Insomnia Explained Clearly – Causes, Pathophysiology & Treatment


crowd welcome to another MedCram
lecture in the next set of lectures we’re going to talk about insomnia what
causes it what are the different diseases that can cause it and how to
manage it and I would say that even though I am a sleep specialist some of
the recommendations I’m going to be giving are not for everybody
so you need to make sure that you follow up with your own physician but let’s go
through insomnia the first thing we got to do is talk about what happens with
normal aging there are different stages of sleep there is stage one what we term
n one there’s stage two and there stage three couple of other stages as well
there is REM sleep which I’m sure you’ve heard about generally speaking what
happens over the period of a night is someone starts out wake they go down
into very transient sleep phase called stage one and then they go down to stage
two and eventually go down into stage three where they stay until they go into
REM sleep which I’ll code here as very dark then they come out of that and they
go right back up to the beginning of stage one and they repeat the same thing
again now as this occurs throughout the night this REM sleep gets longer and
longer until actually most of the REM sleep is towards the end of the night
these deep stages of sleep so stage three are usually longer towards the
beginning of sleep so something that we see here in normal sleep is that stage 3
is concentrated toward the beginning of the night and REM sleep is concentrated
more towards the end of the night both of these are very restful this is
physically restful stage 3 sleep this is where growth hormone is produced and REM
sleep is very mentally restorative so both of these are very very
important and unfortunately as we get older we see a reduction in both of
these types of sleep and an increase in this very sort of bland end to type of
sleep which really is is more of a light sleep so this is what we see with in
normal aging now most of these changes occur by the age of 40 or 50 years of
age and sleep remains pretty constant from the age of 60 to 90 there is one
exception and that sleep efficiency so what is sleep efficiency sleep
efficiency is simply the amount of time of sleep divided by the amount of time
in bed and that steadily decreases from about 95 percent down to about 80
percent in general as one approaches 80 years of age so what happens when you
approach middle age there’s a number of things that occur normally there’s
increased awakenings so you’re waking up more in the middle of the night there’s
a Razzles and there’s more stage shifts this is the stage as I was talking about
before you also see a decrease in stage 3 and you also see a decrease in REM
sleep as I mentioned before you get a decrease in sleep efficiency and as you
reach middle age there is more of what we call a phase advancement what do I
mean by phase advancement with phase advancement you’re going to be getting
up earlier so basically getting up from bed earlier
and going to bed earlier the interesting thing however is that
despite all of these things you’re a little bit more resistant to sleep
deprivation or to the effects of sleep deprivation what I mean by this is that
let’s say as a teenager if you missed four or five hours of sleep it wouldn’t
affect you as much as if you were older and you missed four or five hours of
sleep you’d be able to perform a little better which is kind of paradoxical from
what you would think now in terms of disease in actual disease insomnia goes
up as we get older no surprise there if we look at a study of 18 the 34 year
olds now there’s about 14% incidence of insomnia from the age of 35 to 49 the
incidence is about 15% so it remains pretty stable however when we get to 50
to 64 years of age we hit about a 20% incidence
here’s the key though from 65 to 79 years of age that jumps up to 25% this
is this is a pretty astounding figure when you realize that a quarter of the
population of retirement age has a problem with insomnia and insomnia is a
pretty generic term I mean if we could use a number of different words to
describe it some about 19% of people wake up too early another 19% would describe trouble
falling asleep twenty-five percent have daytime napping 29% basically come right out and just
say they’ve got insomnia and then if you look at both initiating and maintaining
sleep we’re looking at 43 percent of older adults so these are people who
have a mean age of 74 years of age of those people these are what they’re
complaining about and 43 percent have problems with initiation and maintaining
both now this is by no means a geriatric diagnosis there are many of young people
and middle-aged people who have this problem now in terms of the different
causes of insomnia let’s say we got rid of all of the easy causes of insomnia
for instance drinking too much caffeine or some of these things if we were to
break it down what would be the breakdown of insomnia in terms of cause
well it turns out the biggest reason for people to have insomnia so 35 percent of
people who have insomnia have some sort of psychiatric illness and what I mean
by that is depression so you’ve got to know that in terms of treatment because
if you don’t treat the depression the insomnia is not going to get better next
on the list about 15 percent have what we call psycho physiologic or what we call performance anxiety what
do I mean by that have you ever been in the kitchen or in the living room or the
family room felt really tired and then as soon as you went into the bedroom you
just could not fall asleep this is psychophysiological we’re going
to explain about that in the upcoming lectures 12% is alcohol or drug yes
these can cause insomnia another 12% is restless leg syndrome something that
we’ll talk about as well 10% is circadian rhythm circadian rhythm
disorder and finally the last 9% is kind of a weird diagnosis it’s it’s actually
where they think they can’t sleep but they actually are sleeping if you test
them it’s called paradoxical so you can see here that this is where the bulk of
your diagnosis azar this one’s going to be the most interesting so what we’re
going to do is we’ve kind of laid the groundwork of what insomnia is where it
comes from let’s talk about where the pathophysiology meets the road in terms
of causes diagnosis management and treatments join us for the next lecture you

29 thoughts on “Insomnia Explained Clearly – Causes, Pathophysiology & Treatment

  1. Excellent. I have lots of trouble initiating sleep. Most nights it takes me hours to get to sleep, regardless of how tired I am. I believe a lot of it has to do with anxiety. Thanks for the lecture, I'll check out part 2.

  2. You said at middle age we are more resistant to sleep deprivation, but then said it does not affect a teenager as much as it does the middle aged. Didn't you mean to say just the opposite of that?

  3. Great video. Loads of helpful info. And I'm confused. Did you make an error at 4mins, 45secs?: 'As you reach middle age…. despite all of these things, you're a little bit more resistant to sleep deprivation, or to the effects of sleep deprivation. What I mean by this is that, let's say if you were a teenager and you missed 4-5 hours of sleep, it wouldn't affect you as much a if you were older and you missed 4-5hours of sleep. You would be able to perform a little better, which is kind of paradoxical… '
    I can't tell from that if you mean teenagers are more resistant, or 'midagers'. You seem to get your sentence mixed up right?

  4. Five Simple Causes of Insomnia to remember (5)P's
    1. Physical – Restless Legs, Asthma or Sleep apneoa
    2.Physiological- Noise or shift work
    3.Psychological-Stress or abnormal concern about sleeping
    4.Psychiatric- Depression and maniac disorder
    5.Pharmacological – Medication, Alcohol, Caffeine or Nicotine.

  5. Is it connected to circadian rhytm? If I go to bed att 8 pm as a good boy and wake up att 6 am will I then gett less REM than if I go to bed at 12 (24.00) and slep untill 8-9 am?
    I am 29 and try to figure out how to use my study/sleep-time. 🙂

  6. I can't sleep because I'm afraid I'll over sleep my alarms and miss work…. I sleep so deep that I sometimes can't even hear a smoke detector in my own room.. what do I need to do?

  7. I can't sleep because I'm too distracted, I find myself moving my foot side to side a lot and checking the clock every 10 minutes estimating how much rest I can get if I sleep now. I just ruined it tonight .-. I have school tomorrow and it's 3am, I'm so so tired but I can't fall asleep. 2 days ago I stayed home because I was too tired to even stand properly, I can't figure out why I can't sleep and it hurts because I've missed so much school because just being there gives me anxiety, like I can't get away from something. Then I feel like I'm going to puke but after I get to stay home I feel better, then get depressed that I'm letting my parents down. Man I hate this cycle 😐 it feels unbreakable, I mean I'm still only 15…

  8. I'm 12 and I've had insomnia since I was 10, I was a test dummy for a sleep lab and was diagnosed professionally, and I can't sleep at all, In fact I was described "clinically nocturnal"
    By the doctor. I was given a a sort of nerve gear to wear on my head for a weak. My brain waves were very high at night, like a normals person during the day, except, it was at night for me. During the day, I was more, in a dazed faze. I can't help it. People tell me to just force myself to sleep, but I can't. This makes school harder as well, especially since I'm in all advanced classes.they said that they can't give me the normal treatment because if my age. So I have to take the regular non working pills. It's currently 5:26 AM and I'm not tired at all… I don't know how to deal with it.

  9. Very informative video, love the jazzier music and the end of video; Anyone knows what the title song is and by whom? Thanks.

  10. Lately can't sleep in my bed,I get anxious my nose is stuffed. So sleep on the couch sitting up. Can usually get 3 to 4 hours. Take Ativan and benadryl half a pill of ativan plus 2 benadryl. Would like to get off of both. Don't understand sometimes sleep fine in my bed. Next night sorry won't happen.

  11. I am on sleeping pills for 36 years and doing meditation to control thoughts for the last 5 years. Watching Sleep videos on you tube , I once again tried to get rid of pills but in vain. I don't want to go insane.

  12. Any concern for people who wake up during the night to urinate but then fall back asleep easily?

  13. I work nights, 2nd shift. I'm pretty sure I have a form of insomnia. I can be in a deep sleep and be woken by the slightest noise. Always had this problem 😅

  14. How is it a "disorder" when so many people have different sleep cycles? Are blue eyes a disorder? Maybe the worlds needs to stop revolving around medieval farmers. Radical idea, I know.

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