By Melanie Birch

In my last article, I talked about the importance of sleep and gave some tips for healthy sleep habits that we can all follow. If you missed it, pop over to our website and open the Festive Season 2016 newsletter ( ).

Insomnia is the most common of the 60 possible diagnoses listed in the International Classification of Sleep Disorders. Although we can all get a bad night’s sleep now and then, having insomnia means a defined set of things have happened. It means that for at least three months you have had trouble getting to sleep, staying asleep or not feeling restored when you wake up in the morning. In addition, if you have insomnia, this lack of good quality sleep will have been interfering with your normal daytime function. Common effects are irritability, poor memory, fatigue, lack of energy and a general “meh” feeling. If this sounds familiar, you are not alone. Up to a third of the adult Australian population has difficulties getting to sleep or staying asleep.

There is no single cause for insomnia. Someone can have been a “poor” or light sleeper since childhood. Or not uncommonly a major life event can have happened that triggered acute insomnia that over time became chronic. Work stress or a change in work related sleep schedule can be a factor. Sometimes insomnia develops as part of another condition. For instance, 50% of people with depression will also have insomnia. There is also an overlap with insomnia and anxiety, obstructive sleep apnoea and restless leg syndrome. 

The distress associated with insomnia can be overlooked by family, friends and sometimes by those of us in the health field. For someone with insomnia, it is not just a case of the odd bad night’s sleep. There is a high level of fatigue but not sleepiness. A reduction in alertness might be there but there is not the corresponding ability to nap if it is daytime or fall asleep at bedtime. This in itself is frustrating and distressing. It is a feeling of being tired but wired. This in turn impacts all areas of life – performing well at work, being present in relationships, having the energy to attend and enjoy events, having patience and being able to listen to the children. 

Added to this is the overwhelming cognitive burden of knowing it will all probably happen again “tonight”. This can lead to a vicious cycle where the more a person tries to sleep, the more agitation rises and the less you are able to sleep. During the day the mind focusses on what a terrible night’s sleep that was and how lousy things are today. As bedtime approaches, the mind refocusses on how bad the previous night’s sleep was and how it is sure to happen again tonight. The thoughts around sleep can become consuming, sometimes with a rigid and elaborate pre-sleep routine that on the one hand must be kept to maximise the chances of a good night’s sleep, but with an inner knowing that it probably won’t work. And that it will all happen again the next day.

In fact chronic insomnia tends to have a course of relapse and remission. There will be better times and worse times. Treatment focusses on providing skills for managing symptoms over time and looking at strategies to minimise relapses. 

CBT-I Cognitive Behavioural Therapy for Insomnia

CBT-I is the major psychological treatment for insomnia. It looks at the thoughts that might have developed around sleep that are not serving us well. It also looks at the behaviours we might have developed that are, without us realising, contributing to or maintaining a difficulty sleeping. This is not at all about blaming or finger pointing. It is about looking with fresh eyes, training, and the experience that comes from seeing people with the same problems.

CBT-I has components that have been well researched and have been shown to have good effect. Because we all sleep, we tend to think we know a lot about sleep. In fact there is a great deal that goes on in the brain that we don’t generally know about. Understanding what the brain is doing in regulating our sleep is very useful in gaining better control of the process. There is also discussion of sleep routines: how we sleep, when we sleep, what activities, appliances and devices might be helping or stopping us from falling sleep. There is also a closer matching of sleep times to bed times and perhaps a turning on the head of thoughts about what we “should” be doing to get to sleep. Keeping a sleep diary is part of this treatment approach. Although it sounds onerous, it really isn’t. It only needs to happen for a short period of time and gives invaluable detailed information on which to make decisions and is a very good feedback tool. 

Relaxation techniques are an essential component of CBT-I and can include progressive relaxation, imagery training, meditation and biofeedback. Learning to practice these regularly is very useful. It does not mean setting aside a great deal of time, or learning to meditate like a Zen master. Doing a relaxation exercise for a few minutes a few times a day has a good effect. Learning to relax the muscles and turn down the chatter is a habit based activity. The more you do it, the more the body and brain respond positively to it. 

What path to take if you suffer from insomnia can be confusing. There are lots of products on the market. Some of these will provide relief, sometimes temporary, for some people. And if that works for you, great! However what is very useful for both relief in the here and now, and to minimise the duration and severity of insomnia in the longer term, is to address the underlying mechanisms that are leading to insomnia. For each person this will be different, even if on the surface their presentations are similar. 

This is where seeing an insomnia treatment practitioner helps. We are all different! For each person there is a unique pathway and set of circumstances that has led to insomnia. The triggers and ways of coping are individual.  When you come to see someone who treats insomnia you will be asked many questions and a great deal of information will be collected. In this way, a detailed sleep history can be compiled (an essential component) and a treatment plan can be crafted specifically for your needs and circumstances. 

If you are struggling with sleep and haven’t found a useful solution, consider CBT-I. You have nothing to lose but a bad night’s sleep!

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