‘my life is on hold because i can’t sleep’: the exhausting cycle of chronic insomnia
claudia martens has lived regularly on just a few hours of sleep a night for the last three decades — a pattern that’s affected nearly every aspect of her daily life.
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martens is among the six to 10 per cent of canadians who meet the clinical criteria for insomnia disorder. matthew bruce / aspire photography and film
this story is sponsored by
idorsia pharmaceuticals canada ltd.
this story was created by content works, postmedia’s commercial content division, on behalf of a client.
claudia martens has struggled her whole life to get a good night’s sleep.
when she was younger, she often woke up during the night and found it difficult to fall back to sleep. “at the time, it didn’t occur to me there was something wrong,” martens recalls.
by the time she was a young adult and working full-time, martens knew something was very wrong. no matter how tired she was, deep, healing sleep remained out of reach. her insomnia had become persistent and unrelenting. “i got to the point where i just couldn’t function anymore at work. i was like a zombie.”
most of us have experienced that zombie-like feeling after not sleeping well, but successive nights of little to no sleep can lead to far more serious health complications.
“sleep affects mental health and physical health. it is one of the most important processes in our lives,” says toronto-based psychiatrist, dr. martin katzman. “it’s a regenerative process that allows us to recover and heal after the day’s challenges. it impacts everything from neurobiology and cognition to cardiovascular health,” he says.
damaged sleep, and her sleep debt, has taken a toll on martens for more than three decades. “my life is on hold because i can’t sleep,” she says. “i do have a life; i just can’t do a lot of the stuff i want to do because of my insomnia.”
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the stress of living with continual sleeplessness has shown up in various aspects of martens’ life. insomnia drove her to recently retire at age 55, a decision that has impacted her financially. she repeatedly cancels planned activities when she feels too exhausted or unsafe to drive. “there are times i just didn’t want to see anybody,” she says. “i didn’t want to talk to anyone because i was so sleep-deprived. no one can go through this without it affecting their mental well-being.”
martens’ continual difficulties with sleep fit the definition of chronic insomnia, typically diagnosed when someone has trouble falling or staying asleep at least three nights a week for three months or more and causes clinically significant distress or impairment in daytime functioning. she is among the six to 10 per cent of canadians who meet the clinical criteria for insomnia disorder.
over the years, martens has tried approaches to manage her insomnia including meditation, exercise, alternative therapies like acupuncture, reflexology, various herbal supplements, and sleep clinic sessions — all with limited success. unsurprisingly, she also takes sleep hygiene very seriously, maintaining careful bedtime routines to create the best possible conditions for sleep. and yet, despite her efforts, restorative sleep remains out of reach.
sponsored by:
idorsia pharmaceuticals canada ltd
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just over 25 years ago, martens was prescribed a low-dose sleeping pill for the first time. since then, she has treated her insomnia with different medications, which she says have been somewhat helpful. but the “foggy” feeling lasts well into the next day. “normally i’m a morning person and when i’m on sleeping pills i can’t function before 10 am.”
dr. katzman says two options are typically considered in treating chronic insomnia: “broadly speaking, there are pharmacological and non-pharmacological approaches.”
dr. martin katzman is a toronto-based psychiatrist. supplied
the often-recommended latter approach is cognitive behavioural therapy for insomnia (cbt-i). this drug-free treatment helps patients identify and change thoughts and habits that make it challenging for them to fall or stay asleep. cbt-i typically involves 4–8 weekly sessions with a trained therapist, lasting 30 to 90 minutes each session.
dr. katzman describes cbt-i as a first-line approach to treating insomnia but points out that access can be challenging for some patients. “it can be hard to find clinicians with expertise,” he says. “plus, not all health plans cover cbt-i.” furthermore, following cbt-i can be difficult, particularly with stimulus control and sleep restriction, as both require consistent discipline and effort. martens says she tried cbt-i, but after 10 sessions without progress, her therapist recommended ending treatment due to the lack of response.
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regarding pharmacological approaches to treating insomnia, dr. katzman points to benzodiazepines as a traditional option. benzodiazepines have a sedative effect by slowing activity in the brain and nervous system. dr. katzman says other drugs, such as antidepressants, often prescribed to treat insomnia, have the same sedating effect.
he says sedation as an approach to overcoming insomnia has its limitations. when the cause of insomnia is anxiety or stress, waking in the night can cause the body to go into fight-or-flight mode. “your body is reacting as though it’s in acute danger,” he explains. “over time, the body tends to fight sedation. so, as you add a sedative, your body tries to fight it. and this can often result in tolerance and can lead to things like dependence and substance abuse.”
a recent study in ontario suggested inappropriate medication use was noted in more than half of adult patients between the ages of 18 and 65 and nearly 70 per cent of seniors over 65.
furthermore, dr. katzman says those sedating agents can remain in your system through the night and into the next day. “as these agents might drop your blood pressure or sedate you such that your coordination is off, your risk of falling goes up,” he says. “and, of course, falls can trigger a major change in quality of life.”
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recent developments in the treatment of insomnia include an approach that focuses on targeting the specific brain mechanisms that interfere with sleep, offering a more precise way to help people get the rest they need without the sedating effects of traditional sleep medications.
this new class of medications, called dual orexin receptor antagonists (doras), have been available in canada for several years. doras block orexin receptors in the brain, which promote wakefulness. by selectively blocking these receptors, doras help quiet the brain’s wake signals, allowing patients to fall asleep.
“the value of doras is that they target the exact problem and are minimally sedating,” says dr. katzman. “for instance, if your body is staying alert because it senses danger, a dora helps by turning off that internal alarm — treating the root cause of wakefulness.” he adds that without the sedating effect, there is less risk of next-day drowsiness with doras, reducing the risk of “bad outcomes like falls and motor vehicle accidents.”
chronic insomnia can have a profound impact on all areas of everyday life. there is no one-size-fits-all quick fix to treating a sleep disorder, but your life doesn’t have to stay on hold. talk to your health-care provider about treatment options available to you to help you experience more restful sleep.
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this story was created by healthing content works, healthing.ca’s commercial content division, on behalf of idorsia pharmaceuticals canada ltd.
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