# Exercise as it relates to Disease/Exercise to improve sleep quality in insomnia

Insomnia is a sleeping disorder characterised by:
* Difficulty initiating sleep$^1$
* Difficulty maintaining sleep$^1$
* Decreased quality and quantity of sleep$^2$
Insomnia is more prevalent in adulthood and worsens with age, especially in those over 65. If left untreated, it can lead to more severe medical conditions$^3$. It can also affect quality of life and have a negative impact on non-sleeping parts of the day by decreasing mood, causing fatigue, decreasing concentration and cognitive ability during the day.$^4$

## Treatment

There are several different types of treatments available for insomnia:
* CBT (Cognitive Behavior Therapy): Which includes Sleep Hygiene$^5$, Stimulus control$^6$ and Relaxation Technique$^7$
* Medications: Which includes Hypnotic Medications, Antidepressants$^8$, Opioids$^9$ and Antihistamines
* Other treatments: Natural substances such as magnesium, melatonin, valerian and medical marijuana have shown to have effective responses to helping insomnia$^{1011}$

## Aerobic and Resistance Exercise

Research has shown that both aerobic and resistance exercises help reduce the effects of insomnia by:
* Decreasing time onset to sleep and number of sleep disturbances$^{112}$
* Increasing sleep quality and total sleep time$^{113}$
These changes in sleeping patterns importantly lead to: decreases in daytime dysfunction and pre-sleep anxiety $^{112}$, increases in mood and quality of life$^{15}$

## Recommendations and Considerations

The following recommendations refer to the ideal training for maximum efficiency at reducing the effects of insomnia. Aerobic Exercise:
* 3–4 days per week for 30–40 minutes at a moderate intensity$^{13}$
* Exercises can include walking, cycling and low impact aerobics$^{1312}$
Resistance Exercise:
* 2–3 days per week completing 2-3 sets, 10 repetitions 6-8 exercises $^{112}$
* Exercises that utilize bother lower and upper muscle groups, including bench press, leg press, leg extension and shoulder press$^{114}$
* Exercises completed at 50% 1RM (moderate intensity)$^{114}$
Considerations:
* Age: As insomnia is more common in persons aged 65+ it is important to ensure their training program is appropriate.Persons over the age of 65 should consult a doctor or healthcare professional prior to commencing a training program
* Exercise-Induced Insomnia and Time of Day: High intensity exercise can cause exercise-induced insomnia$^1$. Exercising before bed time can also lead to exercise-induced insomnia. High intensity exercise and exercise in the afternoon should be avoided to decreased the symptoms of insomnia$^{12}$

## Further reading

Sleep Foundation http://www.sleepfoundation.org/article/sleep-related-problems/insomnia-and-sleep
Snore Australia Insomnia Information Snore Australia Insomnia Information

## References

* Passos, GS., Poyares, D., Santana, MG., Garbuio, SA., Tufik, S, Mello MT. (2010). Effect of acute physical exercise on patients with chronic primary insomnia. Journal Clinical Sleep Medicine. 6(3): 270-275.
* Holbrook, AM., Crowther, R., Lotter, A., Cheng, C., King, D. (2000). The diagnosis and management of insomnia in clinical practice: a practical evidence-based approach. Canadian Medical Association Journal. 162(2): 216-220
* Montgomery, P., Dennis, J. (2002). Physical exercise for sleep problems in adults aged 60+. Cochran Database of Systematic Reviews. 1(4): CD003404.
* Roth, Thomas. (2007). Insomnia: Definition Prevalence, Etiology, and Consequences J Clin Sleep Med, August 15(3), S7–S10.
* Morin, C. M., Bootzin, R. R., Buysse, D. J., Edinger, J. D., Espie, C. A., & Lichstein, K. L. (2006). Psychological and behavioral treatment of insomnia: update of the recent evidence (1998–2004). SLEEP-NEW YORK THEN WESTCHESTER-, 29(11), 1398.
* Running on Empty: Fatigue and Healthcare Professionals. Medscape. Aug 02, 2012.
* Lehrer, Paul M.; David H. (FRW) Barlow, Robert L. Woolfolk, Wesley E. Sime (2007). Principles and Practice of Stress Management, Third Edition. p. 38. ISBN 1-59385-000-X.
* Bertschy G, Ragama-Pardos E, Muscionico M et al. (2005). "Trazodone addition for insomnia in venlafaxine-treated, depressed inpatients: a semi-naturalistic study". Pharmacol. Res. 51 (1): 79–84
* Ramakrishnan, K.; Scheid, DC. (2007). "Treatment options for insomnia". Am Fam Physician 76 (4): 517–26. PMID 17853625.
* Zammit G; Erman M; Wang-Weigand S; Sainati S; Zhang J; Roth T. Evaluation of the efficacy and safety of ramelteon in subjects with chronic insomnia. J Clin Sleep Med 2007;3(5):495-504
* Meolie AL, Rosen C, Kristo D et al. (2005). "Oral nonprescription treatment for insomnia: an evaluation of products with limited evidence". Journal of Clinical Sleep Medicine 1 (2): 173–87
* Roveda, E., Sciolla, C., Montaruli, A., Calogiuri, G., Angeli, A., Carandente, F. (2011). Effects of endurance and strength acute exercise on night sleep quality. International SportMed Journal. 12(3): 113-124.
* Singh, NA., Clements, KM., Fiatarone, MA. (1997). A randomized controlled trial of the effect of exercise on sleep. Sleep. 20(2): 95-101.
* Ferris, LT., Williams, JS., Shen, C., O’Keefe, KA., Hale, KB. (2005). Resistance Training Improves Sleep Quality in Older Adults – A Pilot Study. Journal of Sports Science and Medicine. 4: 354-360.
* Reid, KJ., Baron, KG., Lu, B., Naylor, E., Wolfe, L., Zee, PC. (2010). Aerobic exercise improves self-reported sleep and quality of life in older adults with insomnia. Sleep Medicine. 11(9): 934-940.