Take the Bed Pill: the Wide-ranging Effects of Insomnia

Author: Brentan Lam

Many people will confirm the low, steady humming of a car engine has magical somnolent effects. A Hong Kong-based travel agency has capitalized on the phenomenon of commuters dozing off on trains and buses by launching a 5-hour, 47-mile bus tour around town, in hopes that many will find it a snoozefest [1].

While the idea that anyone would pay to sleep on a bus seems rather strange, it might also be reflective of how sleep-deprived cosmopolitans are.

One in three adults worldwide experiences 3 or more days of insomnia every year [2]. The prevalence of insomnia, defined as “a subjective complaint of difficulty in falling or staying asleep despite having the opportunity to do so,” suggests that sleep deprivation is an integral part of human functioning [3]. From an evolutionary perspective, the ability to override sleeping mechanisms in the face of an immediate danger or threat increases an organism’s chance of survival [3]. Over time, this ability would become common as organisms that survived longer also produced more offspring. 

But the chastising from a manager or the inability to meet sales growth targets hardly constitute a life-and-death situation, resulting in a “mismatch” since solutions to exigencies in the past no longer benefit us as environments change. 

The hypothesis that insomnia, essentially, is a fear-based, fight-or-flight mechanism has led researchers to examine the process through which we learn how to respond differently in the presence or absence of threats [3]. Reduced levels of activity in the vmPFC of the brain, which is the area activated when we learn that a threat no longer exists, and which is responsible for inhibiting fear-related responses in patients with chronic insomnia, reveal an association between failure in fear extinction mechanism and sleep deprivation [3]. Moreover, the persistence of fear in the absence of threats underlies many anxiety disorders [3].

Insomnia is such a widespread problem in modern society that it costs employers $63.2 billion annually in the United States alone due to reduced productivity and increased frequency of accidents and mistakes [4]. Differences in absenteeism between insomniacs and “good sleepers” are found to be disproportionately large for managers and women [5]. Data obtained in Norway showed that insomnia is a strong predictor for sick leaves; the strength of this effect increased with longer durations of time off work [5]. Ironically, it seems that companies that require staff to work long hours under high-stress conditions to try to maximise productivity might very well be doing the opposite.

What matters more importantly, however, is the effects of insomnia on people’s well-being and relationships. The common perception of obesity is related to how much one exercises and eats, but studies have shown genetics, socioeconomic status, and community environment play a role, as well. In insomniacs, hormones that control our sense of appetite, leptin and ghrelin, are affected in a way that creates increased feelings of hunger [6]. Compounded by growth hormone deficiency, elevated levels of stress hormones, and reduced rates of metabolism of food, people with sleep deprivation are more at risk of obesity [7]. Seeing a two-year old throw a tantrum is a perfect demonstration of how a lack of sleep impacts how humans handle their emotions [8]. The amygdala, the part of the brain that attaches emotions to memories, does not function properly when sleep-deprived, often leading to overreactions or failure to respond aptly to others’ emotions [8].

Counting sheep can only do so much to help you fall asleep. Seeking treatment is crucial when the effects of insomnia manifest [9]. Cognitive behavioral therapy is a common approach to treatment without health risks which includes increasing behaviors that improve sleep quality in patients, reducing time spent in bed awake, and other techniques [9]. And that “sleeping bus tour”? Forget it.

Editors

Kaz Shuji and Majd Al-Aarg

Designer

Web design by Zakaria Kandid and Majd Al-Aarg

Additional Credits

Cover photo provided by camilo jimenez on Unsplash

References

1. Ritchie LC. New Hong Kong Bus Tour is meant to put people to sleep [Internet]. NPR. NPR; 2021 [cited 2021Oct26]. Available from: https://www.npr.org/2021/10/21/1047891650/new-hong-kong-bus-tour-is-meant-to-put-people-to-sleep 
2. Nakata A. Work hours, sleep sufficiency, and prevalence of depression among full-time employees. The Journal of Clinical Psychiatry. 2011 May;72(05):605–14.  
3. Perogamvros L, Castelnovo A, Samson D, Dang-Vu TT. Failure of Fear Extinction in insomnia: An evolutionary perspective. Sleep Medicine Reviews. 2020 Jun;51:101277.  
4. Insomnia costing U.S. workforce $63.2 billion a year in lost productivity, study shows [Internet]. American Academy of Sleep Medicine – Association for Sleep Clinicians and Researchers. 2017 [cited 2021 Oct 26]. Available from: https://aasm.org/insomnia-costing-u-s-workforce-63-2-billion-a-year-in-lost-productivity-study-shows/ 
5. Léger D, Bayon V. Societal costs of insomnia. Sleep Medicine Reviews. 2010;14(6):379–89.  
6. Norton A. How sleepless nights can trigger weight gain [Internet]. WebMD. WebMD; 2018 [cited 2021Oct26]. Available from: https://www.webmd.com/sleep-disorders/news/20180824/how-sleepless-nights-can-trigger-weight-gain 
7. Beccuti G, Pannain S. Sleep and Obesity. Current Opinion in Clinical Nutrition and Metabolic Care. 2011 Jul;14(4):402–12.  
8. Shortsleeve C. How sleep can affect your relationship, according to Science [Internet]. Time. Time; 2018 [cited 2021 Oct 26]. Available from: https://time.com/5348694/how-sleep-affects-relationships/ 
9. Fry A. Treatments for insomnia [Internet]. Sleep Foundation. 2020 [cited 2021 Oct 26]. Available from: https://www.sleepfoundation.org/insomnia/treatment