Insomnia is classified as a sleep disorder, characterised by problems falling asleep, maintaining sleep or waking early, with these problems occurring at least three times a week and over a period of three months or more. In addition, the sleep disturbance causes problems with daytime functioning and leads to significant distress.
What causes insomnia?
It is fairly common to experience short-term sleep disturbance as a result of stress or a difficult life event. About one in three people experience problems with their sleep under these circumstances but these problems usually pass away once the stress has been reduced. It is normal to experience sleeplessness when we are feeling anxious or worried as our brain interprets these worries as a physical threat to our existence and the “flight or fight” response is triggered. This happens even though the worry relates to a psychological threat rather than a physical threat as our brain can’t tell the difference. The flight or fight response makes it much more difficult for us to sleep as we become physically, emotionally and cognitively more alert in order to deal with the threat. Sleep puts us in a very vulnerable position with respect to predators and if we are under threat this is not such a good idea.
Although these short-term problems with sleep may pass away relatively quickly, for some people they develop into insomnia. About one in ten people meet the definition of insomnia given above. Insomnia is usually triggered by a stressful life event or stressful period but the factors that maintain insomnia are something completely different altogether. Insomnia is maintained by unhelpful behaviours and unhelpful thoughts that people develop as they adapt to a sleep problem. These can disrupt the biological systems that control sleep so that they are no longer performing as they should do. The unhelpful behaviours and thoughts coupled with repeated unsuccessful attempts at sleeping, lead to negative associations developing with the bed and sleep, so that the bedroom becomes linked with wakefulness rather than sleep. In addition the negative thoughts associated with insomnia can lead to increased worrying about sleep which makes it harder for someone to sleep.
Let me illustrate this point. After a night of being awake for hours, someone switches off their alarm when it wakes them in the morning and sleeps for an additional half an hour. During the day they worry that they will have another bad night’s sleep. The following night they go to bed an hour earlier than their usual time to catch up on the lost sleep. However, they can’t get to sleep for an hour and a half because their internal body clock is not ready for sleep, despite being tired. So they toss and turn thinking “Why can’t I sleep? I need to get to sleep as I have an important meeting tomorrow and I won’t be able to function.” These thoughts set off the flight or fight response which is fuelled by adrenaline. In this state, it is very difficult to drop off to sleep. This reinforces their belief that they cannot sleep and the cycle continues the next day.
Does this sound familiar to you? Don’t worry you are not alone and the good news is there is an effective treatment to combat insomnia. The bad news is it is not widely available. NICE guidelines (National Institute for Health and Care Excellence) state that for long-term sleep problems, pharmacological treatment is generally not recommended as there is little evidence to suggest it solves the problem, that is, the unhelpful thoughts and behaviours behind insomnia. Instead, the first line of treatment for insomnia is Cognitive and/or Behavioural Therapy. More specifically Cognitive Behavioural Therapy for Insomnia (CBTi) is a structured programme focused on treating long-term sleep problems. This is different to general cognitive behavioural therapy as some of the techniques used are specific to insomnia and the treatment requires some knowledge of the processes that control and regulate our sleep.
What is CBTi for insomnia
CBTi makes use of a number of behavioural and cognitive techniques to combat sleeplessness. These include stimulus control which aims to re-associate the bed with sleep rather than wakefulness and to build a consistent sleep wake pattern; sleep restriction which involves reducing time spend in bed awake in order to improve sleep quality; relaxation training for physical relaxation before bed; and cognitive techniques to identify unhelpful thinking related to sleep and to challenge the validity of some of this thinking.
Clinical trials of CBTi show that about 70% of people with insomnia show long-term improvements to their sleep with this treatment. This is more effective in the long term than sleeping pills, which is why GPs are becoming more and more reluctant to prescribing them for long term sleep problems. The difficulty is that CBTi is not widely available on the NHS, although it is worth asking your doctor about accessing it in your area or online. Alternatively you can look into a private therapist with expertise in CBTi or sleep medicine.
So if you have insomnia don’t just live with it. There is an effective treatment out there to combat sleeplessness in the long term but it will involve you changing your sleep habits and this can be difficult to do. You also need to be prepared to be open-minded about your thinking and be open to challenging some of your thinking. If this sounds like something you can do then that’s the first step towards overcoming insomnia.
Christabel Majendie, the Naturalmat sleep expert, is a sleep therapist with expertise in sleep medicine and CBT for insomnia (CBTi). For more information visit www.christabelmajendie.co.uk
For more sleep tips and advice on how to combat sleeplessness visit www.naturalmat.co.uk/blog/sleep-advice