The 7 most important mental health effects of insomnia

What is the impact of insomnia on people's mental health?

The brain is an organ that harbors countless mysteries. Among all of them, sleep is one of the processes that has aroused the greatest curiosity since ancient times, where it was understood as a bridge between the earthly and the divine. As an open door to the beyond.

We spend between a third and a quarter of our existence entangled in its fine threads, yielding fundamentally during the night to the drowsiness that guides us towards its most inhospitable territories. We all sleep, as it is a universal necessity for survival (and a pleasure for most of us).

However, there are many people who complain of poor quality sleep, either because they find it difficult to fall asleep or because they wake up many times during the night. There are also those who wake up earlier than expected, and all of them tend to feel very tired.

This article discusses the consequences of insomnia on mental health.It is known that the compromise in this area is one of the most important indicators for the inference of psychological suffering. Let's see it, then, in detail.

What is insomnia?

It is understood by insomnia all alteration in the process of sleeping, so much in its beginning (difficulty when acceding to the dream), as in its continuation (constant interruptions) and/or its ending (waking up too early); that limits the quality of life and interferes substantially in the daily activity.

Three basic dimensions could be distinguished in this regard: duration (total time spent asleep, for which there is great variability in terms of interindividual differences), continuity (which is equivalent to the persistence of the process for a sufficient length of time to obtain benefits) and depth (associated with physiology and neural activation). Any of these can be acutely compromised at some point in the life cycle.

Roughly speaking, sleep tends to be divided into two distinct stages: REM and non-REM (nREM).. The latter involves a series of phases (1 to 4) in which there is a progressive slowing of the activity of the central nervous system (CNS), while in the former (which lasts 25% of the time) there is an increase or electrical hyperactivation similar to wakefulness (with eye movements). Both alternate in 90-minute cycles throughout the night, in which the REM phase is extended, and are necessary for the relevant neural rest to occur.

The three forms of insomnia that have been mentioned represent, in their most intimate nature, a difficulty in accessing REM sleep in a pertinent manner (especially when it becomes difficult to stay asleep for the time required to complete the successive cycles). As the situation becomes prolonged, a myriad of physical, cognitive and emotional complications arise. It is important to keep in mind that one third of people recognize occasional sleep problems, and that 10% meet the criteria for a diagnosis of insomnia. As can be deduced, this is not a strange situation, as a significant percentage of the general population identifies with it.

Let us now look at the specific impact of insomnia on psychological health, bringing together the seven most important consequences that can result from it. When any of them occur, it may be worthwhile to visit a health specialist.

Main effects of insomnia on mental health

The relationship between insomnia and mental health is bidirectional: when one is affected, so is the other, regardless of which is considered the cause and which the effect. These are complications that sometimes have a certain gravity, and in some cases even imply an objective risk to life. That is why the treatment of this problem is important, and should never be considered as a minor or incidental matter. We will go into detail on all of this.

1. Emotional changes

One of the common consequences of having poor quality sleep is mood fluctuation, and there is evidence that insomnia and difficulties in regulating emotion have common physiological bases..

Thus, poor sleep can be related to depressive and anxious symptoms, as well as to a notable irritability. In fact, nowadays we know that those who suffer from this type of condition see their intensity worsen when they also have problems in getting a good night's sleep. Pain as a symptom deserves special mention: its presence disturbs sleep, while insomnia promotes a reduction in the pain threshold (making the experience much more intense and difficult to control).

At the process level, it is known that people with insomnia tend to interpret the adverse events they face in a more negative way, and that they also have difficulties in trying to extract the positive aspects of daily experience. This problem is associated with hyperfunction of the amygdala (limbic region in charge of processing different emotions) and a functional decrease in its connection with the prefrontal cortex, on which the emotions "depend".The cognitive mechanisms through which we deal with the turbulences inherent to life "depend" on the prefrontal cortex. All this facilitates a certain tendency to frustration, in cases where daily vicissitudes cannot be solved with the desired immediacy.

On the other hand, there are a few studies that suggest that the accumulation of sleepless nights substantially reduces emotional intelligence evaluated through self-reports. From this it could be deduced a concrete erosion in the basic ability to identify, recognize and communicate what is going on inside us; as well as to infer the states of others when interacting with them.as well as to infer the states of others when interacting with them. In any case, this would be a reversible effect over time, as restorative rest would restore their previous level of "functioning" (since intelligence is a relatively stable trait throughout life).

Finally, many studies indicate that people with insomnia may see altered cognitive decision-making and behavioral inhibition (both dependent on the prefrontal cortex); which would interact with depression, anxiety and/or irritability. The result implies the deployment of passive or impulsive patterns of actionThe result implies the deployment of passive or impulsive action patterns, which are associated with a higher probability of failure during the search for solutions to a problem. This is why it is never recommended to deal with matters of great importance under the influence of insomnia or adverse emotional states.

2. Memory problems

Interference in memory domains is often a recurring complaint among those who have trouble sleeping. Most commonly, declarative memory, especially the procedural subtype, is impaired, limiting the ability to recall events of the recent past.

In turn, an erosion in working memory has been described in connection with insomnia (a function that allows the temporary storage of information for use during a specific task). In the latter case it is very common to experience difficulties in understanding a written/spoken text of a certain length, or in successfully carrying out activities that require a certain amount of time.or to successfully carry out activities that require storing information in the background.

REM sleep is a key physiological process for maintaining memory, since it optimizes the neural process by which we consolidate information in long-term storage and/or eliminate accessory and useless data. It is basic, therefore, for learning; from which it is understood that spending a night awake to study is usually an inadequate and counterproductive strategy. Thus, a subject who finds it difficult to sleep may report difficulties when trying to acquire new knowledge, as well as when applying it later (as in an exam, for example).

Memory problems and insomnia often occur together in older people, and they may share some of the same problems.They may share some physiological basis (such as calcification of the pineal gland, which may also contribute to cortical dementias). Finally, the strong relationship between insomnia and memory decline may be due to the use of sedative/hypnotic psychotropic drugs (benzodiazepines, for example) prescribed for the treatment of sleep disorders, since we know that their prolonged or excessive administration precipitates harmful effects in this area (anterograde amnesia or serious blockage when generating new memories).

3. Attention problems

Along with memory, attention is the process that is most commonly compromised when restful sleep becomes difficult. Usually the orientation response to stimuli that abruptly burst into the perceptual field is fundamentally damaged, which increases response times (the person seems self-absorbed and slowed down). An impairment of alternating attention, i.e., the ability to "switch" focus when two tasks follow each other (one after the other) in short periods of time, has also been observed.

Finally, this decline can be generalized to the sustained and selective subtype.. In this case, there would be explicit problems in maintaining attentional resources during the development of a task whose long extension so requires, as well as in discriminating in a complex environment which of the stimuli are relevant to the intended goal and which are not. Thus, when the person is immersed in an environment saturated by several elements that compete with each other for his or her attention, a feeling of overflow (appreciable when managing a large volume of information) would arise.

Attentional deficits also imply a higher risk of accidents.This would result in increased distractibility and loss of reflexes. For this reason, those who are regular drivers of any vehicle should be especially cautious when suffering from insomnia.

4. Sexual problems

Insomnia can be related to deficits in the sexual sphere, especially in men. Most commonly it is expressed at the erectile level, with problems in reaching a firm swelling of the penis that makes penetration possible. The most notable difficulty is found when the person coexists with other additional clinical symptoms, such as sleep apnea, "delayed" circadian rhythm (falling asleep and waking up too late) or restless legs syndrome (pressing and distressing need to move the legs to relieve an apparent tension that accumulates in them).

Some hypotheses suggest as a possible cause for erectile dysfunction a noticeable reduction of testosterone in Blood circulationThis has been evidenced among men who have difficulty falling asleep properly or who wake up many times during the night (especially in the second half of the night).

There is evidence that the production of this hormone is increased during the beginning of sleep (reaching its peak in the first REM phase), and that its levels are higher during sleep than when awake. Insomnia would hinder its synthesis, which would affect erection (since it is essential for this process), and would also contribute to the increase of cardiopathologies in this population (a risk that has been suggested). in this population (a risk that is accentuated in the case of insomniacs when compared to those who rest well).

5. Hallucinations

Hallucinations are anomalous perceptions involving stimuli that are not in the perceptual field, in any sensory modality. There are many studies in which it is pointed out that insomnia in extreme cases can cause very diverse hallucinations, even in people without any type of pathology.

Some of the ones that accumulate more evidence are hypnagogic (in the process from wakefulness to sleep) and hypnopompic (in the transition from sleep to wakefulness), as well as those that occur in the context of sleep paralysis. All are much more frequent when the person has not slept adequately in the previous days..

In people with a psychotic disorder, such as schizophrenia, insomnia is considered a risk factor for the recurrence of an acute episode or for its onset. In fact, it is one of the main symptoms of the prodromal stage, which precedes the articulation of the "definitive" picture (and which lasts for months or even years). Such insomnia would anticipate the onset of paranoid delusions in some patients, which could be explained by an elevation in the level of dopamine after the first sleepless night (a compensatory mechanism to buffer the deficit of cognitive functions that usually occurs at this time).

6. Reduced vitality

The loss of vitality, at the extreme end of which is fatigue, has as its basic cause (in the general population) a poor quality of sleep. It is a common circumstance, which coincides with the total percentage of people with occasional difficulty to sleep fully (between 20% and 40%, especially in women). The problem results in high daytime sleepiness and loss of productivity, and may even be associated with depressive feelings and impaired memory or attention (referred to above).

Fatigue associated with insomnia is associated with a perception of intense loss of energy, generalized weakness, and generalized weakness. loss of energy, generalized weakness, feelings of malaise and erosion of performance in daily tasks.. Of all the problems that disrupt the integrity of sleep or its structure, apnea is perhaps the most consistent trigger (respiratory blockage that causes a series of brief micro awakenings, which interrupt the active sleep cycle before reaching the restorative phases of REM).

7. Increased risk of Alzheimer's disease

The relationship between insomnia and Alzheimer's disease has been known since the 1990s, although it has only been in the last decade that we have been able to increase our knowledge of this issue. Thanks to neurophysiological studies, and with the invaluable help of neuroimaging techniques or the analysis of postmortem brain tissue, we have come to the conclusion that one function of sleep is to "clean up" the residues of neuronal activity.. Throughout the day, the fact of being awake implies a production of proteins in the central nervous system whose persistence is toxic, but which are "emptied" each time we sleep to avoid excess or accumulation.

Among all of them, it has been shown that beta amyloid protein is undoubtedly the most important explanatory protein, since it is one of the elementary anatomopathological bases of such frequent cortical dementia. Well, it has been corroborated that insomnia promotes its accumulation in the medium/long term, enhancing one of its most important physiological risk factors (according to the available evidence).

Bibliographic references:

• Cunnington, D., Junge, M. and Fernando, A. (2013). Insomnia: Prevalence, consequences and effective treatment. The Medical journal of Australia, 199(8), 36-40.
• Fernandez-Mendoza, J. and Vgontzas, A. (2013). Insomnia and Its Impact on Physical and Mental Health. Current psychiatry reports, 15(12), 418.
• Marin, A., Franco, A., Vinaccia, S., Tobon, S. and Sandin, B. (2008). Sleep disorders, health and quality of life: A perspective from behavioral sleep medicine. Suma Psicologica, 15(1), 57-64.