Better Managing Sleep

Primary insomnia is more than just transient sleep difficulties, it is persistent problems with sleep, lasting for more than one month, and may include:

• • • Difficulty falling asleep – also known as onset insomnia
    • Waking up on and off during the night – also known as middle insomnia
    • Waking up very early and not returning to sleep
    • Unsatisfactory sleep quality

These are different to other sleep problems, such as excessive daytime sleepiness, effects of shift work and jet-lag, or nightmares and sleepwalking.

Surprisingly, insomnia is the most common psychological health problem – it has been estimated that 15-30% of the adult population suffers from insomnia, with twice as many women as men suffering. Insomnia becomes more common as we get older, but it affects a range of ages. Most of us experience problems with sleep at some
point in our lives, generally when under stress, but you should consider seeking help for what we call chronic insomnia. This is when your problems with sleep have
lasted for more than one month or if you cannot get a good night’s sleep without sleeping pills.

Insomnia is often associated with other psychological disorders such as depression, generalised anxiety disorder, and post-traumatic stress disorder. People may underplay the importance of insomnia by regarding it as just a symptoms of another issue, when in fact it may require treatment in its own right.

Impact of Insomnia

Although insomnia is common, it is certainly not a minor issue. Ongoing sleep problems can impact on your functioning during the daytime as well as night. People who do not sleep well may experience:

• • • Low mood or easily irritable
    • Poor memory & concentration
    • Trouble staying alert
    • Worry about not sleeping
    • Poor work performance
    • Conflict in relationships
    •  Less quality of life

If you are experiencing some of these consequences of poor sleep, then speak to your Rehabilitation Consultant.

Causes of Insomnia
There is a wide range of factors which may contribute to insomnia. Just some of these factors are:

• • • Respiratory problems such as sleep apnea
    • Restless legs or twitching legs during sleep
    • Pain
    • Side effects of medications
    • Alcohol – leads to more fitful, less refreshing sleep
    • Caffeine and nicotine
    • Severe anxiety or depression
    • Stressful life events
    • Habits such as daytime napping
    • Dependence on sleeping medication

There may be one set of factors associated with the initial causes of insomnia, and quite another that keeps insomnia going and makes into a chronic problem.

The Vicious Cycle of Insomnia

Management of Insomnia

There are many medications which are used to treat insomnia, yet these are usually only effective in the short term. For long-term management of sleep problems, you
may need to consider strategies such as sleep hygiene, cognitive therapy, and reducing your stress levels.

Primary insomnia is persistent problems with sleep, lasting for more than one month, and may include:

• • • Difficulty falling asleep – also known as onset insomnia
    • Waking up on and off during the night – also known as middle insomnia
    •  Waking up very early and not returning to sleep
    •  Unsatisfactory sleep quality

Insomnia is the most common mental health complaint, affecting up to 30% of adults, and may require specific treatment even when it occurs as part of another disorder (e.g. depression, generalised anxiety disorder, post traumatic stress disorder).

Insomnia and the Role of Thinking
The onset of insomnia may be due to a range of factors such as stress, pain or many other reasons, but it is often quite different factors which keep the problem going. Negative thoughts about sleep can play a very important role in maintaining sleep problems.

Types of Negative Thoughts About Sleep

• • •  Assuming the worst about the meaning or cause of sleep problems. For example, someone who thinks “I haven’t slept well this past week, it must mean that I have lost the ability to sleep” is likely to feel much more distressed than someone who thinks “I haven’t slept well this past week – I might be stressed about something at work or at home, I should address it.
    • Blaming everything on sleep is another common thinking trap. It is true that poor sleep can affect mood, concentration, memory and work performance, but sleep is not the only cause of problems in these areas. People with insomnia tend to assume that their sleep problems are the cause of everything that goes wrong with the day.
    • Unrealistic expectations about how much sleep is needed can make people feel worse about problems with sleeping. People who sleep poorly tend to hold a very strong belief that everyone requires 8 hours of sleep per night to function well. In fact, people vary greatly in terms of how much sleep they need. Some people cope quite well on 4-5 hours per night, while others need 9-10. Setting strict rules or targets for your sleep duration will increase performance anxiety and interfere with the process of falling asleep.
    • Unhelpful thinking styles such as catastrophising, black & white thinking, overgeneralisation, and selective attention can also contribute to maintaining sleep problems. For example, people with sleep problems tend to remember the times they slept poorly but forget the instances of good sleep, or will notice every little body sensation when trying to get to sleep. People with insomnia also tend to classify a night’s sleep as either “great” or “terrible” without leaving room for “ok” and “good enough.”

Challenging Negative Thoughts

You can use the Thought Diary process, described in other information sheets to challenge negative thoughts about sleep. Research has shown that negative thinking
is connected to negative emotions and behaviour, and so healthy thinking is a very important part of healthy sleeping. Thought Diaries are a useful way of identifying your negative thoughts about sleep and the feelings and behaviours associated with these thoughts, and then generating more helpful and balanced ways of thinking.

‘Sleep hygiene’ is the term used to describe good sleep habits. Considerable research has gone into developing a set of guidelines and tips which are designed to enhance good sleeping, and there is much evidence to suggest that these strategies can provide long-term solutions to sleep difficulties.

There are many medications which are used to treat insomnia, but these tend to be only effective in the short-term. Ongoing use of sleeping pills may lead to dependence and interfere with developing good sleep habits independent of medication, thereby prolonging sleep difficulties. Talk to your health professional about what is right for you, but we recommend good sleep hygiene as an important part of treating insomnia, either with other strategies such as medication or cognitive
therapy or alone.

Sleep Hygiene Tips

We’ve included 15 tips for better managing your sleep patterns within your control,  incorporating some of these tips you feel suit you best  may increase the quality of your sleep each night.

1) Get regular. One of the best ways to train your body to sleep well is to go to bed and get up at more or less the same time every day, even on weekends and days off! This regular rhythm will make you feel better and will give your body something to work from.

2) Sleep when sleepy. Only try to sleep when you actually feel tired or sleepy, rather than spending too much time awake in bed.

3) Get up & try again. If you haven’t been able to get to sleep after about 20 minutes or more, get up and do something calming or boring until you feel sleepy, then return to bed and try again. Sit quietly on the couch with the lights off (bright light will tell your brain that it is time to wake up), or read something boring like the phone book. Avoid doing anything that is too stimulating or interesting, as this will wake you up even more.

4) Avoid caffeine & nicotine. It is best to avoid consuming any caffeine (in coffee, tea, cola drinks, chocolate, and some medications) or nicotine (cigarettes) for at least 4-6 hours before going to bed. These substances act as stimulants and interfere with the ability to fall asleep

5) Avoid alcohol. It is also best to avoid alcohol for at least 4-6 hours before going to bed. Many people believe that alcohol is relaxing and helps them to get to sleep at first, but it actually interrupts the quality of sleep.

6) Bed is for sleeping. Try not to use your bed for anything other than sleeping and sex, so that your body comes to associate bed with sleep. If you use bed as a place to watch TV, eat, read, work on your laptop, pay bills, and other things, your body will not learn this connection.

7) No naps. It is best to avoid taking naps during the day, to make sure that you are tired at bedtime. If you can’t make it through the day without a nap, make sure it is for less than an hour and before 3pm.

8) Sleep rituals. You can develop your own rituals of things to remind your body that it is time to sleep – some people find it useful to do relaxing stretches or breathing exercises for 15 minutes before bed each night, or sit calmly with a cup of caffeine-free tea.

9) Bathtime. Having a hot bath 1-2 hours before bedtime can be useful, as it will raise your body temperature, causing you to feel sleepy as your body temperature drops again. Research shows that sleepiness is associated with a drop in body temperature.

10) No clock-watching. Many people who struggle with sleep tend to watch the clock too much. Frequently checking the clock during the night can wake you up (especially if you turn on the light to read the time) and reinforces negative thoughts such as “Oh no, look how late it is, I’ll never get to sleep” or “it’s so early, I have only slept for 5 hours, this is terrible.”

11) Use a sleep diary. This worksheet can be a useful way of making sure you have the right facts about your sleep, rather than making assumptions. Because a diary involves watching the clock (see point 10) it is a good idea to only use it for two weeks to get an idea of what is going and then perhaps two months down the track to see how you are progressing.

12) Exercise. Regular exercise is a good idea to help with good sleep, but try not to do strenuous exercise in the 4 hours before bedtime. Morning walks are a great way to start the day feeling refreshed!

13) Eat right. A healthy, balanced diet will help you to sleep well, but timing is important. Some people find that a very empty stomach at bedtime is distracting, so it can be useful to have a light snack, but a heavy meal soon before bed can also interrupt sleep. Some people recommend a warm glass of milk, which contains tryptophan, which acts as a natural sleep inducer.

14) The right space. It is very important that your bed and bedroom are quiet and comfortable for sleeping. A cooler room with enough blankets to stay warm is best, and make sure you have curtains or an eye mask to block out early morning light and earplugs if there is noise outside your room.

15) Keep daytime routine the same. Even if you have a bad night sleep and are tired it is important that you try to keep your daytime activities the same as you had planned. That is, don’t avoid activities because you feel tired. This can reinforce the insomnia.