By Sally Hamm, MD, MPH and Ann Backus, MS, Harvard Chan School of Public Health
It’s late. So late. You’re tired. So tired. You should be asleep by now. What time is it anyway? It seems like you’ve been lying here for hours. You check your phone, mutter something not suitable for polite company under your breath. You know you need to sleep or you’ll feel like you were run over by a boat when the alarm goes off in just a few hours. You’re strong. You’re sturdy. You’re used to pushing yourself to do things you don’t want to do. You’re so tired it hurts, but you just can’t force yourself to sleep. The frustration is building, and you keep running through your mind all the things you’ll have to do tomorrow, all the people who are counting on you to be on your game. Maybe you get up and walk around. You look around for anything that might help. You realize that in the morning it’ll take a lot of caffeine to cover up this drag, and then you’ll be buzzed and tired. You have Insomnia.
Unfortunately, you’re not alone. Globally, one-third to two-thirds of adults struggle with insomnia symptoms, and 10-15% are so severe that they qualify for an insomnia disorder. In a recent study of commercial fishermen in Alaska, Oregon, and Massachusetts by the Northeast Center for Occupational Safety and Health, nearly one in three of the 262 fishermen who responded to the study surveys said they have trouble going to sleep and nearly half of the fishermen who responded said they have trouble staying asleep.
Insomnia can be caused by pain, stress, or a poor sleeping environment. It can also be a symptom of medical conditions like high blood pressure, diabetes, heart failure, or COPD, or mental health struggles like depression, anxiety, or PTSD. It can be a side effect of certain medications and of alcohol use. The insomnia based on these causes is called secondary insomnia. The insomnia that just comes out of the blue without any of those causes is called primary insomnia. Having a family history of insomnia can also increase your risk, as can social isolation.
Both reduced sleep quantity and quality can lead to compromised daytime function including fatigue, difficulty focusing, mood problems, irritability or aggression, impulsivity, reduced motivation, and increased errors and accidents. Long-term, insomnia increases the risk for high blood pressure, heart attacks, strokes, diabetes, obesity, depression, anxiety, erectile dysfunction, chronic pain, and addiction.
Insomnia can also be a vicious cycle. Lying awake in bed wanting to sleep but not being able to sleep is frustrating. Frustration activates stress hormones and alertness centers in the brain, and a stimulated mind and body has trouble falling asleep. Sometimes the solutions you try can make it worse. Looking at a screen, to scroll or even just to check the time, causes your eyes to send signals to your brain to turn off the melatonin your body produces that, in turn, would normally lead to sleep.
Alcohol might knock you out, but it interferes with sleep quality and makes the morning symptoms that much worse. Modern sleep medications can have a short-term benefit, but when you use them more than a couple of weeks, you can develop a psychological dependence that makes it hard to sleep without them. Taking caffeine to compensate for inadequate sleep can also create a dependence on caffeine. Taking it too late in the day can interfere with the next night’s sleep. Tobacco might calm your nerves in the moment, but nicotine is also a stimulant that interferes with sleep.
So, what can be done to help? If you’re struggling with insomnia, it’s worth taking an extra visit to the doctor just for that, because insomnia can be the first or most noticeable symptom of some other medical or mental condition.
In the meantime, set your sleep up for success with something called Sleep Hygiene. You spend up to a third of your life in your sleeping space, so invest in ways to make your room or bunk conducive to sleep.
Given that insomnia can be a symptom of some serious medical conditions, if practicing good sleep hygiene as outlined above does not help it may be time to seek the care of a healthcare professional. And because reduced quantity and quality of sleep can result in cognitive impairment and poor-decision-making, insomnia is not only a health issue but a safety issue as well for commercial fishermen.