Comorbidity in Insomnia

Like many mental health disorders, insomnia has a long list of comorbidities. Comorbidity refers to the co-occurrence of two or more diseases or disorders in a single patient at one time. These co-existing conditions aren’t symptoms of each other, but rather dual-diagnoses. Many examples of comorbidity seem logical, such as the relationship between obesity and heart disease. But the dangers of comorbid diagnoses are much greater than the sum of its parts, as interactions between the illnesses often aggravate the effects of both conditions. Worse still, it can be difficult to measure the severity of comorbid diagnoses since doctors can’t always be sure which condition is producing which symptoms.

These complications can be seen very clearly in the comorbid loop described in this lesson, between insomnia, anxiety, and depression. These three conditions all have similar neurochemical models, involving deregulation of the stress response and circadian rhythm. In depression and anxiety patients, this commonly manifests as oversleeping, but can just as easily begin a cycle of sleep loss that becomes insomnia. And insomnia itself predisposes many other health conditions, including gastroesophageal reflux disease (GERD) and chronic headaches, which in turn worsen insomnia symptoms. For all these reasons, it’s vital that healthcare providers consider all of the body’s symptoms when prescribing medication for these comorbid conditions.

Circadian Rhythm Disorders

Your biological clock, or circadian rhythm, is responsible for regulating the daily processes your body undergoes, many of which relate to hormone control and sleep timing. This ebb and flow of alertness and body temperature is what keeps us feeling awake during most of the day and fast asleep at night. But when your rhythm goes offbeat, your entire body is affected. This can manifest not just as Delayed Sleep Phase Disorder (DSPD), but also as Advanced Sleep Phase Disorder, Irregular Sleep Phase Disorder, and Non-24 Hour Sleep Phase Disorder. This last condition causes an ever-changing sleep schedule that gets slightly later each day. It can be incredibly difficult to diagnose, but it’s most common in the blind community, where the body must make do without visual cues for night and day.

But while permanent circadian disorders might be rare, daylight savings time and jet lag are common temporary circadian complications. In fact many students suffer from what’s colloquially known as autumn insomnia, a lingering side effect from a summer spent staying up late and shifting their circadian rhythm. But by practicing good sleep, hygiene, and maintaining a consistent sleep schedule, it’s easy to reset your biological clock.

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