# Exercise as it relates to Disease/The effects of exercise on insomnia

Insomnia is a sleep disorder in which their is an inability to fall asleep, poor sleep quality or difficulty in staying asleep for a desired period of time. It is now considered to be the most prevalent sleep disorder and is associated comorbidities such as:
* Depression and anxiety
* Loss of functional ability and slowed reaction time
* Loss of productivity and sleepiness
* High blood Pressure
* Risk of diabetes, heart disease and poor immune function
In terms of treatment, exercise may have a positive or negative effect on an individual. Negatively causing an individual to show symptoms of exercise induced insomnia or positively may be an inexpensive way in improving insomnia and other sleep disorders such as sleep apnea. The positive health benefits and effects on insomnia from exercise far out way the risk of experiencing exercise induced insomnia.

### Issue

Insomnia is most common in the elderly although can occur at any age with it affecting approximately 15% of adults. It can be short (<3 weeks) or a long term problem (> 3 weeks). Severe insomnia is most prevalent in women then men and is classified as less than 3.5 hours of sleep for women and less then 4.5 hours for men. In 2004, sleep disorders had a financial direct and indirect cost of $4524 Million in Australia.

### Classifications and Causes

Primary Insomnia: independent of any other disorders.
* Spending excessive time in bed or completing work on the bed.
* Frequent napping and use of stimulants such as amphetamines or excessive caffeine, especially before bedtime.
* Learned associations between the bed and tension. (Psychophysiological insomnia)
Secondary Insomnia: associated result of another disorder such as depression or anxiety
* Heart disease
* Mental disorders e.g. bipolar, depression, anxiety.
* Pain - a condition that causes a individual to experience pain can lead to sleep disturbance.

## Exercise Induced Insomnia

Exercise induced insomnia can be defined as a disruption to sleep quality or prolonged sleep latency caused by late night exercise, particularly of vigorous intensity. Exercises causes a rush in adrenaline and an elevated heart rate which can cause many people to have trouble falling sleeping and cause much arousal. Adequate amounts of sleep is necessary in order to gain maximal recovery from exercise, and if sleep induced insomnia occurs this can cause many physiological and psychological problems associated from lack of sleep. Exercise raises the concentration of stress hormones and body temperature which has the potential to cause insomnia in some individuals. This condition is uncommon even in those who participate in late night vigorous physical activity.

## Exercise as a Treatment

Research suggests when it comes to improving insomnia, exercise is one of the best non-pharmaceutical medicine's that an individual can participate in due to reducing anxiety, depression, and release of stress. Exercise also has the effect of reducing Primary insomnia in individuals, this is based on the hypothesis that sleep is an energy restoring system that maintains body temperature and rebuilds body cells. Much energy is expelled from exercise therefore the body needs restoration in order to function.
The benefits of exercise on insomnia are:
* Exercise raise's body temperature which warms the neurons in the hypothalamus that are involved in activating sleeping mechanism.
* Reduces anxiety by lowering blood pressure.
* Has antidepressant effects by releasing serotonin (neurotransmitter involved in mood enhancement) and releases endorphin's promoting sleep quality.

### Types of training

Effects from Aerobic Training
* Aerobic exercise is an effective treatment to improve insomnia, sleep quality and quality of life in older adults.
* Improves sleep duration, less sleep onset latency, and is shown to improve physiological building processes involved in recovery.
* Reduces depression anxiety, stress, enhances mood and promotes relaxation.
Effects from resistance Training
* Resistance training is found to improve sleep quality demonstrated in a study by Ferris et al. in 2005, which tested sleep quality measured by the Pittsburgh sleep quality index scale after a 3 month resistance training intervention in older adults.
* Circuit resistance training utilizing major muscle groups such as the legs, demonstrate the best results.

### Recommended Exercise Protocols

* Resistance and aerobic training of moderate intensity is recommended to best combat insomnia.
* exercise at least 3–4 hours before desired sleep time in order to reduce risk of exercise induced insomnia.
* Do not over train as high stress levels are associated with insomnia.
* Monitor eating times with exercise, as large amounts of food requires a large digestion time which can keep your body awake.
| Exercise Type | Frequency/Intensity/Time | Example's |
| Aerobic | 4 x Moderate intensity (75% of Maximal heart rate) for 30–40 minutes/week. | Walking, Running, Swimming, Bike riding |
| Resistance (circuit) | 3 x 50% 1RM (aim to gradually increase each session) x 10-12 reps x 30 minutes/week. | Leg press, Bench press, Shoulder press. |

## Other Treatments

| Treatment | Example's |
| Behavioural Therapies | Sleep hygiene education, reduce day time napping, reduce caffeine and alcohol, relaxation techniques. |
| Medications | benzodiazepines, nonbenzodiazepine sedatives, and melatonin agonist's. |
| Combination Therapy | Undertaking behavioural therapies simultaneously with medications for 6–8 weeks followed by withdrawing from medication usage. |

## Further reading

* National Sleep Foundation: http://sleepfoundation.org/
* Smart Living - How to avoid Exercise Induced Insomnia: https://www.smartlivingnetwork.com/condition-specific/b/how-to-avoid-exercise-induced-insomnia/

## References

* ↑ Roth, T. (2007). "Insomnia: Definition, prevalence, etiology, and consequences". Journal of clinical sleep medicine: 3 (5 Suppl): S7–10
* ↑ Passos, GS. et al. (2010). Effect of acute physical exercise on patients with chronic primary insomnia. Journal Clinical Sleep Medicine. Vol: 6(3), 270-275.
* 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Lee-Chiong, T.L. (2006) Sleep: A Comprehensive Handbook. pp 99
* 1 2 3 4 Buysse, D. J., Angst, J., Gamma, A., Ajdacic, V., Eich, D., & Rössler, W. (2008). Prevalence, course, and comorbidity of insomnia and depression in young adults. Sleep, Vol:31(4), pp.473
* 1 2 3 4 5 6 7 8 9 Myllymaki T, et al. (2011). Effects of vigorous late-night exercise on sleep quality and cardiac autonomic activity. Journal of Sleep Research. vol.20 (146)
* 1 2 3 4 Faulkner G, Taylor H.(2005) Exercise Health and Mental Health: Emerging Relationships
* ↑ Wilson, J. F. (2008). "Insomnia". Annals of Internal Medicine. 148
* ↑ Zahn, Dorothy (2003). "Insomnia: CPJRPC". The Canadian Pharmaceutical Journal.
* ↑ Kripke, D. F et al. (2002). "Mortality associated with sleep duration and insomnia". Archives of general psychiatry. vol.59 (20) pp. 131–136
* ↑ Hillman, D. R., Murphy, A. S., Antic, R., & Pezzullo, L. (2006). The economic cost of sleep disorders. SLEEP-NEW YORK THEN WESTCHESTER-, Vol:29(3), pp.299.
* ↑ Vuori I et al. (1988) Epidemiology of exercise effects on sleep. Europe PubMed Central. vol. 574. pp 3-7]
* 1 2 3 4 Girdwain, J, Mcgee, K. (2013). Fix It with Fitness. Health, vol. 27, (4)
* 1 2 Youngstedt, S.D. (2005). Effects of Exercise on Sleep. Clinics in Sports Medicine, vol 24 (2)
* ↑ Reid K.J et al,(2010). Aerobic exercise improves self-reported sleep and quality of life in older adults with insomnia, Sleep Medicine Vol: 11, (9) Pp 934–940
* ↑ Brassington, S., & Hicks, A. (1995). Aerobic exercise and self-reported sleep quality in elderly individuals. Journal Of Aging & Physical Activity. Vol: 3(2), pp.120-134
* ↑ Montgomery, P., & Dennis, A. (2002) Physical exercise for sleep problems in adults aged 60+. Cochrane Database of Systematic Reviews, 1(4), pp.1-12
* 1 2 3 4 Ferris et al. (2005) Resistance Training Improves Sleep Quality in Older Adults a Pilot Study. J Sports Sci Med. Vol. 4 (3) pp. 354-360
* ↑ 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. 1Vol: 62(2): 216-220
* 1 2 Reid, K.J et al. (2011) Aerobic exercise improves self-reported sleep and quality of life in older adults with insomnia, Sleep Med. Vol: 11(9), pp. 934–940.
* 1 2 3 4 5 6 Bonnet, M. H., & Arand, D. L. (2011). Treatment of insomnia.