WHAT IS INSOMNIA?
Insomnia is defined, when the disturbance of sleep occurs over a period of one month or more on most nights and, that it leads to adverse daytime consequences, you will feel sleepy during the day and feel your performance suffers.
It could be that you find it difficult to fall asleep, fail to stay asleep, wake too early, feel your sleep is non-restorative/not refreshing or any combination of these.
There are numerous causes of insomnia, some more obvious than others. Many can be remedied yourself as they are linked to sleep environment and lifestyle factors that are important to your well-being.
Insomnia can last for days, months or even years. Short-term insomnia lasts up to four weeks and by its very nature resolves itself with time without the need for medical intervention. Chronic insomnia lasts for four weeks and longer until treated.
A small number of people suffer from chronic insomnia for no discernible reason, however for the majority of sufferers insomnia is a symptom of another problem.
HOW DO I KNOW IF I SUFFER FROM INSOMNIA?
There are 3 specific types of insomnia and it is possible to suffer from a combination of them.
Sleep-onset insomnia - is where there is a difficulty in falling asleep, regularly taking more than 30 minutes to fall asleep on the majority of nights. On average most people without a sleep problem take less than twenty minutes to fall asleep after turning the light off.
Sleep-maintenance insomnia - is where there is a problem staying asleep and you repeatedly wake up during the night. Many individuals may wake momentarily numerous times during sleep to check that all is right with the world. These awakenings are very short and you are not aware of them. A person with sleep maintenance insomnia wakes during the night and then finds it difficult to get back to sleep. Anxiety is a common cause of sleep maintenance insomnia but it can also be due to other medical reasons such as pain or repeatedly getting up to go to the lavatory during the night (nocturia). When assessing sleep-maintenance insomnia it is important to be aware of what wakes you up and what then keeps you awake e.g. you may wake needing to go to the lavatory but once you have emptied your bladder it may be pain or anxiety that keeps you from falling back to sleep.
Early morning waking - is where you wake earlier in the morning than you wish and cannot then fall back to sleep. This type of insomnia is commonly linked to depression but may also be related to the changes in circadian rhythm that occur as a result of being a shift-worker or naturally as we get older.
As we get older our sleep naturally becomes lighter and thus more easily disturbed, so problems sleeping are not necessarily indicative of insomnia in the elderly. Generally young people most commonly suffer from difficulty falling asleep (sleep-onset insomnia), whereas older people more commonly have problems with waking during the night or early in the morning.
WHAT ARE THE CONSEQUENCES OF UNTREATED INSOMNIA
Mental health problems, including and not limited to stress, anxiety and depression are also linked to disturbed sleep. Beliefs about sleep, and the effects of a lack of it, can cause anxiety and exacerbate sleep problems.
WHAT TREATMENT OPTIONS ARE THERE?
Cognitive Behavioural Therapy for Insomnia (CBT-I) has been shown to be successful in treating insomnia in some individuals. Unlike sleeping tablets, the benefits of CBT-I have been found to persist beyond the end of treatment. It is designed to target both the inappropriate thought processes and behaviours that can lead to sleep problems, and is usually delivered over a course of 6-8 sessions. CBT-I also aims to give you a more realistic view of how much sleep you need and the effects of insufficient sleep.
There are a number of techniques that come under the umbrella of CBT-I;
Stimulus Control Therapy - this aims to create a strong association between the bed and sleep and its basic principles are; only go to bed when you are tired, limit the activities in bed to sleep and sex only, get out of bed at the same time every morning and when sleep-onset does not occur within a 30 minute period.
Sleep Restriction Therapy - the aim of sleep restriction is to restore the natural drive to sleep by restricting your time in bed (TIB) so that it is equal to the average time spent asleep (TST). Your sleep efficiency is then calculated and then as a general rule if your sleep efficiency is greater than 90% time spent in bed (TIB) needs to increase by 15 minutes and if its less than 80% reduce time spent in bed (TIB) by 15 minutes.
Sleep hygiene - is a basic set of ‘rules’ designed to control the environment and behaviours that precede sleep, they usually involve bedtime routines, diet and exercise that may be pivotal to our well-being.
Cognitive Therapy - this is designed to decrease the anxiety and arousal associated with insomnia by targeting any dysfunctional beliefs and attitudes you may have about sleep; “I cannot function without a good night’s sleep,” “I am worried that I will never get a good night’s sleep”, “I need 8 hours of sleep to feel at my best”, “I can only sleep if I take a sleeping pill”, “Insomnia is just part of growing older”.
Relaxation Therapy - aims to help you relax prior to bedtime and helps you fall asleep. Various techniques used by therapists include hypnosis, guided imagery and meditation. Essentially anything that helps you wind down and relax at the end of the day will help however, relaxation therapy on its own is not considered sufficient treatment for insomnia.
Research has shown that people who claim to suffer from insomnia actually overestimate the amount of time they take to fall asleep and the amount of disturbance they suffer during the night, after learning they slept for longer than they’d thought, they began sleeping better.
Ask ISAAC for an immediate assessment on probable causes for your sleepiness.
There are a number of options with regards to the pharmacological treatment of insomnia.