Doggone Tired

This fella to the left seems to have no problems getting to sleep but sadly this is not the case for many of us. Sleep problems are common, not just amongst those of us suffering from psychological difficulties, but amongst many members of the public. Insomnia is perhaps the most widely-known sleep disorder. Around 30% of people experience at least one symptom of insomnia1 but far less are officially diagnosed with what's called 'primary insomnia'.

Some of more common symptoms of insomnia include:

  • Difficulty falling asleep
  • Difficulty staying asleep
  • Being awake for long periods during the night
  • Experiencing non-restorative (non-refreshing) sleep.

These sleep difficulties may be considered to be primary insomnia once they have persisted for several weeks or more, are not just the result of an underlying medical or psychiatric condition, and result in significant distress and/or adverse effects on day-to-day life.

There are several risk factors for insomnia including older age, being female, and suffering from a psychiatric disorder1. Rates of insomnia in those with mental health issues are particularly high, but it is unclear as to whether insomnia is a cause or consequence of psychiatric disorder2. Sleep disturbance is also a core symptom of specific problems such as anxiety and depression. I commonly see sleep problems in my clients and addressing this problem is often a treatment priority for them. Sleep difficulties can be a source of increased stress for people already experiencing psychological difficulties. Poor sleep can also intensify existing symptoms associated with particular mental health problems. For instance, fatigue, poor concentration and irritability can occur in depression. These can flare-up further when a person is experiencing poor sleep.

The main psychological account of insomnia works on the premise that there are several cognitive and behavioural factors that contribute to the emergence and persistence of insomnia. For instance, some people have unrealistic expectations about sleep (e.g., the belief that you should sleep right through the night, every night of the year). Further problems, such as anxiety, can emerge when these expectations are not met thereby making the original sleep problem worse. Another example is when a person starts to think of the worst-case scenario when sleep does not occur (e.g., 'I won't be able to function at work'). Again, this type of thinking can create a new set of problems such as anxiety and stress. One behavioural contributor to insomnia is napping during the day in order to 'cope' with poor sleep at night. This can start to mess with your body clock making sleep problems worse. Another behavioural example is bringing bedtime forward to earlier in the evening to 'make up' for time spent awake during the night. This may simply result in more time spent awake and frustrated. Culprits of poor sleep can also be environmental. These range from sleeping in an uncomfortable bed to putting up with excessive noise and/or light.

People can get into a vicious cycle with their sleep where initial problems can trigger unhelpful thoughts and behaviours (such as those examples above) which further exacerbate sleep problems. So, how can you drag yourself out of this cycle? I will give you some tips to get you going here, but it is important to see your doctor to rule out any treatable medical conditions. You can also seek in-person help from someone who has experience in treating insomnia psychologically.

  • Keep a sleep diary where you record basic information on a daily basis about your sleep, daytime activities, and anything you think may be contributing to your sleep problems (e.g., changing stress levels at work). Keeping track of this information can help you identify factors that may be contributing to your sleep problems.
  • Have a think about your 'sleep hygiene'. This covers general healthy sleep habits around diet, behaviour, and your sleep environment. Common tips in this area include making sure you exercise regularly, avoid too much liquid after dinner, minimise caffeine in your diet, having a pre-bed routine that you repeat each night (e.g., shower-read-brush teeth-lights off). Check out the University of Maryland's page on sleep hygiene for more specific tips.
  • Keep a regular sleep-wake cycle by going to bed and getting up at the same time each day (find information about circadian rhythms here).
  • Use your bedroom only for sleeping. Don't do non-sleep activities such as paperwork and eating there. This helps your brain see the bedroom as a place only for sleep.
  • Don't lie awake in bed at night. Instead, get up for a short period (20-30mins) and do something fairly low-key (e.g., watch a bit of TV, read). Then go back to bed and see if you fall asleep. Again we want to link the bedroom with sleep. Lying awake in bed for long periods can link the bedroom with negative feelings such as frustration. If this happens, these negative feelings can be triggered by just walking into your bedroom.
  • Try some sort of relaxation exercise just before bed (you can find one from the UK Mental Health Foundation here).
  • Have a think about your thoughts and beliefs about sleep. Are there any obviously extreme or unrealistic thoughts (e.g., 'I will never be able to cope with my day unless I get at least 8 hours of uninterrupted sleep)? If so, it can help to respond to these thoughts with something more realistic.
  • You can also try going to bed later than normal to see if this helps you get off to sleep.

These are just a few suggestions. We have not really covered addressing unhelpful thoughts as these are often best looked at the help of someone trained in this area.

For more useful general information, take a look at Colin Espie's self-help book for insomnia. Another helpful resource is the US National Sleep Foundation's website.

All the best.

Jason.

 
1 Roth, T. R. (2007). Insomnia: Definition, prevalence, etiology, and consequences. Journal of Clinical Sleep Medicine, 3(5), S7-10).
2 Mai, E., & Buysse, D. J. (2008).Insomnia: Prevalence, impact, pathogenesis, differential Diagnosis, and evaluation. Sleep Medicine Clinics, 3(2), 167-174.
Photo credit: Usonian via photopin cc

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