Insomnia, one of the most prevalent sleep disorders, affects millions worldwide, with consequences that extend far beyond nighttime restlessness. Poor sleep quality is increasingly linked to a higher risk of cardiovascular disease, obesity, depression, and impaired cognitive function.

As modern lifestyles continue to evolve, so too does the incidence of insomnia, exacerbated by factors such as increased screen time and heightened stress levels.

We at The Naked Pharmacy make it our mission to empower our customers through knowledge, as we believe it is this knowledge empowerment that enables our customers to make informed decisions about their health.  

In this article, we explore the science of sleep, the different types of insomnia, its potential causes, and how modern living contributes to its rising prevalence.

The Science of Sleep: How Do We Fall Asleep?

Falling asleep is a complex, multi-step biological process controlled by the brain and regulated by two key systems: the circadian rhythm and the sleep-wake homeostat.

• Circadian Rhythm: The body’s internal clock, primarily regulated by the suprachiasmatic nucleus (SCN) (located in the hypothalamus of the brain), responds to environmental cues such as light and darkness. As evening falls, the brain signals the pineal gland to release melatonin, a hormone that promotes sleep.
• Interesting fact – People who have had damage to their SCN not only struggle with their sleep patterns but also suffer from disrupted patterns of behaviour and body temperature too!
• Sleep-Wake Homeostasis: This mechanism tracks the amount of time we’ve been awake and builds “sleep pressure” over the day. The longer we stay awake, the greater our need for sleep. The neurotransmitter adenosine accumulates in the brain during wakefulness, increasing drowsiness.

Once these systems align and external factors (e.g., a dark and quiet environment) support relaxation, the brain transitions from wakefulness to sleep. This shift involves changes in neurotransmitter activity—GABA (gamma-aminobutyric acid) promotes sleep by inhibiting wake-promoting neurons, while a decline in orexin (hypocretin) activity ensures we stay asleep.

The Different Types of Insomnia

Insomnia is not a singular condition but a spectrum of sleep disturbances. It is typically classified based on duration, nature, and underlying causes.

Acute Insomnia

• Also called short-term insomnia, this type lasts a few days to weeks and is often triggered by stress, illness, travel, or environmental changes.
• Example: A person experiencing poor sleep after receiving distressing news or recovering from surgery.

Chronic Insomnia

• Defined as difficulty falling or staying asleep for at least three nights per week for three months or more.
• Often linked to underlying medical conditions, psychiatric disorders, or poor sleep hygiene.

Onset vs. Maintenance Insomnia

• Onset Insomnia: Difficulty falling asleep despite feeling tired. Often associated with anxiety, excessive screen exposure before bed, or stimulant intake (e.g., caffeine).
• Maintenance Insomnia: Waking up frequently during the night and struggling to return to sleep. Linked to medical conditions (e.g., chronic pain, menopause) and mental health disorders.

Pregnancy Insomnia

• Common during pregnancy due to hormonal fluctuations, increased urination, physical discomfort, and anxiety about impending childbirth. 
• Sleep disturbances often peak in the third trimester as the body prepares for labour and the growing baby causes discomfort.

Comorbid Insomnia

• Occurs alongside other health conditions, such as depression, anxiety, chronic pain, or neurodegenerative diseases like Alzheimer’s.

Behavioural Insomnia (Primarily in Children)

• Seen in young children who struggle to sleep without parental intervention or specific bedtime rituals.

Theories and Causes of Insomnia

The underlying causes of insomnia are diverse, involving biological, psychological, and environmental factors. As with many conditions, there is no “one cause fits all” but understanding potential reasons and theories that exist may help us rationalise or identify the root cause of our own insomnia. 

Hyperarousal Theory

• Insomnia is often linked to an overactive hypothalamic-pituitary-adrenal (HPA) axis, resulting in elevated cortisol levels that keep the brain in a heightened state of alertness.
• Chronic stress, anxiety, or PTSD can trigger this response, making relaxation difficult.

Neurotransmitter Imbalance

• An imbalance between GABA (sleep-promoting) and glutamate (excitatory neurotransmitter) can disrupt sleep onset and maintenance.
• Low serotonin levels, often seen in depression, may also impair melatonin production.

Lifestyle and Environmental Factors

• Screen Time & Blue Light Exposure: Blue light from devices suppresses melatonin production, delaying sleep onset.
• Caffeine & Alcohol: Caffeine is a known adenosine receptor antagonist, reducing sleep pressure, while alcohol can disrupt REM sleep.
• Irregular Sleep Patterns: Shift work, jet lag, and inconsistent sleep schedules interfere with circadian rhythms.

Medical and Psychiatric Conditions

• Chronic pain (e.g., arthritis, fibromyalgia)
• Gastroesophageal reflux disease (GERD)
• Menopause (due to declining estrogen levels)
• Neurological disorders (e.g., Parkinson’s, dementia)

These conditions can be the most debilitating as there is no direct route to addressing the root cause of the condition and thus, poor sleep contributes to a vicious cycle in managing such conditions.

Why Insomnia is Getting Worse: The Modern Epidemic

The global prevalence of insomnia is on the rise, with studies estimating that 10-30% of adults experience chronic insomnia, while up to 60% report occasional sleep disturbances. Unfortunately for all its benefits, modern lifestyle is the main culprit contributing to this trend:

1. Increased Screen Time & Digital Overload

• The average person spends 7+ hours per day on screens, with evening exposure to blue light delaying melatonin release.
• A study published in JAMA found that using screens before bed increases sleep latency (time taken to fall asleep) by 30-60 minutes.

2. Higher Stress & Workload

• Sleep deprivation costs the global economy $411 billion annually due to lost productivity and health expenses.
• Chronic stress keeps the brain in a hyper-alert state, leading to difficulty relaxing before bed.

3. Poor Sleep Hygiene & Social Jet Lag

• Late-night eating, excessive caffeine, and irregular sleep schedules disrupt circadian rhythms.
• Social jet lag (staying up late on weekends and waking early on weekdays) can mimic the effects of actual jet lag.

4. Increased Mental Health Disorders

• Anxiety and depression, both closely linked to insomnia, have surged in recent years, particularly following the COVID-19 pandemic.
• Insomnia and depression share a bidirectional relationship—poor sleep worsens mood disorders, and mood disorders impair sleep, again, another example of a negative feedback cycle.

Treatments for Insomnia Managing Insomnia 

Treatments for insomnia require a combination of lifestyle changes, behavioural therapies, and in some cases, medical interventions. Below are the primary treatment options available:

• Cognitive Behavioural Therapy for Insomnia (CBT-I): A structured, evidence-based approach that helps individuals identify and change negative thoughts and behaviours contributing to sleep disturbances. Considered the gold standard for chronic insomnia. 
• Sleep Hygiene: Establishing consistent sleep schedules, creating a dark and cool sleeping environment, and reducing screen time before bed. 
• Relaxation Techniques: Mindfulness meditation, deep breathing exercises, and progressive muscle relaxation to reduce stress and promote sleep. 
• Medication: Prescription sleep aids such as benzodiazepines or non-benzodiazepine sedatives (e.g., zolpidem) may be used in severe cases, though they come with risks of dependence and side effects. 
• Melatonin: Useful for sleep-onset insomnia and shift workers but should be used under expert guidance to avoid excessive use. 
• Magnesium for Insomnia: Magnesium plays a crucial role in nervous system regulation and has been shown to enhance GABA activity, promoting relaxation and better sleep quality. 
• Herbal Remedies: Natural sleep aids such as lavender, valerian root, chamomile, and passionflower have been traditionally used to support restful sleep. 
• Light Therapy: Exposure to bright light in the morning can help regulate circadian rhythms, particularly for those with delayed sleep phase disorder.

Conclusion 

Insomnia is not just a night-time nuisance but a condition with profound consequences on health and well-being. Understanding its underlying mechanisms, risk factors, and worsening trends can help individuals make informed lifestyle adjustments.

Addressing insomnia requires a holistic, integrated approach, including improved sleep hygiene, stress management, and in some cases, targeted interventions such as prescribed medications cognitive-behavioural therapy (CBT-I) or nutritional support.

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