LAUSANNE — There are books and newspaper articles, technologies promising relief, even theater productions devoted to the topic. Indeed, it seems like everyone is talking about insomnia these days.
In Switzerland, insomnia already affects about a third of the population, according to a study carried out between 2009 and 2012 by the Center for Investigation and Research in Sleep at Lausanne University Hospital. And it's only getting worse, say doctors José Haba-Rubio and Raphaël Heinzer, authors a book entitled Je rêve de dormir ("I Dream of Sleeping"). "We are clearly facing a public health problem," Heinzer insists.
But where did it come from? How did this scourge become so strong? Haba-Rubio says it "appeared with the evolution of society" — especially after electric lighting was invented. And is has been accelerated, Heinzer adds, by "the pressures of a productivist world and the perpetual interconnection made possible by new technologies, which have ended up disrupting our sleep-wake rhythms."
With our current way of life, our wake system is hyper-stimulated.
U.S. researchers have conducted studies among three tribes living away from any technology. "None of them had a word for insomnia," Haba-Rubio says. "For them, insomnia doesn't exist. Sleep is still a natural phenomenon."
That may be the case. But there's still the question of why the insomnia problems keep getting worse. Thomas Edison's light bulb isn't exactly a recent invention, after all. Nor, at this point, is the internet, for that matter. Haba-Rubio says the answer lies in our overly stressful and hectic lifestyles.
"There should be a balance in our sleep-wake system," he says. "But with our current way of life, our wake system is hyper-stimulated. We have so much to do, professionally but also in our free time, that the sleep system can't compensate for this state of hyperarousal."
Can't sleep — Photo: Alyssa L. Miller
Complicating matters are our attitudes about sleep, Heinzer argues. "We have great expectations regarding sleep, and that's a real problem," he says, noting as evidence the popularity of electronic and connected gadgets that promise to analyze and improve sleep. "But the more we try to control our sleep so as to perform better the next day, the more it eludes us," he says. "These excessive expectations create a kind of focalization, which can actually end up producing insomnia."
The problem with pills
But what exactly is insomnia? Specialists distinguish secondary insomnia (which is related to another pathology, such as depression or respiratory illness) from primary insomnia. By nature, though, sleep disorders can easily become chronic, meaning that in the case of the secondary variety, the insomnia can continue even after the contributing pathology has been treated.
"Secondary insomnia then becomes a pathology in itself," Haba-Rubio explains. "It's as if the brain has learned to sleep badly."
When dealing with primary insomnia, doctors talk in most cases about "psychophysiological" insomnia. And for good reason: If the insomnia is triggered by a psychological factor, stress or a difficult event, "this episode will induce a real change of the brain system," says Haba-Rubio. "Sometimes it only takes a few bad nights for insomnia to set in. This bad memory remains, and ultimately it's the fear of not being able to sleep that prevents you from sleeping."
In terms of treatments, somnologists advocate the benefits of cognitive-behavioral therapy, which consists of techniques to relearn how to sleep, by temporarily restricting the amount of time spent in bed, for instance. The goal is for patients to change their bedtime behavior and get back to enjoying the experience.
You will always need to increase the dosage.
Breaking the association between bad nights and poor performance is also a way to block the anxiety insomnia can generate. "It is essential that insomniacs be able to regain confidence in their ability to sleep," Heinzer explains. "It's the only way to break this vicious circle."
The doctors don't recommend sleeping pills. "We haven't found the right medicine, the perfect sleeping pill that produces physiological sleep," Haba-Rubio says. "These are only drugs that slow down wakefulness and slow down brain activity, with all the potential side effects and addiction risks this entails."
The other pitfall of sleep medication is that users build up a tolerance. "For the drugs to keep on having the same effect, you will always need to increase the dosage," he adds. Despite the risks, an estimated one in five Swiss people take sleeping pills at least once a month.
Even for those who don't get hooked on pills, insomnia can have some some serious personal and economic repercussions and ought, therefore, to be treated as a real public health issue, Haba-Rubio and Heinzer argue. A good starting point would be to launch a public information campaign on "sleeping well," the way the state already does for healthy eating.
"We know that the less we sleep, the more we encounter other health problems," says Haba-Rubio.