Insomnia Treatment

Human beings, quite simply, need a lot of sleep. While some people need more sleep than others, most of us should be spending up to a third of our lives sleeping, and when we do not get enough over a period of time, it can have serious impacts on our mood, our general mental health, and our physical health. When we are severely tired, we can also struggle to perform daily tasks such as driving or operating machinery safely, and our relationships with the important people in our lives can suffer.

Insomnia is such a common issue, and with such serious ramifications for all areas of life, that it is considered to also have a significant economic cost in terms of lowered performance at work for those who experience it. It is therefore fair to say that insomnia is a significant social problem, and not just an issue for the individuals who experience it personally.

While anyone can suffer from insomnia it is more common – at all ages – among women than men, and also tends to be co-morbid with certain other physical and/or mental conditions, as discussed below. The incidence of the condition also tends to rise over time, with older people of both sexes more likely to suffer from insomnia than younger.

If you are suffering from insomnia, your first port of call should be your GP, as it is very important to rule out physical causes for the problem first. One of the most common physical causes is sleep apnoea, which can also lead to heavy snoring. People with sleep apnoea are often woken repeatedly during the night – as is anyone sharing their room – when they become unable to breathe, their oxygen levels are lowered, and they are startled awake. If your doctor thinks that you might have this issue, you may need to undergo a sleep study at a hospital or other centre to assess how you sleep and how your apnoea can be treated. Other causes can include asthma, allergies, menopause in women, chronic pain or itching issues, gastrointestinal disorders, obesity, and health conditions that lead to excessive nocturnal urination, or, less often, serious conditions such as Parkinson’s Disease. It is essential to explore if you have one of these potential causes, as if you do, treating the underlying condition will often also treat the insomnia. In some cases, such as in women going through menopause, the insomnia may be temporary, while in others, such as in people with obesity, if the underlying condition changes for the better, they may also cease to experience insomnia.

However, in many other cases, even after extensive medical testing, no physical cause for insomnia can be located. In these situations, your insomnia may relate to a mental health condition, to temporary circumstances that are causing you stress and anxiety, to chronic mental health issues, to learned habits that are contributing to the problem, or – often – a combination of the above.

Ironically, one of the great aggravating factors of insomnia is excessive worry about the condition itself. People can find themselves lying awake at night as they experience heightened and growing anxiety about how they will be able to function the following day if they do not get the sleep they need. The more their anxiety grows, the harder it becomes to fall asleep in a self-perpetuating vicious circle.

Various forms of medication are available to treat insomnia, including mild over-the-counter and prescription medications. These can sometimes play a useful role in treatment in very short-term, specific circumstances (for example, while dealing with severe jet-lag due to time differences in travel, or for a brief, clearly-defined period during a particularly challenging time, such as a recent bereavement), but they are never a good long-term approach to the condition. Some types of sleeping pills are addictive and can lead to withdrawal symptoms when they are no longer prescribed, while all can be psychologically addictive, and will only make the problem worse in the longer term. Unless the underlying causes for the insomnia are treated, it will never be satisfactorily addressed, and medication will never provide more than a “sticking plaster” solution.

Moreover, such medications can be associated with reduced ability to function during the hours of wakefulness, up to and including issues with driving or operating machinery safely. Some natural sleeping aids, such as those based on medicinal cannabinoids, have been clinically proven to assist with sleep. While they may not work as quickly as synthetic pharmaceuticals, they can have fewer side effects. Other medications, including a range of “alternative” therapies, may also help in the short term (although they often have not been subject to rigorous clinical trials and their efficacy is unproven) but again, they do not treat the underlying causes of the insomnia and therefore are, at most, of limited short-term use.

Unexplained insomnia can be extremely stressful in and of itself. However, a suitably trained therapist can help.

Firstly, your therapist may want to work with you to understand your routine around sleeping. If possible, making some simple changes such as going to bed and getting up at the same time every day, avoiding caffeine, nicotine, alcohol, and other substances that can disrupt sleep, reducing ambient noise or using earplugs, and not using your phone shortly before bed can make a significant difference. You may be advised to keep a diary for a few weeks to figure out if certain behaviours around sleep and going to bed are contributing to the problem. Making positive changes around going to bed and sleep may be referred to as “good sleep hygiene.”

Secondly, you and your therapist are likely to explore any underlying mental health issues that may be contributing to the problem. Common mental health disorders such as chronic stress and anxiety (when you are persistently impacted by these negative feelings even in the absence of obvious triggers), obsessive compulsive disorder, depression, psychosis, addictive behaviour relating to the use of devices such as smartphones, and more can all contribute to insomnia. In these cases, your insomnia is unlikely to improve until the underlying condition is managed more effectively, so your therapist will design an approach to treatment that aims to reduce the symptoms of both the underlying condition and the related insomnia.

Your therapist may suggest that you combine other approaches with the use of a device that measures how long you are sleeping and provides feedback about the quality of your sleep and how long you are spending in different periods of sleep, such as the rapid eye movement (REM) phase of sleep, which is less restful, and deep sleep. These devices – of which a variety is available for purchase from various sources – also provide data about how often you are waking at night, and how long you are spending awake. They can help to provide an accurate picture of how severe your insomnia is. This is important, because people often feel that they are getting less sleep than they actually are, which they can find extremely worrying.

Treatments that have been proven to be effective with insomnia, and with the common underlying causes listed above, include:

• Cognitive Behavioural Therapy (CBT). This is one of the most common approaches to insomnia, and it has been clinically proven to be extremely effective in the long-term treatment and management of the condition. With CTP, your therapist works with you to figure out what thoughts and behaviours have been impacting on your ability to fall asleep and stay asleep. Once these are recognised, it will become easier to identify triggers to these thoughts and behaviours, and you will also be able to work with your therapist to identify and build on new thoughts and behaviours that are more positive and more useful in terms of sustaining a good night’s sleep.
• Behavioural Sleep Medicine (BSM), is an approach that focuses on the psychological, physiological, and other factors that impact on the ability to sleep. BSM utilises a combination of good sleep hygiene, as outlined above, and therapies including relaxation techniques and mindfulness techniques designed to reduce worrying and anxiety.
• Biofeedback, which helps you to understand how biological processes can interact with stress and other factors that interfere with sleep, can work in conjunction with learning relaxation techniques or engaging with a process such as CBT.
• Acceptance and Commitment Therapy (ACT), which is similar to CBT, is based on a method whereby the person works with their therapist towards changing their relationship with thoughts and feelings; in this case, with the thoughts and feelings they have about sleep, including the process of falling asleep, and the anxieties and stress they experience when they fail to sleep. Like CBT, ACT focuses on identifying behaviours that are less than useful, and replacing them with new behaviours that are more useful; in this context, behaviours that are more compatible with falling and staying asleep, when this is the desired outcome. This form of therapy can be offered individually, but is commonly provided in the context of group therapies or interventions.
• Neurofeedback is an emerging treatment for insomnia that a growing number of therapists are integrating into their practice, where indicated. It focuses on abnormal brain activity that may be impacting on sleep, and on training the brain to respond differently to triggers that can contribute to the insomnia.
• If the problem relates to addictive behaviours, most commonly addictions to smartphone use or gaming consoles, overeating leading to obesity, or addiction to substances that might include caffeine, alcohol, nicotine, or a range of prescription and non-prescription substances, then in tandem with other treatments an approach designed to replace the addictive behaviour associated with the insomnia will be indicated.
• Depending on the reasons for the insomnia, its severity, and other factors, your therapist might recommend a treatment approach that combines all or a number of the strategies outlined above, specifically tailored to your needs. As your relationship with sleep shifts and evolves, they will adapt the treatment accordingly until the insomnia is effectively managed and your sleep and quality of life improve.

Some people may always be more inclined towards insomnia than others, but with therapy, good sleep management, and openness to exploring different treatment modalities and approaches, most people respond well to treatment and find that their insomnia becomes much more manageable, even after a relatively brief period of therapy. It may be useful to consider having a “top up” session periodically if the insomnia flares up so that it can be treated before it escalates.

The primary motivation for and benefit of treating insomnia effectively with therapy is that, in the vast majority of cases, it becomes much easier to fall asleep and to stay asleep. Also, given the profound effect of insomnia on quality of life and on issues such as work performance, there are many secondary benefits, including: ceasing or not having to take pharmaceutical aids to sleep, with the risk of dependence and of various side effects; lowered risk of accidents and mishaps related to tiredness; reduced impact of insomnia on depression or other psychiatric conditions; and improved relationships with loved ones and co-workers.

Above all, it is important to know that for most people with insomnia, with professional therapeutic support the condition is very treatable and the prognosis is extremely good.

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