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Is Your Chronic Condition Leaving You Sleepless?

  • Home
  • Insomnia
  • Is Your Chronic Condition Leaving You Sleepless?
Insomnia SCOFA

 
Medically reviewed by
Dacelin St Martin, MD
Triple board-certified in Sleep Medicine,
Internal Medicine, and Pediatrics.

 
 
Causes  |  Clinical Presentation  |  Chronic Conditions  |  Diagnosis  |  Treatment

 

Overview 

If you’re suffering from sleeplessness you’re not alone. Approximately 30% to 40% of Americans report symptoms of insomnia on a yearly basis.[1]

Primary insomnia is not associated with an underlying medical or psychiatric condition and falls into one of two categories: acute or chronic.

Acute (short-term) insomnia typically occurs after a stressful event. Acute insomnia can sometimes turn into chronic insomnia, a prolonged inability to either get to sleep or stay asleep, accompanied by daytime fatigue and an inability to stay focused.

If you’ve had trouble sleeping at least three times a week and have had the problem for three months or more, you probably have chronic insomnia.[2] 

Secondary insomnia is a symptom or side effect of a chronic condition, like Alzheimer’s, Parkinson’s, or arthritis, which needs to be managed for sleep to improve, and quality of life to resume.

Keep reading to find out more about insomnia, and the effects that chronic conditions have on your sleep. 

 

Causes and Risk Factors

The causes of insomnia, as well as the risk factors for the condition, go hand in hand. The best way to look at both is to classify the risk factors into three categories: predisposing, precipitating, and perpetuating. 

  • Predisposing risk factors – As the name implies, these factors affect people who are predisposed, or more inclined, to suffer from insomnia. Those with mood disorders, such as bipolar disorder or depression, or psychotic disorders, such as schizophrenia are more likely to suffer from insomnia. People with insomnia also tend to have higher heart rates than those who don’t have the condition.[3] 
  • Precipitating risk factors – This means that someone either has a medical condition or some other issue that precipitates, or triggers, insomnia. Precipitating risk factors include illness. For example, neurodegenerative diseases such as Parkinson’s disease can lead to insomnia.[4]There are chronic conditions, like obesity, that are exacerbated by sleeplessness or musculoskeletal disorders, like osteoarthritis, that interfere with sleep due to pain. Additionally, the use of stimulants, such as cocaine, can lead to insomnia, as well as the use of certain prescription medicines, such as antidepressants.[5] Restless legs syndrome, a sleep disorder, can also trigger insomnia.[6]
  • Perpetuating risk factors – These are issues that can perpetuate, or maintain, insomnia once the condition has already started. Doing something as simple as leaving your television on in the bedroom or eating a midnight snack can perpetuate insomnia, as can taking naps or consuming beverages that contain caffeine.[7] 

 

Clinical Presentation

Painful chronic conditions can exacerbate sleeplessness, making you feel worse and negatively impact your quality of life. Medications, like the steroid Prednizone that’s used to treat rheumatoid arthritis, can also interfere with sleep, making it harder to deal with the pain associated with chronic conditions. This discomfort may lead to:   

Insomnia and Chronic Conditions

 

Chronic Conditions & Insomnia

  • Heart Disease – Researchers conducting a study of 772 people between the ages of 20 and 98 found that approximately 22% of participants with chronic insomnia also had heart disease. In comparison, only 9.5% of participants without any type of insomnia had heart disease.[8] 
  • Respiratory diseases – More than half of people with respiratory issues experience insomnia.[9] There are a lot of potential reasons why this is the case. Lung disease patients may have to work harder to breathe when they lie down, for example. Stimulant drugs, or other medications used to treat respiratory problems, can cause insomnia as well.
  • Cancer – Approximately 60% of people diagnosed with cancer have insomnia.[10] Pain associated with the disease, emotional distress, and the side effects of drugs can all contribute to a lack of sleep. Women with breast cancer appear to be especially prone to insomnia for a lot of reasons. These include hot flashes linked to sudden menopause, which can sometimes be a side effect of cancer treatment, as well as depression. Another reason is the simple fact that women suffer from insomnia more than men.[11] 
  • Diabetes – About 50% of diabetics also suffer from insomnia.[12] Like other conditions, pain and medicinal side effects are two of the main reasons. People under the age of 40 are particularly susceptible to developing diabetes if they have insomnia. According to one study, people in this group are more than 30% more likely to develop diabetes than those who don’t have insomnia. It also seems that the duration of insomnia has an effect on diabetes risk, regardless of age. If you’ve experienced sleeplessness for at least eight years, your chances of getting diabetes is 50% higher.[13] 
  • Alzheimer’s disease – Research indicates that as many as 25% of people with Alzheimer’s have insomnia. People with Alzheimer’s who also suffer from insomnia often experience nighttime delirium, wandering, and agitation.[14] As you age, you undergo changes in the way you sleep. These changes can, in some instances, increase the production of amyloid-beta, an amino acid responsible for the accumulation of plaque found in the brains of Alzheimer’s sufferers.[15] 
  • Parkinson’s disease – Insomnia is very common in people suffering from Parkinson’s disease (PD). As many as 30% of PD patients also have a sleeping disorder. It appears that insomnia can worsen as a person’s Parkinson’s progresses.[16] PD patients tend to have more trouble staying asleep than getting to sleep in the first place. They wake up more frequently during the night and can only sleep for short periods of time.[17]
  • Obesity – Nearly 30% of obese people who participated in one study also reported experiencing insomnia on a regular basis.[18] When we don’t get enough sleep, our body releases a hormone called ghrelin, which leads to increased feelings of hunger.[19] Think back to the last time you had a restless night and how it affected your appetite the next day. Now, your sleepless-hunger situation worsens because your body releases less leptin, which is a hormone that controls your appetite.[20] Before you know it, you’re digging into a triple-stacked burger with all the fixings.
  • Asthma – Asthma is yet another medical condition that appears to have a relationship with insomnia. Researchers surveyed 263 people with asthma and found that 37% of them also had insomnia. They were also more than two times more likely to have problems controlling their asthma than those without insomnia and 1.5 times more likely to need medical care for their breathing problems.[21]

 

How to Make a Diagnosis

Studies show that up to 90% of people with the discomfort associated with chronic conditions experience sleeplessness. Sleep disturbance includes trouble falling asleep, staying asleep, or waking too early due to physiological responses, like pain or discomfort.

However, studies show that it’s more common for people to experience sleep maintenance disturbance (trouble staying asleep) than delayed sleep onset (falling asleep) when dealing with chronic comorbid conditions.

What’s key is treating and managing the primary condition to minimize the effects of insomnia. Chronic sleeplessness leads to heightened pain sensitivity, which exacerbates the sleepless cycle.

There’s a strong comorbid correlation between psychiatric illness and insomnia; however, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), indicates that insomnia is a distinct entity that requires a separate diagnosis.[22]

The doctor will take a comprehensive sleep history that includes a review of social, medical, and psychiatric factors present at the onset of insomnia. Predisposing and precipitating factors include an individual’s underlying reactivity to sleep disturbance when under stress, medical and psychiatric conditions, and genetic factors. These factors are of significance regarding identifying the proper treatment for the following reasons: [23]

• Insomnia precipitated by pain or discomfort from a primary condition is unlikely to improve without medical treatment

• Sleep disorders, like obstructive sleep apnea, need to be addressed for the symptom of insomnia to be resolved

• Psychiatric disorders and insomnia often have a comorbid relationship, with both needing to be addressed for a full recovery

• Childhood trauma may lead to sleeplessness as an adult, which can be addressed through cognitive behavioral therapy 

 

Treatment for Insomnia

Comorbid physical and mental conditions must be managed for sleep to improve. In cases where insomnia is the primary condition, cognitive behavioral therapy (CBT-I) is the gold standard for treatment. It involves addressing specific types of behaviors and thoughts that can interfere with sleep. 

CBT-I directs patients to adopt cognitive and behavioral changes to help improve their sleep, including going to bed at the same time every night and waking up at the same time every morning, using the bed for only sleep and sex, as well as avoiding naps. 

A program that uses CBT-I techniques helps patients manage anxious thoughts that can lead to sleeplessness, promoting relaxation through meditation and other strategies.

CBT-I is the preferred first-line option for treating insomnia as it gives patients the lifetime tools they need to improve the quality of their sleep. 

 

Don’t Be Discouraged

If you’re dealing with a chronic condition and insomnia, it might seem like there’s no hope; however, talking openly with your medical provider is key. Management of primary disorders is imperative if you’re to get the restorative sleep you need, for the quality of life you deserve.

 

References:

  1. Black DW, Grant JE, eds. DSM-5 Guidebook: The Essential Companion to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Washington, DC: American Psychiatric Association Publishing; 2014. Retrieved from https://www.ajmc.com/view/insomnia-overview-epidemiology-pathophysiology-diagnosis-and-monitoring-and-nonpharmacologic-therapy
  2. American Academy of Sleep Medicine. International Classification of Sleep Disorders, 3rd ed, American Academy of Sleep Medicine. Chest. 2014 Nov;146(5):1387-1394. doi: 10.1378/chest.14-0970. PMID: 25367475. Retrieved from <https://pubmed.ncbi.nlm.nih.gov/25367475/>
  3. Bonnet MH, Arand D. Hyperarousal and insomnia. Sleep Med Rev. 1997;1:97-108. doi: 10.1016/S1087-0792(97)90012-5/ PMID: 15310517. Retrieved from <https://pubmed.ncbi.nlm.nih.gov/15310517/
  4. Kryger MH, Roth T, Dement WC, eds. Principles and Practice of Sleep Medicine. Philadelphia: WB Saunders; 2000. Hardcover ISBN: 9781416066453. doi:10.1002/ppul.1065/ Retrieved from <https://onlinelibrary.wiley.com/doi/abs/10.1002/ppul.1065>
  5. Stepanski EJ. Behavioral therapy for insomnia. In: Kryger MH, Roth T, Dement WC, eds. Principles and Practice of Sleep Medicine. Philadelphia: WB Saunders; 2000:647-655. Hardcover ISBN: 9781416066453. doi:10.1002/ppul.1065/ Retrieved from <https://onlinelibrary.wiley.com/doi/abs/10.1002/ppul.1065>
  6. Zorick FJ, Roth T, Hartse KM, Piccione PM, Stepanski EJ. Evaluation and diagnosis of persistent insomnia. Am J Psychiatry. 1981;138:769-773. doi: 10.1176/ajp.138.6.769PMID: 7246806. Retrieved from <https://pubmed.ncbi.nlm.nih.gov/7246806/>
  7. Stepanski EJ. Behavioral therapy for insomnia. In: Kryger MH, Roth T, Dement WC, eds. Principles and Practice of Sleep Medicine. Philadelphia: WB Saunders; 2000:647-655. Hardcover ISBN: 9781416066453. doi:10.1002/ppul.1065/ Retrieved from <https://onlinelibrary.wiley.com/doi/abs/10.1002/ppul.1065>
  8. Taylor DJ, Mallory LJ, Lichstein KL, et al. Comorbidity of chronic insomnia with medical problems. Sleep. 2007. Feb;30(2):213-8. doi: 10.1093/sleep/30.2.213. PMID: 17326547. Retrieved from <https://pubmed.ncbi.nlm.nih.gov/17326547/>
  9. Taylor DJ, Mallory LJ, Lichstein KL, et al. Comorbidity of chronic insomnia with medical problems. Sleep 2007. Feb;30(2):213-8. doi: 10.1093/sleep/30.2.213. PMID: 17326547. Retrieved from <https://pubmed.ncbi.nlm.nih.gov/17326547/>
  10. Hirst Jeremy M, Irwin Scott A et al. Overview of insomnia in palliative care. Retrieved from <https://www.uptodate.com/contents/overview-of-insomnia-in-palliative-care>
  11. Fiorentino Lavinia, Ancoli-Israel Sonia. Sleep dysfunction in patients with cancer. Curr Treat Options Neurol. 2007 Sep;9(5):337-46. PMID: 17716597. Retrieved from <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2951736/>
  12. Taylor DJ, Mallory LJ, Lichstein KL, et al. Comorbidity of chronic insomnia with medical problems. Sleep 2007. Feb;30(2):213-8. doi: 10.1093/sleep/30.2.213. PMID: 17326547. Retrieved from <https://pubmed.ncbi.nlm.nih.gov/17326547/>
  13. Chia-Ling Lin, Wu-Chien Chien, et al. Risk of type 2 diabetes in patients with insomnia: A population-based historical cohort study. Diabetes Metab Res Rev. 2018 Jan;34(1). doi: 10.1002/dmrr.2930. PMID: 28834008. Retrieved from <https://pubmed.ncbi.nlm.nih.gov/28834008/>
  14. Moran M, Lynch CA, Walsh C, et al. Sleep disturbance in mild to moderate Alzheimer’s disease. Sleep Med. 2005 Jul;6(4):347-52. doi: 10.1016/j.sleep.2004.12.005. Epub 2005 Mar 31. PMID: 15978517. Retrieved from <https://pubmed.ncbi.nlm.nih.gov/15978517/>
  15. Osorio Ricardo S., et al. Greater risk of Alzheimer’s disease in older adults with insomnia. J Am Geriatr Soc. 2011 Mar; 59(3): 559–562. doi: 10.1111/j.1532-5415.2010.03288.x. PMID: 21391952. Retrieved from < https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3378676/>
  16. Banno K, Kryger MH. Comorbid insomnia. Sleep Med Clin 2006; 1:367. https://www.uptodate.com/contents/risk-factors-comorbidities-and-consequences-of-insomnia-in-adults
  17. Loddo, Giuseppe et al. The Treatment of Sleep Disorders in Parkinson’s Disease: From Research to Clinical Practice. Front Neurol. 2017; 8: 42. doi: 10.3389/fneur.2017.00042. PMID: 28261151. Retrieved from <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5311042/>
  18. Pearson, N. J., Johnson, L. L., & Nahin, R. L. (2006). Insomnia, trouble sleeping, and complementary and alternative medicine: Analysis of the 2002 national health interview survey data. Archives of internal medicine, 166(16), 1775–1782. PMID: 16983058. Retrieved from <https://pubmed.ncbi.nlm.nih.gov/16983058/>
  19. Hargens, Trent A et al. Association between sleep disorders, obesity, and exercise: a review. Nat Sci Sleep. 2013; 5: 27–35. doi: 10.2147/NSS.S34838. PMID: 23620691. Retrieved from <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3630986>
  20. Hargens, Trent A et al. Association between sleep disorders, obesity, and exercise: a review. Nat Sci Sleep. 2013; 5: 27–35. doi: 10.2147/NSS.S34838. PMID: 23620691. Retrieved from <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3630986>
  21. Luyster Faith S, Strollo, Patrick J, et al. Association Between Insomnia and Asthma Burden in the Severe Asthma Research Program (SARP) III Chest. 2016 Dec; 150(6): 1242–1250. PMID: 27720882. Retrieved from <https://pubmed.ncbi.nlm.nih.gov/27720882/>
  22. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington, VA 2013.
  23. Singareddy R, Vgontzas AN, Fernandez-Mendoza J, Liao D, Calhoun S, Shaffer ML, Bixler EO. Risk factors for incident chronic insomnia: a general population prospective study. Sleep Med. 2012 Apr;13(4):346-53. doi: 10.1016/j.sleep.2011.10.033. Epub 2012 Mar 17. PMID: 22425576; PMCID: PMC3319648. Retrieved from <https://pubmed.ncbi.nlm.nih.gov/22425576/>