Insomnia
Sleep is important to all of us. Every person requires sleep as a normal part of daily activity and for continued health and stability. Almost everyone experiences disrupted sleep at one time or another. Several of my clients report struggling with sleep at some point. For some individuals, it may be external factors such as living next to a noisy alleyway or taking care of a child. For others, it may be anxious thoughts that keep them up throughout the night. For a percentage of the population, sleep is continuously disrupted as a result of sleep disorders. There are several conditions that may impact the ability to achieve good, quality sleep. For the purpose of this article, we will focus on the topic of insomnia.
Sleep is so critical to our functioning and ultimately affects focus and concentration, memory, emotional stability, and even weight. In addition, sleep is important for the consolidation of memories, regulation of immune function, body growth through the release of growth hormone while sleeping, and energy conservation (Wyatt, 2017). There is still so much research that is needed in order to fully understand all of the important reasons as to why we need sleep.
According to Smith and colleagues (2014), the optimal amount of time needed for sleep among adults is less than that for children and adolescents, although adults still need between 7.5 and 9 hours of sleep each night. I’m often surprised that several of my clients rarely get 7 hours of sleep per night. Sleep is a struggle for many people. Lack of sleep will negatively impact our physical/mental health, functioning at work, in school, and in our social relationships.
Insomnia occurs when an individual consistently has difficulties falling asleep, staying asleep, waking up too much during the night, or generally having poor quality sleep and feeling as if a full night sleep barely happened. Insomnia can develop for a number of reasons and is associated with certain illnesses and physical conditions. However, there are some people who develop insomnia that is unrelated to any other underlying disorder.
According to an article completed by the University of Maryland Medical Center (2017), approximately 50 percent of cases of insomnia have no identifiable cause. There are many other conditions that can predispose a person to developing insomnia. Some conditions that may increase the risk include advancing age, substance use, menopause in women, gastroesophageal reflux, changes in body temperature due to illness, altered hormone secretion or function, or other sleep disorders, including circadian rhythm sleep disorders. The person may suffer from daytime fatigue, irritability, headaches,and difficulties concentrating. When going to bed at night, he/she may still be unable to sleep despite feeling exhausted.
Insomnia can lead to mental health issues, most commonly anxiety and depression related to lack of sleep. Often, when insomnia occurs every night, the affected person may become more anxious as evening approaches. It can be very difficult to lie in bed awake while trying to get to sleep; if the situation has continued for many nights, anxiety may increase due to worrying that another sleepless night will happen. Further, while lying awake, a person often feels anxious and worries about getting too little sleep to face the day. This further compounds anxiety and may make getting to sleep more difficult.
Insomnia may also be related to depression. Some people with chronic insomnia may be more likely to develop depression because they typically feel isolated when they cannot sleep and others can. They may feel as if no one else understands how difficult insomnia can be, and it truly can be difficult for a person who normally has no trouble sleeping to understand insomnia. A person may also develop depression due to frustration from not being able to achieve sleep or not finding an appropriate treatment to resolve sleep deprivation. According to a study completed by the University of Maryland Medical Center, depression is so widely associated with insomnia that studies have shown up to 60 percent of people with insomnia also have depression.
There are various approaches to treatment of insomnia. Some patients use medications to help them sleep and, while these may work, often a change in certain lifestyle factors can be even more successful. In some cases, lifestyle changes alone may be enough to promote sleep such that insomnia is resolved.
For the purpose of this article, I will focus on certain lifestyle factors that we can change in order to treat insomnia and improve overall sleep. As a clinician, I encourage clients to avoid taking naps during the day, especially closer to dinnertime in the evening when bedtime is approaching. Avoiding other activities and substances late in the day, such as alcohol, caffeine, and exercise, can all help a person to better “wind down” while getting ready for bed. Alcohol has an initial depressant effect but can later cause a person to awaken more, ultimately having the opposite effect. Caffeine acts as a stimulant, which can inhibit sleep and should be avoided while trying to get to sleep. Exercise is beneficial and should be done during the day to improve circulation and flexibility; however, exercise late in the day may cause a person to feel more awake and have difficulty sleeping at bedtime.
Cognitive-behavioral therapy (CBT) is a behavior modification that may be used for some types of sleep disorders. It has been effective in the treatment of insomnia. A therapist serves as a guide for the patient to coach him/her in learning to recognize the factors that are contributing to sleep problems. For example, a patient with insomnia may learn to recognize those thoughts and ideas that he or she consistently thinks about every night that sometimes prevent asleep from occurring. After learning to recognize the cognitive factors that lead to sleep impairment, the patient then learns behavioral factors that can counteract the cognitive disturbances.
Some types of behavioral changes that may be successful include making changes in sleep hygiene habits, such as by avoiding the bedroom unless using it for sleep, keeping the bedroom quiet and dark when trying to sleep, moving the clock to avoid checking the time too frequently, and eliminating exterior light and noise that can prevent sleep. Other examples of behavior modifications include progressive relaxation, meditation, prayer, and mental imagery. For some people with insomnia, it may also help to establish a solid bedtime routine, in which certain activities are performed each night that help to promote relaxation and restfulness. The bedroom should be designed as a place used only for sleep, and the person should not spend significant amounts of time in bed reading or working on a computer. The body may later have difficulties transitioning to sleep when the individual has already been in the same place and position for hours doing other activities. It may also help to have slow, soothing activities before bed, such as taking a bath or listening to soft music, which can help to slow down the pace of the day and help a person feel relaxed.
When working with a client who struggles with falling asleep, paradoxical intention has been a helpful tool. According to Herbert (2017), paradoxical intention is the process of trying to perform the opposite of the intended effect as a method of tricking the mind into actually getting the body to engage in the opposite behavior. For example, a client who cannot sleep because of insomnia due to continued ruminations might benefit from paradoxical intention by telling themselves not to go to sleep and focusing on trying to stay awake. The paradoxical intent may trick the mind into going to sleep when the patient attempts to stay awake.
Sleep restriction therapy may be another option that can help a person with sleep difficulties to get to sleep. Many people who have difficulty falling asleep lie in bed for hours, trying to force themselves to sleep. Sleep restriction therapy uses the guideline that if the person is unable to fall asleep within a certain amount of time, he or she should get up and leave the bedroom and rest in another location until ready to try and sleep again. By doing this, sleep restriction prevents a person from developing anxiety that may occur while lying in bed and trying too hard to sleep. Behavioral interventions and modifications can successfully help some patients with sleep disturbances because these activities alter the sleep environment as well as the patient’s approach and thoughts about sleeping.
Finally, treatment and management of other disorders that may be contributing to insomnia can be extremely helpful in improving sleep for the affected person. For example, an individual who struggles with insomnia may also struggle with sleep apnea or gastroesophageal reflux. These comorbid conditions once treated may further improve sleep.
There are a number of options for the treatment of insomnia and other sleep related disorders. I hope the lifestyle changes and strategies discussed here increase awareness in order to improve overall sleep. - Rhiannon Seward, Psy.D.
ReferencesBonnet, M. and Arand, D. (2017). Treatment of insomnia in adults. UpToDate.Herbert, V., et al. (2017). Does cognitive behavioural therapy for insomnia improve cognitiveperformance? A systematic review and narrative synthesis. Sleep Med Rev. Retrieved online athttps://www.ncbi.nlm.nih.gov/pubmed/28918315.Mayo Clinic. (2014). Insomnia treatment: Cognitive behavioral therapy instead of sleeping pills.Retrieved online at http://www.mayoclinic.org/diseases-conditions/insomnia/indepth/insomnia-treatment/art-20046677Sharma, M. P., Andrade, C. (2012). Behavioral interventions for insomnia: Theory and practice. Indian Journal of Psychiatry 54(4): 359-366. Retrieved online at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3554970/Smith, M., Robinson, L., Segal, R. (2014). How much sleep do you need? Retrieved online athttp://www.helpguide.org/life/sleeping.htmUniversity of Maryland Medical Center (2017). Insomnia. UMMC. Retrieved online athttp://www.umm.edu/health/medical/ency/articles/insomniaWyatt, J. (2017). Overview of circadian sleep-wake rhythm disorders. UpToDate.
Sleep is so critical to our functioning and ultimately affects focus and concentration, memory, emotional stability, and even weight. In addition, sleep is important for the consolidation of memories, regulation of immune function, body growth through the release of growth hormone while sleeping, and energy conservation (Wyatt, 2017). There is still so much research that is needed in order to fully understand all of the important reasons as to why we need sleep.
According to Smith and colleagues (2014), the optimal amount of time needed for sleep among adults is less than that for children and adolescents, although adults still need between 7.5 and 9 hours of sleep each night. I’m often surprised that several of my clients rarely get 7 hours of sleep per night. Sleep is a struggle for many people. Lack of sleep will negatively impact our physical/mental health, functioning at work, in school, and in our social relationships.
Insomnia occurs when an individual consistently has difficulties falling asleep, staying asleep, waking up too much during the night, or generally having poor quality sleep and feeling as if a full night sleep barely happened. Insomnia can develop for a number of reasons and is associated with certain illnesses and physical conditions. However, there are some people who develop insomnia that is unrelated to any other underlying disorder.
According to an article completed by the University of Maryland Medical Center (2017), approximately 50 percent of cases of insomnia have no identifiable cause. There are many other conditions that can predispose a person to developing insomnia. Some conditions that may increase the risk include advancing age, substance use, menopause in women, gastroesophageal reflux, changes in body temperature due to illness, altered hormone secretion or function, or other sleep disorders, including circadian rhythm sleep disorders. The person may suffer from daytime fatigue, irritability, headaches,and difficulties concentrating. When going to bed at night, he/she may still be unable to sleep despite feeling exhausted.
Insomnia can lead to mental health issues, most commonly anxiety and depression related to lack of sleep. Often, when insomnia occurs every night, the affected person may become more anxious as evening approaches. It can be very difficult to lie in bed awake while trying to get to sleep; if the situation has continued for many nights, anxiety may increase due to worrying that another sleepless night will happen. Further, while lying awake, a person often feels anxious and worries about getting too little sleep to face the day. This further compounds anxiety and may make getting to sleep more difficult.
Insomnia may also be related to depression. Some people with chronic insomnia may be more likely to develop depression because they typically feel isolated when they cannot sleep and others can. They may feel as if no one else understands how difficult insomnia can be, and it truly can be difficult for a person who normally has no trouble sleeping to understand insomnia. A person may also develop depression due to frustration from not being able to achieve sleep or not finding an appropriate treatment to resolve sleep deprivation. According to a study completed by the University of Maryland Medical Center, depression is so widely associated with insomnia that studies have shown up to 60 percent of people with insomnia also have depression.
There are various approaches to treatment of insomnia. Some patients use medications to help them sleep and, while these may work, often a change in certain lifestyle factors can be even more successful. In some cases, lifestyle changes alone may be enough to promote sleep such that insomnia is resolved.
For the purpose of this article, I will focus on certain lifestyle factors that we can change in order to treat insomnia and improve overall sleep. As a clinician, I encourage clients to avoid taking naps during the day, especially closer to dinnertime in the evening when bedtime is approaching. Avoiding other activities and substances late in the day, such as alcohol, caffeine, and exercise, can all help a person to better “wind down” while getting ready for bed. Alcohol has an initial depressant effect but can later cause a person to awaken more, ultimately having the opposite effect. Caffeine acts as a stimulant, which can inhibit sleep and should be avoided while trying to get to sleep. Exercise is beneficial and should be done during the day to improve circulation and flexibility; however, exercise late in the day may cause a person to feel more awake and have difficulty sleeping at bedtime.
Cognitive-behavioral therapy (CBT) is a behavior modification that may be used for some types of sleep disorders. It has been effective in the treatment of insomnia. A therapist serves as a guide for the patient to coach him/her in learning to recognize the factors that are contributing to sleep problems. For example, a patient with insomnia may learn to recognize those thoughts and ideas that he or she consistently thinks about every night that sometimes prevent asleep from occurring. After learning to recognize the cognitive factors that lead to sleep impairment, the patient then learns behavioral factors that can counteract the cognitive disturbances.
Some types of behavioral changes that may be successful include making changes in sleep hygiene habits, such as by avoiding the bedroom unless using it for sleep, keeping the bedroom quiet and dark when trying to sleep, moving the clock to avoid checking the time too frequently, and eliminating exterior light and noise that can prevent sleep. Other examples of behavior modifications include progressive relaxation, meditation, prayer, and mental imagery. For some people with insomnia, it may also help to establish a solid bedtime routine, in which certain activities are performed each night that help to promote relaxation and restfulness. The bedroom should be designed as a place used only for sleep, and the person should not spend significant amounts of time in bed reading or working on a computer. The body may later have difficulties transitioning to sleep when the individual has already been in the same place and position for hours doing other activities. It may also help to have slow, soothing activities before bed, such as taking a bath or listening to soft music, which can help to slow down the pace of the day and help a person feel relaxed.
When working with a client who struggles with falling asleep, paradoxical intention has been a helpful tool. According to Herbert (2017), paradoxical intention is the process of trying to perform the opposite of the intended effect as a method of tricking the mind into actually getting the body to engage in the opposite behavior. For example, a client who cannot sleep because of insomnia due to continued ruminations might benefit from paradoxical intention by telling themselves not to go to sleep and focusing on trying to stay awake. The paradoxical intent may trick the mind into going to sleep when the patient attempts to stay awake.
Sleep restriction therapy may be another option that can help a person with sleep difficulties to get to sleep. Many people who have difficulty falling asleep lie in bed for hours, trying to force themselves to sleep. Sleep restriction therapy uses the guideline that if the person is unable to fall asleep within a certain amount of time, he or she should get up and leave the bedroom and rest in another location until ready to try and sleep again. By doing this, sleep restriction prevents a person from developing anxiety that may occur while lying in bed and trying too hard to sleep. Behavioral interventions and modifications can successfully help some patients with sleep disturbances because these activities alter the sleep environment as well as the patient’s approach and thoughts about sleeping.
Finally, treatment and management of other disorders that may be contributing to insomnia can be extremely helpful in improving sleep for the affected person. For example, an individual who struggles with insomnia may also struggle with sleep apnea or gastroesophageal reflux. These comorbid conditions once treated may further improve sleep.
There are a number of options for the treatment of insomnia and other sleep related disorders. I hope the lifestyle changes and strategies discussed here increase awareness in order to improve overall sleep. - Rhiannon Seward, Psy.D.
ReferencesBonnet, M. and Arand, D. (2017). Treatment of insomnia in adults. UpToDate.Herbert, V., et al. (2017). Does cognitive behavioural therapy for insomnia improve cognitiveperformance? A systematic review and narrative synthesis. Sleep Med Rev. Retrieved online athttps://www.ncbi.nlm.nih.gov/pubmed/28918315.Mayo Clinic. (2014). Insomnia treatment: Cognitive behavioral therapy instead of sleeping pills.Retrieved online at http://www.mayoclinic.org/diseases-conditions/insomnia/indepth/insomnia-treatment/art-20046677Sharma, M. P., Andrade, C. (2012). Behavioral interventions for insomnia: Theory and practice. Indian Journal of Psychiatry 54(4): 359-366. Retrieved online at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3554970/Smith, M., Robinson, L., Segal, R. (2014). How much sleep do you need? Retrieved online athttp://www.helpguide.org/life/sleeping.htmUniversity of Maryland Medical Center (2017). Insomnia. UMMC. Retrieved online athttp://www.umm.edu/health/medical/ency/articles/insomniaWyatt, J. (2017). Overview of circadian sleep-wake rhythm disorders. UpToDate.