% sleep more than eight hours and 28% spend less than six hours. The ideal, according to Golombek, would be to achieve at least seven hours a night in a row.

But bad rest is not all. According to the surveys of the Argentine Association of Sleep Medicine, 6% of the participants had nightmares more than three times a week in 2020, a marker of neuronal changes associated with stress and anxiety. In 2021, the proportion remained high, at 4%.

Daniel Bogiaizian, doctor of psychology and former president of the Argentine Association of Anxiety Disorders, lists some of the most frequent fears he encountered in his patients: infect others, not being able to financially care for family members or not being able to access the health system. “Insomnia feeds on our intolerance of uncertainty,” he synthesizes.

It is not a minor problem. Rather the opposite: it is crucial for the health of the population. “Inadequate sleep affects the immune system, increases the risk of cardiovascular, neurological and metabolic diseases, also of diabetes, depression and dementia ”, warns Daniel Cardinali, senior researcher at the Conicet and emeritus professor at the University of Buenos Aires.

More than 45 minutes in bed without being able to fall asleep can be considered a symptom of insomnia
More than 45 minutes in bed without being able to fall asleep can be considered a symptom of insomniaPexels

The format is not always the same. There are those who take hours to fall asleep (more than 45 minutes is already a symptom of insomnia), others who wake up frequently at night and not a few who wake up in the first hours of the day and cannot go back to sleep.

“In general, the cause of insomnia has an unresolved emotional situation at the base. For this reason, we work as a team with psychiatrists and psychotherapists in different aspects, both physical and emotional or mental, ”explains Pérez Chada.

In addition to conventional therapies, in their various currents, specific techniques for this disorder are added.

“We train the patient to relax and the belief that he is not going to sleep disappears. Let them lose their fear when they see the bed ”, describes Arturo Garay, head of the sleep medicine section of the Cemic in Buenos Aires and author of works on “coronainsomnia”.

Sleep test carried out by the Cemic team
Sleep test carried out by the Cemic teamsilvana colombo

Phototherapy, melatonin supplements, sleep restriction – which basically consists of spending fewer hours in the room and in bed – and Information and news “diets”, are some of the most used resources.

“Cognitive behavioral therapy is the first line of treatment. With the patient, we work on the factors that cause tension that prevent them from falling asleep or that keep them awake in the middle of the night ”, describes Bogiaizian.

The psychiatrist Adrián Cillo, director of the center NeuroCare, mentions other techniques that are being used in people with insomnia, especially when the problem is related to a disorder, but the cause is unknown. “Sometimes anxiety was generated from a situation in the past that was stored in a non-adaptive neural network. With EMDR (eye movement desensitization and reprocessing therapy) we allow the transition from this situation to an adaptive network ”, he details.

The use of drugs is limited because they can cause addiction, warns Cardinali. If they are used, their consumption should not last more than two or three months.

Beyond therapies, the so-called “sleep hygiene” is essential. “There is no patient with insomnia who is effectively treated if he does not have good sleeping habits”, warns Pérez Chada.

The guidelines are clear and simple, but they are not always incorporated into the routine. Avoiding screens for at least half an hour before going to sleep is a critical first step in improving sleep. “LEDs have a wavelength that tends towards blue. It is the light that stimulates the biological clock the most and tells it that it is daytime “, explica Golombek.

Sleep studies accurately measure patients' rest during a night
Sleep studies accurately measure patients’ rest during a nightsilvana colombo

It is also not advisable to eat and drink before going to bed as it can cause an interrupted rest. Intense physical exercise at night is also discouraged.

Going to bed without sleep is another common mistake. Until the need for rest is manifested, it is better to be out of bed.

For those who go over topics on the pillow, ideas are suggested such as writing down all the pending items in a notebook and, by leaving them in writing, they somehow come out of thought because they are already on track.

Although specialists are the first to promote these behaviors, they also warn about the risk that making the dream concrete becomes an obsession.

The ortosomnia is the anxiety generated by the excessive desire to achieve the perfect dream, another associated disorder that is of growing concern to experts. Garay argues that this phenomenon is motivated by applications and smartwatches.

The new tools used to monitor sleep are varied: they can be watches worn on the wrist, proximity devices located on the bedside table or applications that collect biometric data, noise and movement.

These elements can generate dependency in those who seek to improve rest and, in this way, cause the opposite effect: insomnia symptoms are exacerbated.

What not to do


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