Night-time sleep disturbances manifest in various ways, with individuals experiencing trouble sleeping in distinct forms. Some struggle with the challenge of initially falling asleep, while others find themselves awakened during the night and unable to return to slumber. Still, there are those who face the issue of frequent awakenings throughout the night.
Insomnia, is a persistent challenge involving difficulty falling asleep or staying asleep, detrimentally affects one’s well-being and can cause significant distress. It’s a prevalent concern, with Australian research indicating that 1 in 3 individuals struggle with sleep, and 1 in 10 meet the criteria for an insomnia disorder diagnosis.
Insomnia Disorder isn’t a sporadic night of poor sleep but rather a chronic sleep problem profoundly impacting well-being, often persisting long after the initial sleep disturbance triggers have faded. It can manifest as ongoing difficulty initiating sleep (sleep onset insomnia) or resuming sleep (sleep maintenance insomnia) after nocturnal awakenings. Insomnia can feel uncontrollable, exacerbating wakefulness as individuals try increasingly harder to sleep.
Chronic insomnia can breed counterproductive sleep habits and heightened anxiety and worry, perpetuating the issue. Consequently, it diminishes the quality of life and heightens the risk of developing associated problems such as depression and anxiety.
There are 2 Types of Insomnia:
Primary insomnia: Sleep problems not linked to any other health condition or problem.
Secondary insomnia: Sleep difficulties caused by health conditions (e.g., asthma, depression), pain, medication, or substance use (e.g., alcohol).
Understanding the Causes of Insomnia
Primary causes of insomnia include:
- Stress from major life events
- Environmental factors (noise, light, temperature, too much screen time in the evening)
- Changes in sleep schedule (jet lag, shift work, bad habits)
- Stress: Heavy workloads, relationship issues, and life changes.
- Genetic predisposition
Secondary causes of insomnia include:
- Mental health issues (depression, anxiety)
- Excessive Worrying: People who identify as “worriers.”
- Medications (colds, allergies, high blood pressure)
- Pain or discomfort at night
- Substance use (caffeine, tobacco, alcohol, illicit drugs)
- Endocrine problems (hyperthyroidism)
- Other sleep disorders (sleep apnoea, restless legs syndrome)
- Pregnancy, Alzheimer’s disease, ADHD, PMS, menopause
Perpetuating Factors of Insomnia
Insomnia often endures due to several key factors:
- Unhelpful Sleep Habits: Irregular sleep schedules, lengthy naps, excessive time spent in bed, failure to wind down before sleep, alcohol consumption before bedtime, and dependence on sleeping pills.
- Disrupted Daytime Routines: Avoiding regular activities like exercise, work, or social interactions.
- Mental Overactivity: Overthinking, generalised worry, and obsessive thoughts about sleep and fatigue.
Concerns about sleep can lead to counterproductive coping behaviours, exacerbating the problem. For example, attempting to sleep earlier, sleeping in, and taking daytime naps can hinder achieving restful sleep. Similarly, excessive coffee consumption, avoiding exercise, and withdrawing from daily life due to fatigue can worsen sleep quality and heighten anxiety.
A detrimental cycle ensues, wherein poor sleep fosters worry and unhelpful habits, which, in turn, worsen sleep quality, perpetuating the cycle of insomnia.
Diagram of the cycle of insomnia (Source: SleepStation Uk)
Insomnia Treatment Options
The encouraging news is that insomnia is a condition that often responds positively to treatment. In some cases, clients may require as few as 4-6 consultations to regain better sleep quality. A variety of remedies and therapies are available, with differing levels of effectiveness. The preferred initial treatment is Cognitive Behavioural Therapy for Insomnia (CBT-I).
Here are evidence-based treatments utilised:
- Cognitive Behavioural Therapy for Insomnia (CBT-I): This is the recommended first-line treatment.
- Mindfulness-Based Approaches: Incorporating mindfulness practices into treatment.
- Light Therapy: Using light therapy as part of the treatment plan.
- Stress Management: Addressing stress as a contributing factor to insomnia.
Additionally, your doctor may prescribe the following treatments, which can be used in conjunction with these therapies:
- Melatonin: A natural hormone regulating the body’s circadian rhythm, useful if your body isn’t producing enough or is producing it at the wrong time.
- Sleeping Pills: Recommended for short-term use only, typically not meant for extended periods exceeding 3-4 weeks.
Mindfulness and Acceptance-Based Approaches to Insomnia: Mindfulness can serve as a standalone treatment or be integrated with other approaches like CBT and Acceptance and Commitment Therapy (ACT). ACT focuses on helping individuals lead richer, more meaningful lives by teaching acceptance of difficult thoughts and emotions rather than struggling against them.
Stress Management and Insomnia: Long-term or chronic stress can contribute to insomnia. In addition to CBT-I, developing skills in stress, anxiety, and mood management can enhance treatment outcomes.
Sleep Hygiene: Establishing a healthy sleep routine, often referred to as sleep hygiene, plays a crucial role in managing insomnia.
1. Establish a bedtime routine: Set regular times for going to bed and waking up.
2. Create a sleep-friendly environment: Keep the bedroom cool, dark, and quiet. Use earplugs, eye masks, or white noise machines if needed. Ensure comfort and support from the mattress and pillows.
3. Limit screen time before bed: Avoid electronic devices at least an hour before sleep as it can seriously disrupt melatonin surge needed to fall asleep. Try reading a book, listening to music or other type of relaxing activity.
4. Watch diet and exercise: Avoid large meals, caffeine, and alcohol before bed. Regular exercise promotes better sleep (avoid strenuous exercise 2 hrs or less prior going to sleep as there won’t be sufficient time to wind down).
5. Practice relaxation techniques: Deep breathing, progressive muscle relaxation, or meditation can calm the mind and prepare for sleep.
If you suspect you have insomnia, it is advisable to consult your GP, as they can assess you for any underlying conditions. If you would like assistance to improve your sleep, please don’t hesitate to reach out to us. We combine psychology with sleep science. 📞 Give us a call at (08) 9248 7852 or visit www.ndpsych.com.au to schedule an appointment 😊
