Chronic insomnia has wide-ranging effects, and the complications ascribed to it are myriad. The most overt complication of insomnia is addiction and dependence on medications used to treat its symptoms. Benzodiazepines in particular, which are a class of medications that includes Valium®, have a host of problems associated with long-term use. The pharmaceutical lorazepam is a benzodiazepine commonly prescribed. Tolerance and even rebound insomnia symptoms may occur with long-term use (more than six months), along with other complications, such as cognitive impairment, agitation, depression, anterograde amnesia (the loss of the ability to create new memories), confusion, nightmares and safety issues (like motor vehicle accident). In studies, 58 to 84 percent of patients prescribed benzodiazepines were still taking them six months after initiation. Equally concerning is the specter of codependency with alcohol and drugs. In one study, 80 percent of people reporting long-term benzodiazepine use carry other diagnoses, such as alcoholism, depression or substance abuse, and up to 40 percent of alcoholics report benzodiazepine use. Due to the high risk of tolerance and dependence, these drugs have fallen out of favor for the treatment of insomnia. Newer benzodiazepine-like medications, such as zolpidem and eszopiclone, with lower abuse potential are becoming more commonly prescribed.
Obesity is more prevalent in adults with insomnia who sleep less than six hours per night, and growing evidence points to an association between insufficient sleep and childhood obesity. Children with insufficient sleep time have twice the risk of being obese than children with sufficient sleep times. Correlations have also been made between obesity and excessive screen time (via television, smartphones and video games) in children and adolescents. Approximately 71 percent of American youth report a television in their bedroom, and this has direct implications for sleep hygiene and sleep duration. Television- and Internet-free bedrooms are recommended by numerous organizations, including the American Academy of Pediatrics. Use of these devices close to bedtime can elicit insomnia and delay sleep phase in children and adolescents by disrupting their natural circadian rhythms and marginalizing their potential for getting adequate slow-wave and rapid eye movement (REM) sleep. Slow-wave sleep is particularly important in children and young adults because substances like growth hormone are released during this sleep phase. While slow-wave sleep naturally decreases with age, early loss of slow-wave sleep has been associated with metabolic abnormalities that perpetuate obesity, diabetes and high blood pressure.
Poor sleep can impact athletic performance in both elite and recreational athletes. Insufficient sleep has been shown to reduce cardiovascular response to exercise by 11 percent. Insomnia symptoms and chronic short sleep have also been associated with increased pain perception, higher levels of pre-training fatigue, decreased learning and memory functioning, impaired inflammatory and immune responses and prolonged recovery from high-intensity training. A number of issues contribute to sleep deprivation in athletes. Early-morning training sessions, excessive caffeine and frequent nighttime urination due to aggressive hydration strategies can contribute to insomnia.
Younger People More at Risk
Younger people are even more susceptible to the adverse effects of chronic sleep deprivation. A minimum of nine hours of sleep per night is generally recommended for adolescents 12 to18 years old. In one study, student athletes with less than eight hours per night of sleep over a 30-day period were 1.7 times more likely to suffer a sports-related injury than a comparable group of student athletes getting more than eight hours of sleep per night. In swimmers mandated to sleep 10 hours or more per night for seven weeks, significant improvement was seen in 15-meter sprint times, reaction time, turn time and overall mood. Sleep has also been strongly associated with skill learning and skill acquisition. Early-morning workouts can be particularly deleterious to sleep quality in young athletes, and coaches should be mindful of this issue.
Finally, it is important to know that one bad night’s sleep does not generally impair athletic performance. Two-thirds of elite athletes report worse-than-normal sleep on the night preceding a competition. The excitement, anxiety and apprehension that often contributes to pre-competition insomnia can be mediated by increasing sleep on the days prior to competition and being mindful of maintaining good sleep and nutritional habits in the time leading up to competition.