# Exercise as it relates to Disease/Aerobic Exercise and its effect on Insomnia

Insomnia is a common sleeping disorder that displays symptoms of;
* Increased sleep onset latency$^{[7][9][13]}$.
* Frequent awakenings during sleep with difficulty getting back to sleep$^{[7][8][9][13]}$.
* Non-restorative sleep$^{[7][8]}$.
Insomnia is often diagnosed as either acute or chronic$^{[12]}$. Acute insomnia involves difficulties with sleep lasting less than a month while chronic insomnia is associated with problems persisting longer than a month$^{[12]}$. Insomnia can also be catergorised as primary or secondary$^{[12]}$. Primary is the term given to subjects who cannot sleep for no apparent reason while secondary members cannot sleep due to an underlying condition$^{[12]}$.

## Issue

Insomnia is more common in women and the elderly$^{[8][12]}$. With chronic insomnia affecting approximately 15% of adults$^{[8][12]}$, while some studies have reported that insomnia incidence rises to 50% in the elderly population$^{[10]}$. Given the widespread occurrence of insomnia, it is now the most prevalent sleep disorder$^{[8]}$. Severe sleep deprivation also induces stress on carers and is a common cause for instigating institutional care$^{[6]}$. If chronic insomnia is not treated effectively it can lead to a magnitude of other conditions including;
* High blood pressure$^{[2][9]}$
* Type ‖ Diabetes$^{[2][6][9]}$
* Heart Disease$^{[2][6][9]}$
* Depression$^{[2][6][9][12]}$,
* Cancer$^{[2][9]}$
* Mortality$^{[2][6][8][9][12]}$

## Aerobic exercise and insomnia

The most common treatment for insomnia is pharmacological which may lead to a drug related tolerance or dependency$^{[6][8]}$. However, benefits can be achieved through regular moderate aerobic exercise$^{[1][2][3][4][5][7][8][9][10][11][12][13]}$. A regular aerobic exercise regime displays better sleep quality in the form of greater sleep duration, less sleep onset latency and a more restorative sleep$^{[1][4][5][8][10][11]}$. Aerobic exercise also promotes relaxation$^{[6]}$ and reduces anxiety and stress levels$^{[1][8]}$, depressive symptoms and daytime sleepiness$^{[10]}$. Participants who undertook aerobic exercise as a treatment also reported improvements in mood, vitality, slow wave sleep or greater restorative sleep and quality of life$^{[10]}$.

## Recommendations

The following table is a general aerobic exercise regime that is applicable to the wider population.
| Training level | Intensity | Duration | Frequency |
| Trained | Moderate/Vigorous | 60 mins | 5+ days/week$^{[3][13]}$ |
| Untrained | Moderate | 30-40 mins | 3–4 days/ week$^{[10]}$ |
Moderate Intensity: 75% of maximum heart rate$^{[10]}$.
Vigorous Intensity: 85% of maximum heart rate$^{[3]}$
To obtain the maximum benefit from aerobic exercise subjects should also adhere to the subsequent guidelines;
* Exercise 4–8 hours before going to sleep$^{[8][13]}$.
* Undertake sleep hygiene education which provides instructions or help to maximize beneficial sleeping habits$^{[10]}$.
* Maintaining a sleep log$^{[1][8][10]}$.
* Avoiding drinking alcohol before going to bed$^{[9]}$.
Finally exercise need not be intense to attain significant results$^{[8][9][13]}$. While the greatest benefits were seen in participants who exercised for over an hour, moderate exercise reduced total time awake compared to intense exercise$^{[9]}$. In fact research shows that prolonged intense exercise actually increased insomnia symptoms$^{[8][9]}$

## Further reading

Better Health Chanel http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Sleep_problems_insomnia
National Sleep Foundation http://www.sleepfoundation.org/article/sleep-related-problems/insomnia-and-sleep
Sleep Health Foundation http://sleephealthfoundation.org.au/pdfs/Insomnia.pdf

## Reference List

* Brassington, S., & Hicks, A. (1995). Aerobic exercise and self-reported sleep quality in elderly individuals. Journal Of Aging & Physical Activity, 3(2), 120-134.
* Dowdle, H. (2013). Sweet Surrender. Yoga Journal, (259), 88-110.
* Inoue, S., Yorifuji, T., Sugiyama, M., Ohta, T., Ishikawa-Takata, K., & Doi, H. (2013). Does Habitual Physical Activity Prevent Insomnia? A Cross-Sectional and Longitudinal Study of Elderly Japanese. Journal Of Aging & Physical Activity, 21(2), 119-139.
* King, C., Oman, F., Brassington, S., Bliwise, L., & Haskell, L. (1997). Moderate-intensity exercise and self-rated quality of sleep in older adults. A randomized controlled trial. Journal Of The American Medical Association, 277(1), 32-37.
* King, A., Pruitt, L., Woo, S., Castro, C., Ahn, D., Vitiello, M., Woodward, S., & Bliwise, D. (2007). Effects of moderate intensity on polysomnographic and subjective sleep quality in older adults with mild to moderate sleep complaints. The Journals of Gerontology, 63 (9), 997-1004.
* Montgomery, P., & Dennis, A. (2002) Physical exercise for sleep problems in adults aged 60+. Cochrane Database of Systematic Reviews, 1(4), 1-12
* Nieman, D. C. (1998). Chapter 16: SLEEP. Exercise-Health Connection, 217-226.
* 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.
* Physical Activity: Nature's Sleep Aid. (2009). Running & FitNews, 27(5), 3-4.
* Reid, K., Baron, K., Lu, B., Naylor, E., Wolfe, L., & Zee, P. (2010). Aerobic exercise improves self-reported sleep and quality of life in older adults with insomnia. Journal of Sleep Medicine, 11(9), 934-940.
* 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.
* Silber, H. (2005). Chronic Insomnia. The New England Journal of Medicine, 2(353) 803-810
* Taylor, R. (2001). The Influence of Exercise on Sleep Quality. International Sportmed Journal, 2(3), 1-10.
* Wong, N., Halaki, M., & Chow, C. (2013). The effects of moderate to vigorous aerobic exercise on the sleep need of sedentary young adults. Journal Of Sports Sciences, 31(4), 381-386.