Even a single night of sleep trouble can feel distressing and lonely. You toss and turn, stare at the ceiling, and wonder how you’ll cope tomorrow. No wonder many people start to worry they’ve developed insomnia.

Insomnia is one of the most talked-about sleep problems, but it’s also one of the most misunderstood.

But just because you can’t sleep, it doesn’t mean you have insomnia. You might have another sleep disorder, or none at all.

What is insomnia?

Let’s clear up some terms, and separate short-term or intermittent sleep problems from what health professionals call “insomnia disorder”.

Sleep problems can involve being awake when you want to be asleep. This could be lying in bed for ages trying to fall asleep, waking in the middle of the night for hours, or waking up too early. Having a sleep problem is a subjective experience – you don’t need to tally up lost hours to prove it’s a problem.

But insomnia disorder is the official term to describe a more problematic and persistent pattern of sleep difficulties. And this long-term or chronic sleep disorder has clear diagnostic criteria. These include at least three nights a week of poor sleep, lasting three months or more. These criteria help researchers and clinicians make sure they’re talking about the same thing, and not confusing it with another sleep problem.

So, what are some reasons why a sleep problem might not be insomnia?

1. It’s short term, or comes and goes

About a third of adults will have a bout of “acute insomnia” in a given year. This short-term problem is typically triggered by stress, illness or big life changes.

The good news is that about 72% of people with acute insomnia return to normal sleep after a few weeks.

Insomnia disorder is a longer-term, persistent problem.

2. It doesn’t affect you the next day

Some people lie awake at night but still function well during the day. More fragmented and less refreshing sleep is also a near-universal part of ageing.

So if your sleep problem doesn’t significantly affect you the next day, it usually isn’t considered to be insomnia.

For people with insomnia, the struggle with sleep spills into the day and affects their mood, energy, concentration and wellbeing. Worry and distress about not sleeping can then make the problem worse, which creates a frustrating cycle of worrying and not sleeping.

3. It’s more about work or caring

If you feel tired during the day, an important question is whether you’re giving yourself enough time to sleep. Sometimes sleep problems reflect a “sleep opportunity” that is too short or too irregular.

Work schedules, child care, or late-night commitments can cut sleep short, and sleep can slip down the priority list. In these cases, the problem is insufficient sleep, not insomnia.

You might have noisy neighbours or an annoying cat. These can also affect your sleep, and reduce your “sleep opportunity”.

The average healthy adult gets around seven hours sleep (though this varies widely). For someone who needs seven, it usually means setting aside about eight to allow for winding down, drifting off, and waking overnight.

4. It’s another sleep disorder

Other sleep disorders can look like insomnia, such as:

• obstructive sleep apnoea (when your breathing stops multiple times during sleep) can cause frequent awakenings through the night and daytime sleepiness
• restless legs syndrome creates an irresistible urge to move your legs in the evening that often interferes with falling asleep. It’s often described as jittery feelings or having “creepy crawlies”, and is often undiagnosed
• circadian rhythm problems, such as being a natural night owl in an early-bird world, can also lead to trouble falling asleep.

5. Medications and substances are interfering

Caffeine, alcohol and nicotine all create insomnia symptoms and worsen the quality of sleep.

Certain medications can also interfere with sleep, such as stimulants (for conditions such as attention-deficit hyperactivity disorder or ADHD) and beta-blockers (for various heart conditions).

These issues need to be considered before labelling the problem as insomnia. However, it’s important to keep taking your medication as prescribed and discuss any concerns with your doctor.

Getting the right help

If your sleep is worrying you, the best first step is to see your GP. They can help rule out other causes, review your medications, or refer you for a sleep study if needed.

However, once insomnia becomes frequent, chronic (long term) and distressing, you can worry too much about your sleep, constantly check or track your sleep, or try too hard to sleep, for instance by spending too much time in bed. These psychological and behavioural mechanisms can backfire, and make good sleep even less likely.

That’s why “cognitive behavioural therapy for insomnia” (or CBT-I) is recommended as the first-line treatment.

This is more effective, and longer-lasting than sleeping pills. This therapy is available via specially trained GPs, and sleep psychologists. You can take part in person or online.

In the meantime

If you’re in a rough patch of sleep:

• remind yourself that short runs of poor sleep usually settle on their own
• avoid lying in bed panicking if you wake at 3.30am. Instead, step out of bed or use the time in a way that feels restful
• keep a consistent wake-up time, even after a poor night. Try to get some morning sunlight to reset your body clock
• make sure you’re putting aside the right amount of time for sleep – not too little, not too much.

Amelia Scott, Honorary Affiliate and Clinical Psychologist at the Woolcock Institute of Medical Research, and Macquarie University Research Fellow, Macquarie University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

The human brain is remarkably complex, with trillions of connections that control how you move, think and feel.

Yet it’s still vulnerable to debilitating conditions such as paralysis, stroke, epilepsy and various neurodegenerative diseases.

Scientists are investigating if a kind of technology, known as the brain-computer interface, could help patients move and communicate better.

So how does it work? And what are the potential risks?

What is a brain-computer interface?

A brain-computer interface works by reading electrical signals produced by the brain, which it translates into digital signals that an external computer can understand. The computer then sends instructions – such as the command to move a cursor, steer a wheelchair or read a sentence aloud – back to the brain. This whole process happens in real time, allowing patients to do tasks more independently.

There are two types of brain-computer interfaces:

Non-invasive

Non-invasive brain-computer interfaces are worn externally, usually in the form of electroencephalogram headsets. An electroencephalogram, or an EEG, is a type of test that measures activity in the brain. This technology is already available on the consumer market, found in everything from meditation apps to video games.

Invasive

Invasive brain-computer interfaces are surgically implanted. This involves placing electrodes – devices that carry electrical signals from the body to medical instruments – directly onto the exposed surface of the brain. These interfaces aim to help restore key functions such as speech and mobility in people with a disability, caused by conditions such as stroke or spinal cord injury.

It is this second category that’s attracting attention from investors and scientists. Several companies – including early developer Blackrock Neurotech, Australian-owned Synchron, and Elon Musk’s Neuralink – are racing to get implantable brain-computer interfaces to patients.

Under current regulations, only a handful of clinical trial participants globally can access this technology. But this may change as interest grows. The international brain-computer interface market is expected to be worth roughly A$14 billion by 2033, up from its current value of just under $3 billion.

Their role in health care

Brain implants may sound dystopian, but they are a promising part of neuroscience research.

More than three billion people worldwide live with a neurological condition that affects their motor, communication or sensory functions. Examples include stroke, epilepsy, Parkinson’s disease, cerebral palsy and traumatic brain injury.

Brain-computer interfaces are particularly helpful for communication. In one 2023 study, paralysed patients that used a brain-computer interface were able to communicate up to 78 words per minute. That’s a five-fold improvement from the 15 words per minute achieved by patients in 2021. And recent research shows this technology is still rapidly improving.

Beyond communication, surgeons are using brain-computer interfaces to map brain activity in real time. This is particularly useful during complex or high-risk procedures, where surgeons must protect key brain regions.

Sleep researchers are also using this technology to analyse brain signals in people who may have a sleep disorder, such as insomnia or sleep apnoea. Brain-computer interfaces may be a more accurate way to diagnose and treat such disorders, compared to other methods such as sleep diaries that rely on participant reports.

Scientists are also investigating how these interfaces could be used in rehabilitation, particularly for people with conditions such as depression, epilepsy, stroke and Parkinson’s disease.

What are the risks?

Here are three worth noting.

Physical harm

Any kind of brain implant can cause physical damage that may affect how neighbouring brain regions work.

For example, if there’s bleeding in a part of the brain that controls speech or movement, even a small blot clot could impair those functions. And while infections in the brain are rare, they can cause swelling and further complications if not immediately treated.

Research suggests there are long-term effects of having foreign material inside the skull. Over time, the brain treats the implant as an intruder, forming scar tissue around it in a bid to destroy nearby brain cells and stop the implant from working. Regular movements such as breathing may also create friction between the hard implant and soft brain tissue, causing some brain regions to become inflamed.

Cybersecurity threats

One recent study found a large-scale breach of brain-computer interface systems could theoretically allow hackers to access sensitive neural data, such as patients’ thoughts and memories. Hacking may also enable them to impair a patient’s cognitive functions such as the ability to concentrate, or even manipulate motor signals to affect how well they move. That’s a scary prospect, especially if these devices become more common in health care and other sectors. In the United States, some jurisdictions are already working to protect neural data rights in law, but there are still major regulatory gaps.

Unequal access

Currently, getting a brain implant will set you back between $50,000 to $140,000. That doesn’t include the cost of ongoing maintenance and follow-up care. So ordinary patients are unlikely to access this technology anytime soon, widening the gap between who can and can’t afford to improve their health.

Where to next

Brain-computer interfaces are a promising new technology, but they come with risks.

We urgently need more high-quality research into the long-term effects – both physical and psychological – of permanent brain implants. Importantly, this research should be funded publicly and not just by a handful of large, profit-driven companies.

David Tuffley, Adjunct Senior Lecturer, Applied Ethics and CyberSecurity, Griffith University

This article is republished from The Conversation under a Creative Commons license. Read the original article.