Insomnia

Do you often have trouble getting asleep or sleeping through the night? Do you often wake up at 4 am without apparent reason? If this is a recurrent experience for you, it could be insomnia. Insomnia is prevalent; it’s the most common among sleep disorders, and either physical or psychological problems can cause it - or both interacting together.

Understanding Insomnia

Insomnia is a sleep disorder. It is characterised by problems in falling asleep or staying asleep through the night (for example, waking up multiple times or waking up and not being able to go back to sleep), which consequently impacts the person’s daily functioning due to the lack of sleep, presenting symptoms during the day like fatigue, sleepiness, irritability, impaired cognitive abilities and many more.

Although it's natural to experience periods in our life where we may experience changes in our sleeping patterns or difficulties in getting good quality sleep, usually due to periods of stress, once the problematic/stressful moment passes, generally, most individuals go back to their usual sleeping patterns. However, if sleeping difficulties persist after a stressful period, it might result in long-term difficulties.

Different Types Of Insomnia

People can develop:

• Episodic Insomnia – characterised by symptoms lasting at least one month but not more than three months.

• Persistent Insomnia - characterised by symptoms lasting for three months or longer, also defined as chronic insomnia.

• Recurrent Insomnia - characterised by recurring episodes with symptoms lasting 1 to 3 months for each episode and occurs multiple times a year.

If the primary problem of the individual is falling asleep, we will talk about sleep-onset insomnia; if the person struggles with staying asleep, we will talk about sleep-maintenance insomnia.

What Are The Main Symptoms Of Insomnia?

The main symptom of insomnia is a general dissatisfaction with the quality and quantity of sleep, which can involve waking up not rested even if it seemed to have slept enough hours -nonrestorative sleep. This can significantly impact the person’s social, academic, occupational, emotional, and behavioural functioning. Although the outcome of not having good quality and quantity of sleep can differ significantly from individual to individual, here are a few main symptoms that most people generally report:

• Difficulties falling asleep

• Difficulties staying asleep – often marked by waking up frequently with or without difficulties in going back to sleep after waking up

• Waking up early in the morning without being able to go back to sleep

What Causes Insomnia?

There are several possible different causes of insomnia. Research suggests that insomnia tends to result from different physiological arousal at inconvenient times (for example, when you are about to go to bed), which disrupt normal sleeping patterns. The type of arousal can manifest in many different presentations. For example, it can include an increase in specific hormones like cortisol, heart rate, and body temperature. Insomnia often occurs alongside mental health conditions.

Common causes of insomnia are stress, irregular sleeping schedule, pain and illness, lifestyle and poor sleeping habits, mental health conditions like anxiety and depression, and medications. Further, a combination of these factors can trigger and worsen insomnia.

- Stress

Stress can come from different sources and can affect people in different ways. The way our body responds to stress creates a situation of hyperarousal, leading to insomnia. Furthermore, the difficulty in getting asleep or staying asleep may become a source of stress, making it even harder to break the unhelpful cycle.

- Irregular sleeping schedule

Ideally, our body’s internal clock, called circadian rhythm, follows the day and night pattern. However, for some people, their sleeping schedules create a misalignment of their circadian rhythm—for example, people who work day and night shifts. Jet lag also causes problems with our sleep as our body cannot adjust quickly to a different time zone. A disrupted circadian rhythm can thus result in insomnia.

Some people may have a misaligned circadian rhythm without an apparent cause, and this will lead to experiencing persistent issues in the quality and quantity of sleep.

- Pain and Illness

Pain can disrupt sleep. It might be difficult to find a comfortable position to lie in bed that would allow you to fall asleep. This difficulty can be amplified if underlying stress and other sleeping difficulties exist.

Furthermore, physical illnesses such as type II diabetes can impact sleep and lead to episodic or chronic insomnia.

- Lifestyle and poor sleeping habits

The risk of developing insomnia is higher if the individual has unhealthy routines and lifestyle habits, including what the person is eating or drinking regularly.

Lifestyles habits that can increase the risk of insomnia are:

- Playing video games and using the phone or computer screen until late keeps our brain stimulated and unable to relax, which can lead to difficulties falling asleep after.

- Taking naps during the late afternoons (although napping could create problems even if taken in the early afternoon for some people).

- Using the bed for other activities not associated with sleep can create difficulties in associating the bed with rest/sleep time.

- Sleeping too late in the mornings can alter your body’s internal clock and increase difficulties in developing a healthy sleep schedule.

- Drinking too much caffeine in your day -particularly in the afternoon and evening- can contribute to developing insomnia as caffeine is a stimulant that can remain in your system for hours. Nicotine is also shown to impact your sleep, being another stimulant.

- Alcohol can also negatively affect your sleep. Even though it is not a stimulant, it can affect the quality of your sleep as it might make you feel sleepy, altering your normal sleep cycle and can result in non-restorative sleep.

- Eating heavy meals in the late evening can create difficulties in your sleep patterns as it challenges your digestive process, resulting in potential sleeping difficulties.

- Mental health conditions

Mental health difficulties such as depression and anxiety often contribute to developing sleeping problems. Sleep can be affected by intrusive negative thoughts characteristics of these conditions and the hyperarousal of your brain due to spiralling thoughts. Furthermore, research has shown that insomnia can worsen anxiety, mood disorders and depression symptoms.

- Medications

Insomnia can be developed as part of the side effects of certain medications, such as antidepressants and blood pressure medications. Further, other medications can induce drowsiness during the day, and that can alter the regular sleeping schedule.

Treatment For Insomnia

Cognitive Behavioural Therapy (CBT) is an effective treatment for insomnia, which may help improve the quality and quantity of your sleep.

This therapy model starts from the assumption that you can change how you feel and respond to different situations by changing your beliefs and thoughts about yourself, others, and the world. With your therapist, you will work collaboratively to develop a shared understanding of the underline cause(s) of insomnia and develop a treatment plan tailored to your specific needs, managing your anxiety and establishing better sleeping habits.

Please get in touch with us to learn more about therapy for insomnia or schedule an appointment for a free initial consultation.