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

Insomnia is a common sleeping disorder that displays symptoms of;

1. Increased sleep onset latency^[7][9][13].
2. Frequent awakenings during sleep with difficulty getting back to sleep^{[7][8][9][13]}.
3. 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

1. Brassington, S., & Hicks, A. (1995). Aerobic exercise and self-reported sleep quality in elderly individuals. Journal Of Aging & Physical Activity, 3(2), 120-134.
2. Dowdle, H. (2013). Sweet Surrender. Yoga Journal, (259), 88-110.
3. 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.
4. 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.
5. 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.
6. Montgomery, P., & Dennis, A. (2002) Physical exercise for sleep problems in adults aged 60+. Cochrane Database of Systematic Reviews, 1(4), 1-12
7. Nieman, D. C. (1998). Chapter 16: SLEEP. Exercise-Health Connection, 217-226.
8. 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.
9. Physical Activity: Nature's Sleep Aid. (2009). Running & FitNews, 27(5), 3-4.
10. 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.
11. 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.
12. Silber, H. (2005). Chronic Insomnia. The New England Journal of Medicine, 2(353) 803-810
13. Taylor, R. (2001). The Influence of Exercise on Sleep Quality. International Sportmed Journal, 2(3), 1-10.
14. 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.