Many people experience difficulties with sleep at some point in their lives. While for most people this difficulty will be transitory, approximately 10-20% of the population struggle with insomnia on a much more persistent basis. People who suffer from insomnia often feel unrested and chronically tired, which can make it very difficult to function normally in their day to day lives, and over time, this can impact on their physical, mental, and emotional health. Seeking help from a professional like individual counselling can help you to deal with insomnia.
What is insomnia?
Insomnia is defined as a problem with falling asleep, staying asleep or getting restful sleep, despite the opportunity for adequate sleep, which impacts on daytime functioning, and persists for more than six months duration.
Types of insomnia:
- Psychophysiological insomnia – Learned sleep-preventing associations, conditioned arousal
- Paradoxical insomnia – Experience of poor sleep disproportionate to actual sleep duration
- Idiopathic insomnia –Non restorative sleep with typical onset in childhood
- Inadequate sleep hygiene – Lifestyle and daily activities inconsistent with producing good sleep quality
- Secondary or comorbid insomnia – Insomnia that occurs as a result of other sleep disorders (eg restless leg syndrome or obstructive sleep apnoea), psychiatric illnesses (eg depression) or medical conditions (eg chronic pain)
Common symptoms and impacts of insomnia include:
- Fatigue or daytime sleepiness
- Cognitive difficulties including problems with attention, concentration or memory
- Impact on functioning including social problems, work-related problems, or poor school performance
- Mood disturbance or irritability
- Reduced motivation, energy, or initiative
- Proneness for errors or accidents
- Tension, headaches, or gastrointestinal symptoms
- Concerns or worries about sleep
Treatments for insomnia
Traditionally insomnia has been treated with the use of medications. These can be effective in the short-term, but they may not be the best for treatment of insomnia in the long-term. Cognitive behavioural therapy for insomnia, often called CBT-I, is an effective insomnia treatment for chronic sleep problems. CBT-I is a structured program that aims to improve sleep habits by targeting the unhelpful thoughts and behaviours that otherwise maintain insomnia. Key components of CBT-I which may be used in treatment include:
- Stimulus control – Producing an environment where the bedroom is only for sleep, removing factors that have become associated with poor sleep
- Sleep restriction – Decreasing the time you spend in bed, leading to partial sleep deprivation, with the result of increased sleep efficiency over time
- Relaxation or imagery training – Develops your ability to calm your mind and body, and may include breathing, mindfulness, imagery, and muscle relaxation
- Cognitive restructuring – Challenging unhelpful or maladaptive misattributions about insomnia and its impact
- Paradoxical intention – Trying to lie passively awake rather than trying to get to sleep, in order to let go of the performance anxiety about trying to sleep
- Cognitive control – Setting aside time in the early evening to rehearse the day and plan ahead
- Sleep hygiene – Changing basic lifestyle habits that influence sleep (eg smoking, excessive alcohol, lack of exercise), as part on an integrated intervention
Unlike medication, CBT-I addresses the underlying causes of insomnia rather than just relieving symptoms. But it does take time and effort to make it work. In some cases, a combination of sleep medication and CBT-I may be the best approach.
It is also important to consider that some sleep disorders may be caused by medical conditions, while others may have psychological roots. Medical conditions such as fibromyalgia, thyroid and kidney disease, asthma, and diabetes can contribute to the development of sleep problems. In these cases, medical treatment for the underlying condition may be the most effective way to treat the sleep disturbance, so it is important to visit your General Practitioner for a thorough examination.
References and further information:
GoodTherapy.org – http://www.goodtherapy.org/
Mayo Clinic – http://www.mayoclinic.org/
Portland Psychotherapy Clinic – http://www.portlandpsychotherapyclinic.com/
Sleep WA Perth Sleep Disorders Centre – http://www.sleepwa.com.au/