# Exercise as it relates to Disease/aerobic vs anaerobic exercise with insomnia

Insomnia is a common, subjective condition of unsatisfactory sleep. It can be categorized as transient (less than one week), acute (symptoms lasting up to 1 month) and chronic (symptoms present for over 1 month). While the cause of insomnia is not required for diagnosis, it usually stems from a specific stressful life event. This can develop into a chronic condition if the precipatory stress remains, poor sleep habits or due to issues with sleep-regulating mechanisms. In some cases, it is an underlying psychological or physiological condition that is the cause e.g depression, anxiety, cancer or arthritis

### Prevalence

Some research suggests that up to 30% of western populations present with symptoms of insomnia. It is found to be 1.5 to 2 times more likely to occur in women. In older populations, insomnia is reported to affect up to 50%. Insomnia is present in more than 50% of people who already suffer from 2 or more health conditions. Additionally, half of cases of insomnia are related to psychiatric disorder.

### Symptoms and Diagnosis

Compiled diagnostic criteria from the International Classification of Sleep Disorders (ICSD) International Classification of Diseases (ICD) and Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) defines insomnia by the sharing of three key elements:
| Difficulty with: | Occurs: | One or more of these symptoms post-rest: |
| initiating sleep maintaining sleep waking up too early non-restorative sleep | Despite adequate opportunity for sleep Occurs 3 times/week for a month At least a month | fatigue or malaise error proneness attention, concentration or memory impairment mood daytime sleepiness motivation, energy or initiative anxiety over sleep tension, headaches or GI distress |

### Co-morbidities

There is a high co-morbidity rate with insomnia and many physiological and psychological conditions including:
| Physiological | Psychological |
| Coronary Heart Disease Hypertension Arthritis Lung Disease (including chronic bronchitis, asthma and emphysema) Cancer Back Problems Hip impairment Prostate problems | Major Depressive Episodes (MDE) Anxiety Schizophrenia |

## Treatments

Pharmacological treatment is still the highest used intervention, however evidence of long term efficiency of this treatment is under analysed. Psychological treatments have been assessed with varying degrees of success. Hypnotherapy has shown improvements to sleep latency, total sleep time, total sleep quality as well as reduced night time awakening but also reported adverse affects such as increased falls risk and confusion in older populations Behavior therapy consisting of lifestyle changes, diet changes and better sleep habits prior to sleep, exhibit decreased sleep latency and time spent awake and, therefore, increases total sleep time by approximately 30 minutes and efficiency of sleep by 70-85% Behavior therapy are not as readily available to the general population as they must be administered by a specialist. Physical exercise could be an alternative or complementary approach to existing therapies for sleep problems

### Exercise Treatments
#### Aerobic

Moderate intensity aerobic exercise has shown to be an effective treatment option for insomnia and other sleep-related conditions. High intensity aerobic exercise has shown no significant effect on time spent in sleep stages or perceived quality of sleep All perceived effects were obtained using the Pittsburgh Sleep Quality Index (PSQI). Total Sleep time, Sleep Efficiency and Sleep onset latency values were obtained via polysomnography.
| Intensity | Duration | Effects |
| Moderate (50-85% HRMax) | 40–60 minutes, 3-5 times/week | Improved perceived sleep quality Reduced sleep onset latency Reduced insomnia medication use Increased Total Sleep Time (TST), Sleep Efficiency (SE) and Sleep Onset Latency (SOL) |
| High (85%+ HRMax) | 60 minutes, 3-5 times/week | No significant effects |

#### Anaerobic

The majority of research on anaerobic exercise an its' effect on insomnia symptoms show negative results with no change in Slow Wave Sleep (SWS) or Rapid Eye-Movement sleep (REM) and positive studies are derived from single bouts of exhaustive exercise Positive effects were still observed within particular intensities of training. Perceived long-term sleep quality was assessed using the PSQI scale and perceived short-term sleep quality was assessed using the Likert scale.
| Intensity | Duration | Effects |
| Moderate (50% of 1RM) | 60 minutes | no significant effect on anxiety or sleep variables |
| High (80% of 1RM) | 60 minutes, 3 times/week | Improved perceived long-term sleep quality Improved perceived short-term sleep quality Positive increase in depression score Positive increase in general health score |

## Recommendations

* Moderate-Intensity aerobic exercise (50-85% HRMax), 40–60 minutes and at least 3 times per week has highly documented scientific and perceived benefits for those suffering insomnia symptoms.
* High-intensity aerobic training showed no benefits to perceived sleep quality
* Moderate-intensity anaerobic training showed no benefits to those categorized as 'poor sleepers'
* While there is evidence that increases in perceived sleep quality and general health can be achieved through high-intensity anaerobic exercise (80% 1RM) further research in the area is required to confirm these benefits. Questions also arise about adherence to this training intensity with older adults

### General Tips for improved sleep

* Do not exercise within 4 hours of sleep
* Do not smoke 6 hours prior to sleep
* Do not consume alcoholic beverages 6 hours prior to sleep
* Do not consume stimulants 6 hours prior to sleep

## Further reading

* National Sleep Foundation
* Sleep health foundation - Fact sheet on insomnia
* Snore Australia
* Mental Health information

## References

* 1 2 3 Ohayon, M. (2002) Epidemiology of insomnia: what we know and what we still need to learn. Sleep medicine review. vol: 6(2), 97-111
* 1 2 3 4 5 Wilson, S. et al. (2010) British Association for Psychopharmacology consensus statement on evidence-based treatment of insomnia, parasomnias and circadian rhythm disorders. Journal of Psychopharmacology. vol: 24(11), 1577–1600
* ↑ Reid, K. et al. (2010). Aerobic exercise improves self-reported sleep and quality of life in older adults with insomnia. Journal of Sleep Medicine. vol: 11(9), 934-940.
* ↑ Edinger, J. et al. (2004). Derivation of Research Diagnostic Criteria for Insomnia: Report of an American Academy of Sleep Medicine Work Group. SLEEP 2004. vol: 27(8), 1567-96
* 1 2 3 4 5 6 7 8 9 10 11 Katz, D. et al. (1998). Clinical Correlates of Insomnia in Patients With Chronic Illness. Arch Intern Med. 1998. vol: 158(10). 1099-1107
* ↑ Glass, J. et al. (2005). Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits. BMJ. 2005. vol: 331. 1169.
* 1 2 3 4 Yang, P. et al. (2012). Exercise training improves sleep quality in middle-aged and older adults with sleep problems: a systematic review. Journal of Physiotherapy. vol: 58(3). 157-163
* ↑ Brassington, S. et al. (1995). Aerobic exercise and self-reported sleep quality in elderly individuals. Journal Of Aging & Physical Activity. vol: 3(2), 120-134.
* 1 2 Passos, G. (2010). Effect of Acute Physical Exercise on Patients with Chronic Primary Insomnia. Journal of clinical sleep medicine. Vol: 6(3). 270-275
* 1 2 3 Singh, N. (1997). A Randomized Controlled Trial of the Effect of Exercise on Sleep. American Sleep Disorders Association and Sleep Research Society. vol: 20(2), 95-101