Insomnia

Overview

People with insomnia have a hard time falling asleep at bedtime or they wake up in the middle of the night or too early in the morning and then aren't able to go back to sleep. At least one in three of us will experience a few sleepless nights at some time in our lives. Usually this is due to stress sleeping in a strange bed or drinking too much caffeine or alcohol before going to sleep. Insomnia is more common among women older adults shift workers and people with medical or psychological disorders. Repeated lack of sufficient sleep eventually leads to daytime fatigue loss of productivity irritability and a decreased quality of life.

Symptoms

Insomnia symptoms aren't the same for everyone. Some people may only experience difficulty falling asleep while others might wake up frequently in the night or never feel refreshed in the morning. Generally the symptoms of insomnia may include any of the following:

  • Difficulty falling asleep (lying in bed wide awake)
  • Waking up repeatedly during the night
  • Waking up too early
  • Not feeling refreshed upon waking up
  • Feeling tired irritable and lacking concentration during the day

Causes

Stress anxiety and depression are the most common causes of insomnia. Chronic insomnia may itself increase the risk of developing depression. The pain that comes with some medical problems can also disrupt sleep as can emotional stress about the illness or even the treatment you are receiving. Some prescription and over-the-counter medications list insomnia as a side effect. Insomnia can also be a result of drinking too much alcohol or coffee or by the nicotine in cigarettes. Insomnia can also be caused by another sleep disorder like restless leg syndrome or sleep apnea.

Treatment

If your life is being adversely affected by a lack of sleep go and see your doctor. He or she will identify and treat any underlying cause like pain or depression. If the insomnia persists there are two main treatment options:

Sleep Medications

Sleeping pills and other hypnotic drugs are often helpful in alleviating sleep disturbances resulting from jet lag separation from a loved one or worry about an upcoming event. These medications should be used only for a short period of time because they can make you drowsy the following day and they lose their effectiveness and increase the risk of dependency when used on a nightly basis over a prolonged period of time. Despite their widespread availability over-the-counter sleep aids and herbal/dietary supplements don't do much for insomnia. Because Health Canada does not regulate these products there is always a risk that they do not contain exactly what is on the product labels.

Behaviour Therapy

The Canadian Sleep Society says 70-80 per cent of people with insomnia can benefit from changes in their bedtime routine. In an excellent brochure on insomnia which you can download here they suggest the following:

à Learn to relax. Relaxation is helpful when stress or anxiety is part of an insomnia problem. Some relaxation exercises are designed to reduce physical tension whereas others seek to eliminate intrusive thoughts and worries at bedtime.

à Give yourself at least one hour to unwind before bedtime. Use this transitional period to read watch television listen to music or simply relax. Do not ruminate about events of the day. Rather write down your worries and set aside another time to deal with them.

à Go to bed only when sleepy. Insomniacs often go to bed too early. Such practice is counterproductive because the bed becomes a cue for wakefulness rather than for sleep. Postpone your bedtime until you are sleepy.

à Get out of bed if you can't sleep. Don't "clock watch". If you can't fall asleep or return to sleep within 15-20 min. get up go to another room and engage in some quiet activity. When you feel that sleep is imminent return to bed. Do not sleep on the couch as this would only create an association between sleep and the couch not with your bed.

à Arise at the same time every morning. Set the alarm clock and get out of bed at the same time every morning weekdays and weekends regardless of the amount of sleep obtained on the previous night. Sticking to a schedule will help regulate your internal biological clock and synchronize your sleep/wake rhythm.

à Reserve your bed and bedroom for sleep only. Do not read watch television or worry in bed either during the day or at night. When you engage in these practices the bedroom becomes associated with wakefulness rather than with sleepiness.

à Avoid daytime napping. Among insomnia sufferers napping is generally counterproductive. A nap disrupts the natural sleep/wake rhythm and interferes with nighttime sleep.

à Restrict the amount of time you spend in bed to your actual sleep time. Insomniacs often spend excessive amounts of time in bed in a misguided attempt to ensure that they get enough sleep. Spending too much time spent in bed may actually lead to poorer sleep quality. Insomniacs often obsess about their sleep. Trying to force yourself to sleep rarely works but if you focus on the basics (activity reducing worry treating depression and eating well) your chances of success will improve.

You might also want to think about setting your alarm and then moving the clock to a place in your bedroom where it is not staring you in the face all night long. The less you know what time it is at night the better you'll sleep. Regular exercise (but not just before bed time) can make a significant difference in your sleep pattern.

Additional Resources:

Canadian Sleep Society