"'So Tired, But...' Eyes Popping Open at Dawn? Start by Checking 'This' [Kok! Health]"

Balance between slow-wave and REM sleep shapes brain and emotions
Early diagnosis and lifestyle correction are key

Everyone has experienced feeling less focused and in a low mood after a night of poor sleep. However, if you repeatedly have trouble falling asleep, wake up frequently during the night, or wake up too early in the morning and cannot fall back asleep so that this becomes your daily routine, it should not be dismissed as simple fatigue. Experts stress that insomnia easily becomes chronic if left untreated, and that identifying the underlying causes and correcting lifestyle habits must go hand in hand.

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Sleep serves different functions at each stage. Slow-wave sleep, the early deep stage of sleep, helps with physiological recovery such as restoration of the brain and body, strengthening of immunity, and removal of waste products. Rapid eye movement (REM) sleep, a lighter stage of sleep, plays an important role in emotional regulation and the consolidation of memory and learning. When the balance between these two stages is disrupted, it can affect both brain health and emotional stability.

Insomnia is difficult to explain with a single cause. It is the result of a complex interaction among predisposing factors, precipitating factors, and perpetuating factors. The risk increases with age, is higher in women than in men, and is higher in people with a family history or psychological vulnerabilities such as anxiety or depression. On top of this, severe stress, acute illnesses, and pain can act as mental or physical burdens that trigger the onset of insomnia. After that, staying in bed for a long time even when not sleepy, using smartphones or watching TV in bed, excessive worry such as "I must sleep well tonight," and taking overly long daytime naps become factors that make insomnia chronic. Sleep is also sensitive to environmental changes such as temperature, humidity, and light.

Yoon Jieun, Professor of Neurology at Soonchunhyang University Bucheon Hospital, explained, "From a neurological perspective, one of the important causes of insomnia is an abnormality in the sleep-wake regulation mechanism of the central nervous system," adding, "When the brain needs to fall asleep, arousal signals should be blocked so that it can shift into deep sleep, but in insomnia, these arousal signals are excessively maintained, making it difficult for normal sleep transition to occur."

"Sleeping pills should be used appropriately...improving lifestyle habits is crucial"

Cognitive behavioral therapy is recommended as the first-line treatment over medication. Stimulus control therapy involves going to bed only when sleepy and getting out of bed if you cannot fall asleep, in order to break behaviors that are inappropriately associated with sleep. Sleep restriction therapy adjusts the amount of time spent in bed to match the actual sleep time, thereby improving sleep efficiency. There are also relaxation training methods such as diaphragmatic breathing and progressive muscle relaxation to reduce physical tension.

Some people are concerned about a possible link between the use of sleeping pills and the risk of dementia, but at present it is difficult to conclude that there is a direct causal relationship. However, the principle is to use sleeping pills only when truly necessary, at an appropriate dose, and for a short period. Long-term or high-dose use can increase the risk of cognitive decline and falls, and using several types of sleeping pills together can raise the risk of side effects, making consultation with medical professionals essential.

As people age, total sleep time tends to decrease and sleep becomes more easily fragmented. Secretion of melatonin, which serves as a signal to regulate the sleep-wake rhythm, also decreases. Pain and nighttime urination caused by underlying conditions such as respiratory or cardiovascular diseases, as well as the use of medications, can interfere with sleep. For this reason, rather than simply relying on sleeping pills, evaluation and treatment of coexisting diseases should be carried out together.

Lifestyle management is also important. The most basic step is to maintain regular bedtimes and wake-up times. If wake-up time is inconsistent, the body clock becomes unstable and this affects the time it takes to fall asleep at night. Light exercise and exposure to sunlight during the day help to normalize the sleep-wake rhythm. Daytime naps should be limited to within 15 minutes, and late afternoon naps are best avoided. Caffeine intake and excessive drinking in the evening, as well as strong light stimulation from smartphones or TV before bedtime, should be reduced. It is advisable to keep the bedroom quiet and dark, and to maintain appropriate temperature and humidity.

Professor Yoon said, "Sleep disorders are not just a minor inconvenience, but a medical issue that can be closely associated with cardiovascular disease, metabolic disease, and neurodegenerative disorders," adding, "Rather than dismissing them as simply due to aging, it is important to receive an accurate diagnosis and systematic treatment at an early stage."

Yoon Jieun, Professor of Neurology at Soonchunhyang University Bucheon Hospital. Soonchunhyang University Bucheon Hospital