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Insomnia: Understanding and Managing Sleep Struggles

Studies show that the number of people experiencing sleep problems has skyrocketed. In 2021, the University of Southampton reported an increase from 1 in 6 people experiencing insomnia to 1 in 4. While the pandemic had a severe impact on sleep for many of us, this trend has continued post-pandemic.

Insomnia is not just a minor inconvenience, but a serious condition that can have a major impact on our physical and mental health. Sleep deprivation leaves people at greater risk of long-term health issues, including obesity, cardiovascular disease, diabetes, and mental health problems such as anxiety and depression. This blog will explore what warning signs to look out, what practical steps we can take now, and when we should seek additional support for sleep problems.

What is Insomnia?

Insomnia is more than just occasional sleeplessness. It’s characterised by:

  • Persistent difficulty falling asleep, staying asleep, or experiencing non-restorative sleep.
  • Poor sleep occurring three or more nights per week.
  • Sleep onset latency (difficulty falling asleep) or being awake for more than 30 minutes after sleep onset.
  • Symptoms persisting for over six months.
  • Significant distress or impairment in your social life, work, family and relationships, or other important areas of life.

Persistent insomnia disrupts the automatic process of falling and staying asleep, making sleep more vulnerable to our emotions and behaviours. For instance, you might spend excessive time in bed without sleeping, associating your bed with frustration and failure. Worrying about sleep can be a critical difference between good and poor sleepers.

Who is More Likely to be Impacted by Insomnia?

Insomnia can affect anyone, but certain groups of people or issues can make you more susceptible to developing sleep problems:

Stress, Mental Health, and Insomnia

Stress and mental health issues are major contributors to insomnia. High levels of stress from work, personal life, or significant external events like the current cost-of-living crisis, can make it difficult to relax and fall asleep. Anxiety and depression can create a vicious cycle with insomnia, where poor sleep exacerbates mental health issues, and those issues, in turn, make it harder to sleep. Addressing these underlying issues through therapy, stress management techniques, and lifestyle changes can help to break the cycle.

Women and Insomnia

Women are particularly prone to insomnia due to hormonal fluctuations. The menstrual cycle, pregnancy (and raising children), and menopause contribute to sleep disturbances. During the menstrual cycle, fluctuations in oestrogen and progesterone can cause mood swings and physical discomfort, which can interfere with sleep. Pregnancy brings a range of sleep challenges, from physical discomfort and frequent urination to hormonal changes and anxiety about impending motherhood. Early motherhood often brings with it the impacts of sleep deprivation with night time feeding. The hot flushes, night sweats, and other symptoms of menopause and perimenopause can significantly disrupt sleep.

Older Adults and Insomnia

As we age, our sleep patterns change. Older adults often experience lighter, less restorative sleep and may wake up more frequently during the night. Medical conditions such as arthritis, chronic pain, and respiratory issues can interfere with sleep. Additionally, older adults are more likely to take medications that can disrupt sleep. It’s important to address these issues with your doctor to find appropriate solutions.

Shift Workers and Insomnia

Shift work, particularly night shifts or rotating shifts,  disrupt the body’s natural circadian rhythm. Shift workers can struggle to maintain a regular sleep schedule. The constant adjustment to different sleep and wake times can lead to chronic sleep deprivation and insomnia. Implementing strategies such as creating a dark, quiet sleep environment and maintaining a consistent sleep schedule, even on days off, can help ease these effects, but more in depth support may be needed if mood suffers, and for some shift work cannot be tolerated long-term.

Teenagers and Insomnia

Teenagers are not immune to insomnia, and their sleep issues are often overlooked or attributed to typical adolescent behaviour. However, hormonal changes, increased academic and social pressures, and lifestyle factors such as late-night screen time, can all contribute to insomnia in teens. It is crucial to recognise and address these issues early, as chronic sleep deprivation during adolescence can impact academic performance, mental health, and overall development.

Is medication the answer?

Doctors have a difficult task when giving advice about persistent insomnia. Traditionally doctors prescribe medication, but sleeping pills are recommended for short-term use only, and their prescription is discouraged in older adults. Many people who take sleeping tablets find that they continue to have significant problems getting to sleep or staying asleep – the beneficial effects of medication tending to wear off, requiring a different drug or higher dose, with the risk of dependency.

The other prescription option is antidepressant medication, either because there is a suspicion of underlying depression or because the antidepressant has a sedative side effect when taken at night. The most commonly used drugs for this purpose are tricyclics. However, there have been few controlled clinical trials for the use of tricyclics for insomnia and this remains a matter for debate.

The best clinically proven, evidence-based treatment for insomnia is Cognitive Behavioural Therapy (CBT).

How Can Cognitive Behavioural Therapy (CBT) Help?

Cognitive Behavioural Therapy for Insomnia (CBT-I) is considered the most effective treatment for chronic insomnia. NICE guidelines recommend CBT-I as the gold standard for treating insomnia. Studies suggest as many as 70-80% of people with insomnia found CBT-I effective (Trauer, et al., 2015). Here’s how it works:

Assessment and Goal Setting

CBT-I begins with a detailed assessment of your sleep patterns, often involving a sleep diary. This helps both you and your therapist understand the severity and unique elements of your insomnia. Together, you’ll set specific, measurable goals for improving the quantity and quality of your sleep. These goals provide a clear roadmap for treatment and will help you track your progress over time.

Understanding Sleep Patterns

One of the key components of CBT-I is identifying and understanding the thoughts and behaviours that contribute to your sleep problems. This involves exploring your sleep habits, routines, and any negative thoughts or beliefs you might have about sleep. For example, you might discover that you have unrealistic expectations about how much sleep you need or that you spend too much time in bed trying to force yourself to sleep.

Sleep Hygiene and Relaxation

Improving sleep hygiene is an essential part of CBT-I. Sleep hygiene refers to the practices and habits that promote good sleep. You and your therapist will help identify and manage factors such as caffeine, nicotine, alcohol, diet, and exercise – all of which can impact your sleep. You’ll also work to develop a pre-bedtime routine that helps you relax and prepare for sleep. This might include activities like reading, taking a warm bath, or practicing relaxation techniques such as deep breathing or progressive muscle relaxation.

Behavioural Techniques

Behavioural techniques in CBT-I focus on changing the behaviours that interfere with sleep. One common technique is sleep restriction therapy, which involves limiting the amount of time you spend in bed to the actual amount of sleep you’re getting. This helps strengthen the association between your bed and sleep and reduces the frustration and anxiety that come from spending too much time awake in bed. Over time, as your sleep improves, you will gradually increase the amount of time you spend in bed.

Cognitive Techniques

CBT-I addresses the negative thoughts and worries that contribute to insomnia. This involves identifying and challenging the irrational beliefs and catastrophic thinking that can make it difficult to sleep. For example, you might learn to recognize and reframe thoughts like “I’ll never get to sleep” or “If I don’t sleep well tonight, tomorrow will be a disaster.” By changing these negative thought patterns, you can reduce the anxiety and stress that interfere with sleep.

Managing Worries and Stress

Many people with insomnia struggle with worry and stress. CBT-I includes strategies for managing pressures and worries, such as setting aside a specific time during the day to address your concerns or practicing mindfulness meditation to stay present and reduce stress. Learning to manage your worries can help you create a more peaceful and relaxed state of mind that’s conducive to sleep.

Recommended Reading and Self-Help Options

  • Overcoming Insomnia and Sleep Problems by Professor Colin Espie offers a comprehensive self-help guide using cognitive behavioural techniques. This book provides practical strategies and exercises that you can implement on your own to improve your sleep.
  • Sleepio: An online and app-based sleep improvement program developed by Professor Espie’s team. It is a six-week clinically proven programme used to treat insomnia and it’s completely free on the NHS. It’s designed to help you achieve healthy sleep without medication. Sleepio uses scientifically proven CBT-I techniques and offers personalised sleep plans based on your specific needs and challenges. According to studies, 76% of Sleepio users with long-term sleep problems achieve healthy sleep. You can find out more about Sleepio in this video.

Tips for Better Sleep

In addition to professional treatments and self-help resources, there are several practical steps you can take to improve your sleep straight away:

  1. Create a Sleep-Conducive Environment: Ensure your bedroom is dark, quiet, and cool. Consider using blackout curtains, earplugs, or a white noise machine if necessary.
  2. Establish a Consistent Sleep Schedule: Go to bed and wake up at the same time every day, even on weekends. This helps regulate your body’s internal clock.
  3. Limit Screen Time Before Bed: The light emitted by phones, tablets, and computers can interfere with your ability to fall asleep. Try to avoid screens for at least an hour before bedtime.
  4. Be Mindful of What You Eat and Drink: Avoid large meals, caffeine, and alcohol close to bedtime. These can disrupt your sleep.
  5. Stay Active: Regular physical activity can help you fall asleep faster and enjoy deeper sleep. Just be sure to finish exercising at least a few hours before bedtime.
  6. Manage Stress: Practice relaxation techniques such as yoga, meditation, or deep breathing exercises to reduce stress and promote relaxation before bed.

When Should You Seek Support?

What if you’ve been experiencing sleep problems for more than a month and self-help and sleep hygiene tips haven’t improved things? Then it’s time to seek more support. Insomnia can lead to significant health issues, and getting help early is crucial. Of course, you should speak to your GP to rule out any underlying medical conditions, but persistent insomnia should not be ignored or just ‘put up with’.

If you find that your sleep problems are affecting your daily life, causing significant distress, or contributing to health issues, professional support is essential.

In summary, prioritising good sleep is a cornerstone of maintaining and improving your physical health, mental well-being, and overall quality of life. If you struggle with insomnia, it’s important to take proactive steps to address it through lifestyle changes, self-help strategies, and professional support as needed. By doing so, you can enhance your sleep and, consequently, your overall health and happiness.

Would you like to know more about how CBT can help you with insomnia or sleep problems? Our consultant psychologist, Dr Sian Thrasher, offers a free 15-minute telephone consultation specifically for you to discuss CBT and treatment options.

References

Espie, C.A. (2021) Overcoming insomnia and sleep problems: a self-help guide using cognitive behavioural techniques, 2nd Edition. Little, Brown Book Group, London. EBOOK / ISBN-13: 9781472141408

Trauer, J. M., Qian, M. Y., Doyle, J. S., Rajaratnam, S. M., & Cunnington, D. (2015). Cognitive Behavioral Therapy for Chronic Insomnia: A Systematic Review and Meta-analysis. Annals of internal medicine, 163(3), 191–204. https://www.acpjournals.org/doi/10.7326/M14-2841

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