Your Complete Guide to Insomnia: Symptoms, Causes & Cures
This comprehensive guide will take you through everything you need to know about sleep and insomnia. We’ll provide you with information about causes, treatments, and self management, to help you make informed choices about how you can get the restful sleep you need.
What is insomnia?
Insomnia is by far the most common sleep disorder, experienced by up to 35% of adults. If you struggle with insomnia, you might find it difficult to fall asleep or to stay asleep, or both! Insomnia can vary in severity for each individual. Symptoms can even vary for one person over time, depending on external factors and how proactive they are in treating their insomnia. Insomnia can lead to both nighttime and daytime symptoms. Daytime symptoms often revolve around issues functioning during the day, since you aren’t getting the sleep you need for your mind and body to function optimally.
Why is sleep important?
You might be wondering why insomnia is such a big deal. Well you’ll no doubt know that sleep is vital for all of us, but it’s not just about getting rest. While we’re asleep there’s a great deal going on in our mind and body which keeps us physically and mentally healthy.
When you’re asleep your mind is consolidating everything that happened during the day and forming memories. It’s forming new pathways to help you learn and develop moving forward. Studies show that sleep enhances learning, creativity, attention, and good decision making.
Sleep is also vital for our physical health. During sleep our mind communicates with our body to release hormones which perform vital jobs. This includes hormones which boost muscle mass, help us grow and develop, and repair cells and any tissue damage (including repairing our heart and blood vessels to keep them strong). Our immune system also needs sleep to stay strong and work efficiently.
Sleep helps to regulate insulin, which controls our blood sugar level and keeps us healthy. It also helps to control the hormones which control when we feel hungry and full, therefore actively helping us to maintain a healthy weight. Sleep also helps us to maintain a healthy sex drive.
Benefits of sleep
To summarize let’s go over the benefits of a restful sleep:
- Increased energy and alertness during the day
- Improved memory
- Improved concentration
- Improved ability to learn
- Improved daytime productivity
- Maintaining a healthy weight
- Keeping your heart healthy
- Keeping your immune system strong
- Enhancing mental health and emotional wellbeing
- Reducing stress levels
- Reduced risk of stroke
- Reduced risk of diabetes
- Regulation of inflammation
- Better social interaction and stronger relationships
- Reduced risk of cancer
- Maintaining a healthy sex drive
- Reduced risk of other chronic illnesses
- Stronger, healthier body
What happens if we don’t get enough sleep?
If we don’t get the sleep we need it can take its toll on our mind and body. Sleep deficiency can cause cognitive difficulties including making it tough to learn new things; to form new memories and recall old ones; to make positive, helpful choices; to pay attention to the task at hand; and to regulate our emotions, among many other factors. This can markedly impact our quality of life. The National Institutes of Health states that, “If you’re sleep deficient, you may have trouble making decisions, solving problems, controlling your emotions and behavior, and coping with change.”
Since lack of sleep causes us to struggle with emotional regulation, this can contribute to mental illness. Many people who have chronic insomnia struggle with mood swings, acting out of character, being impulsive, feeling hopeless, or lacking motivation. Research shows that insomnia is linked to higher levels of depression and suicide. Lack of sleep can also lower libido in both men and women, causing reduced sex drive. This can impact relationships and confidence levels.
All of these cognitive issues can make it very hard to function during the day. It’s easy to see how this can lead to problems at work or school. You might find that you are unable to keep up with tasks or aren’t performing as well as you would normally. Your reaction times might be slower, affecting your performance. You might be more forgetful, or find that you are not retaining new skills as well as you should be. The American Academy of Sleep Medicine explains that, “Studies show that insomnia negatively affects work performance, impairs decision-making and can damage relationships.”
Long term insomnia can lead to microsleep, which means you fall asleep for very brief moments of time when you should be awake. The Better Sleep Council describes micro sleeping as, “a brief, involuntary episode of unconsciousness lasting anywhere from a fleeting moment up to several seconds.” You can even think you’re awake and are performing a task, but certain parts of your brain are actually asleep. We often refer to this as being ‘zoned out’ or ‘spaced out’. This isn’t something you can control and can happen at any time. Understandably, this can be dangerous for yourself and others! You are far more likely to make a mistake or miss something important. In fact, lots of accidents (including major ones) have been linked back to microsleep.
As well as the cognitive and emotional impact of sleep deprivation, our physical health is also significantly impacted. The National Institutes of Health states that long term sleep loss can lead to: “increased risk of heart disease, kidney disease, high blood pressure, diabetes, and stroke.”
We’re also more likely to become obsese and to have an increased risk of developing diabetes. When we aren’t sleeping well, how our immune system reacts is affected. This can make it harder for our body to fight off illnesses, and make us more susceptible to getting sick.
In a very real way, insomnia can make us feel grumpy, irritable, confused, unable to function as we usually do, and can be highly frustrating. It can even make us feel alone! It’s common to feel as though you are all on your own in being unable to sleep, especially when it’s the middle of the night and everybody else seems to be fast asleep. This can increase the impact insomnia can have on mood insomnia, and even lead to you withdrawing socially.
Understanding sleep cycles
Now that we know the importance of sleep and what insomnia is, let’s take a look at what actually happens when we’re asleep. As science and technology has progressed, sleep studies and scans have revealed that our sleep moves in cycles.
What are sleep cycles?
When we’re asleep our brain moves between two types of sleep: Non-rapid Eye Movement (NREM) sleep and Rapid Eye Movement (REM) sleep. NREM sleep is divided into three stages: N1, N2, and N3 sleep. Each stage plays a specific vital role to keep our mind and body healthy. The brain moves through these stages repeatedly throughout the night, which is why we call it a cycle. Each cycle tends to last around 90 minutes. How many cycles you go through depends on how long you sleep.
What are brainwaves?
To understand sleep cycles you also need to understand brainwaves. Brainwaves are electrical impulses which are sent between different areas of our brain as they communicate with one another. This communication keeps our body and mind functioning correctly. This article explains that brainwaves help to control everything, stating: “At the root of all our thoughts, emotions and behaviours is the communication between neurons within our brains. Brainwaves are produced by synchronised electrical pulses from masses of neurons communicating with each other.”
Brainwaves change speed depending on what we’re doing. When we’re active or alert they’re faster, and when we’re relaxed they’re slower. They’re measured in Hertz, which simply refers to how many cycles they go through every second. For example, when they’re faster, the number of Hertz is higher because they’re going lots of cycles each second. Brainwaves are divided into bands which are given names categorized by their speed.
Non-rapid Eye Movement (NREM) is where our sleep cycles start. During these stages of sleep our brainwaves are slower, which means we’re more relaxed (as you might expect). However despite this relaxation, there’s a lot going on in our brain during these stages.
When we’re awake, part of our brain called the thalamus helps us to detect and process stimuli. Stimuli refers to things which happen in our environment and within our bodies. When we’re asleep, the thalamus shuts down this response. The cortex is another area of our brain that is involved in almost all our neural processes. By shutting down this conscious response to stimuli, the cortex can relax.
As we move into deeper stages of NREM sleep, the shutting down of the response to stimuli also means that we’re less likely to wake up. This allows us to sleep peacefully, even through stimuli which would otherwise wake us up (such as noise from outside).
Once the brain is in this relaxed state, it starts to fine tune motor skills which improve our physical performance. It also works on enhancing our mental capacity. The slow brainwaves work as messengers to help us form memories from what we’ve experienced and learnt during the day. The brainwaves send short term memories from the front of the brain, to the back of the brain where they can be turned into long term memories. This also gives us ‘space’ to be able to continue learning new things when we wake up again.
Now we can look at the three stages of NREM sleep:
- N1During the first stage of NREM sleep, we’re just falling asleep. This means that we’re in a very light sleep as we begin to drift off. Our brainwaves start to slow down more, and during this stage are known as theta waves. This article explains that, “During this stage, heart and breathing rates begin to slow, eye movements also slow, and muscles relax.”Since this is very light sleep, it’s very easy to be woken up from, which means you can get disturbed by fairly small sounds. The N1 stage can last up to 10 minutes of each sleep cycle.During this stage you can experience what are known as hypnagogic jerks, myoclonic jerks, or ‘sleep starts’. All of these names refer to the same thing: an involuntary twitch or movement which startles you out of sleep. This is sometimes accompanied by an image or sensation, such as the feeling of falling.
- N2As we begin to fall more deeply asleep, we become less aware of our surroundings and less reactive to them. This means that we’re less likely to be woken up. Our body and mind relax further, slowing our heart rate and breathing rate, and relaxing our muscles. This stage lasts for roughly 20 minutes of each cycle.
- N3The N3 stage is the deepest stage of sleep we experience. During this stage we experience delta waves, which are the second slowest type of brain wave. This means that we are extremely relaxed. Therefore, it’s very hard to wake us up from this stage of sleep. You might also hear this referred to as slow wave sleep.We all need this deep sleep to feel refreshed in the morning: without it, we don’t feel properly rested. It’s during this stage that the body does most of its healing and repairing, as well as lots of vital work to regulate biological processes. The N3 stage can last between 20 and 40 minutes. We tend to have longer periods of N3 sleep in the first half of our night’s sleep.
Lack of NREM sleep, or disturbed sleep during this stage of your sleep cycles, can contribute to daytime tiredness, fatigue, cognitive issues, problems with mood, and physical health issues.
Rapid Eye Movement (REM) sleep gets its name from the rapid eye movements we display while our eyes are closed. Our brainwaves during this stage are faster, more like when we’re awake. The REM stage takes up around 25% of our sleep cycle.
This stage is when we tend to do most of our dreaming. Dreams can happen during NREM sleep, but tend to be more vivid and more common during REM sleep. It’s during this stage that the brain connects our experiences and lessons we’ve learnt, with our thoughts and skills we’ve built: this allows us to come up with new ideas and to be creative! It’s also thought that the REM stage of sleep plays a vital part in memory consolidation.
During this stage our brain temporarily paralyses our limbs. This sounds scary but is actually for our own safety: it’s so that we don’t act out our dreams and hurt ourselves! Lack of REM sleep or disturbed sleep during REM stages contributes to issues with weight gain, memory, learning, and the other cognitive issues we mentioned earlier.
The sequence of sleep stages
It usually takes us around 15 minutes to fall asleep. Once we fall asleep the brain cycles through lighter stages of NREM sleep down into deeper stages of NREM sleep, descending through N1, to N2, to N3 sleep. We then ascend back up through some of the lighter stages of NREM sleep, until we reach REM sleep, the lightest stage of sleep.
This 2019 article describes the sequence of sleep stages aptly: “Sleep begins in stage 1 and progresses into stages 2, and 3. After stage 3 sleep, stage 2 sleep is repeated before entering REM sleep. Once REM sleep is over, the body usually returns to stage 2 sleep. Sleep cycles through these stages approximately four or five times throughout the night.”
Understanding sleep wake regulation
When we’re asleep and when we’re awake is controlled by two processes: our circadian rhythm and sleep-wake homeostasis. They work together to make us tired enough to sleep at night, to help us sleep peacefully, and to help us feel awake during the day. It’s when this regulation is disrupted that we experience sleep disorders like insomnia.
The circadian rhythm
Our circadian rhythm is like our internal biological clock. It uses external factors, such as sunlight, to decide when we should be asleep and when we should be awake. A hormone called melatonin is released as we move into early evening, starting to get our mind and body more tired and ready for sleep.
Levels of melatonin build as we move closer to night time so we’re ready for bed. Melatonin also helps us to stay asleep, so that we sleep restfully. While we’re asleep, the amount of melatonin being released is gradually reduced to help us feel less tired: this gets us ready to wake up in the morning.
Once we’re awake, a chemical called adenosine is released gradually throughout the day. As levels of adenosine build throughout the day, we become more tired. By the end of the day, levels of adenosine are at their highest to ensure we’re ready for bed. Once we’re asleep, levels of adenosine reduce so that we’re ready to wake up in the morning.
Theories of why we sleep
Over the years scientists have tried to answer the question of why we need to sleep. They developed a number of theories. As science has progressed scientists’ viewpoints have changed, until we reached the level of understanding we have now about what happens when we sleep. We’ll cover 5 of the main theories which have developed over the years.
This was one of the earliest theories of why we sleep. It’s sometimes referred to as the adaptive or evolutionary theory. This theory suggests that we were inactive at night as a survival mechanism, to keep us out of harm’s way when we would be most vulnerable. They believed that this evolved from animals staying out of the way of predators, and avoiding accidents through trying to function in the dark.
However, we now understand it would be safer to stay awake if there was a threat, so that we could react in an emergency. This is why we wake up when we hear a startling noise, to ensure we’re ready to react if there’s a threat to deal with.
Energy conservation theory
One of the biggest factors in natural selection is the, “competition for and effective utilization of energy resources.” This theory suggests that the point of sleep is to reduce our need for energy, particularly at times when it would have been less helpful to look for food (such as during the night).
This article from the Division of Sleep Medicine at Harvard Medical School explains that research has shown, “energy metabolism is significantly reduced during sleep (by as much as 10 percent in humans and even more in other species).” This fits in with the idea that sleep helps to conserve energy resources.
As time went on, a number of theories centered around the idea that we need sleep in order to allow our bodies to restore themselves, and to keep us functioning effectively. A lot of scientific findings supported this, including research which showed that animals who were completely deprived of sleep lost their immune function and passed away within a few weeks.
Under this theory scientists began to discover information about our sleep wake cycle. They realised that adenosine plays a vital role in helping us to be ready for sleep, and that during sleep levels of adenosine fall so that we’re ready to wake up.
This article explains that significant scientific findings backed this theory: “This is further supported by findings that many of the major restorative functions in the body like muscle growth, tissue repair, protein synthesis, and growth hormone release occur mostly, or in some cases only, during sleep.”
Brain plasticity theory
This theory is very recent and revolves around the fact that our brain changes and learns throughout life, which is also known as neuroplasticity. This theory suggests that sleep plays a vital role in how the brain organizes and structures itself.
For example, we know that young children sleep a lot more, which helps their brains to develop. It also helps them to process what has been happening around them when they were awake, and to learn from their experiences.
Research is also beginning to reveal that sleep impacts an adults ability to learn too! When adults don’t have enough sleep, they struggle to learn new skills and function cognitively. Therefore, we know that sleep plays a vital role in how we learn. Research has also shown that during sleep, things we’ve learnt during the day are transferred into our long term memory.
The clean-up theory
As our brain cells function, they naturally produce some waste. This theory suggests that during sleep, we’re able to get rid of this waste. This 2020 article explains that: “As we sleep, fluid flow through the brain increases. This acts as something of a waste disposal system, cleansing out the brain of these waste products.”
The theory suggests that if we didn’t sleep, the brain wouldn’t have the opportunity to get rid of this waste. This would cause significant problems and interfere with functioning.
How much sleep do we need?
Sleep guidelines by age
As we grow from babies to adults, we’re constantly developing and learning, as well as going through different challenges. Therefore at different stages of our lives, we need different amounts of sleep. The National Sleep Foundation list the following recommendations based on age categories:
- Birth to 3 months: 14 to 17 hours (no less than 11 hours, no more than 19 hours)
- 4 to 11 months: 12 to 15 hours (no less than 10 hours, no more than 18 hours)
- 1 to 2 years: 11 to 14 hours (no less than 9 hours, no more than 16 hours)
- 3 to 5 years: 10 to 13 hours (no less than 8 hours, no more than 14 hours)
- 6 to 13 years: 9 to 11 hours (no less than 7 hours, no more than 12 hours)
- 14 to 17 years: 8 to 10 hours (no less than 7 hours, no more than 11 hours)
- 18 to 25 years: 7 to 9 hours (no less than 6 hours, no more than 11 hours)
- 26 to 64 years: 7 to 9 hours (no less than 7 hours, no more than 10 hours)
- 65 years and older: 7 to 8 hours (no less than 5 hours, no more than 9 hours)
Additional factors to consider
The guidelines by age are of course rough guidelines to help you judge the amount of sleep you need. Fundamentally, we’re all individuals and have different lives, therefore our sleep needs may vary. Let’s take a look at some other factors which can affect how much sleep you need:
- Health issues: A long term physical or mental health issue may mean you need more sleep to help your body or mind cope.
- How active you are: Working hours, exercise levels, and other activity levels can affect how much sleep we need.
- Genetics: Our individual genetic makeup can mean we need more or less to feel refreshed in the morning and during the day. This article explains: “Certain genetic mutations can affect how long you need to sleep, at what time of day you prefer to sleep and how you respond to sleep deprivation.”
- Sleep quality: The quality of your sleep can affect how many hours of sleep you need. For example, if you have a low quality sleep which is regularly disturbed, you might need more sleep. If you have a high quality sleep, you may feel refreshed after less sleep.
What works for one person might not work for you. It’s about figuring out what works best for your life and your needs, and using the guidelines to do just that: guide you.
While we don’t need naps, when naps are short, they can actually be very productive. They should be no longer than 20-30 minutes, otherwise they can contribute to sleep issues at night. When napping is done right, it can improve alertness and performance. Children often nap during the day to help them get the amount of sleep they need.
Naps can also be very useful in coping with life’s responsibilities which can interrupt our sleeping schedule, such as when dealing with shift work. Some people use naps to catch up on ‘sleep debt’, meaning hours of sleep they’ve missed, for example due to insomnia or needing to get up very early for work. Napping can also help us to cope with additional health issues, such as fatigue caused by chronic illness.
Naps should be taken earlier on during the day (too late in the day can interrupt night time sleeping), kept short, and used to enhance daytime performance. If they begin to contribute to insomnia, they should be reduced or eliminated.
Working out your ideal bedtime
Having a consistent bedtime and wake time is important in tackling insomnia, and to ensure you get the amount of sleep you need. Working when your bedtime should be is all about figuring out what works for you. You need to take into account your preferences and of course, your responsibilities (such as family schedule, work schedule, and so on).
When you’re working out your bedtime, you should account for around 15 minutes to fall asleep. You should then look at the sleep guidelines for your age and factor these in. For example, if you’re an adult under 64 years old, you’ll need between 7 to 9 hours of sleep.
This is when you can also take your previous experience into account: if 7 hours is enough to allow you to feel rested, you can work from there, however if you feel you need the full 9 hours, you can account for this. If you are unsure, you can use a process of trial and error to figure out how many hours of sleep allows you to feel refreshed in the morning.
Next you need to figure out what time you need to wake up, allowing enough time to wake up, get ready, and carry out any morning routines (back to those responsibilities again). Then you can work backwards from the time you need to set your alarm, to figure out your bedtime.
For example, if you need to get up at 7am for work, and you’ve worked out that you need 8 hours of sleep to feel rested, your bedtime would be at 10:45pm (accounting for the 15 minutes to fall asleep). Try to be as consistent as possible, but don’t worry too much if you occasionally go to bed later or earlier than your bedtime.
Symptoms of insomnia
Insomnia causes a range of both nighttime and daytime symptoms including:
- Problems getting to sleep
- Issues staying asleep
- Waking up early and being unable to get back to sleep
- Unrefreshing sleep/poor quality of sleep
- Fatigue during the day
- Cognitive impairment: problems with concentration, focus, memor, and attention span
- Mood disturbances: low mood, irritability, anger, increased stress, increased impulsiveness
- Worries about sleep
- Problems performing at work or school
- Increased risk of making mistakes or having an accident
Types of insomnia
You may hear a number of phrases used to describe types of insomnia. These phrases refer to how long insomnia lasts, as well as what stage in the night an individual has trouble with insomnia. Therefore, a person can have more than one type of insomnia, for example both chronic insomnia and onset insomnia: this simply means that they have a long term problem with insomnia which causes issues falling asleep at the beginning of the night.
Transient insomnia refers to insomnia which lasts a very short time, typically from a few days to a week. It passes quickly and is usually in reaction to an event in your life like a job interview, an exciting social event, a short term illness, or sleeping in a new place for example.
Acute insomnia refers to a short term sleeping problem, usually lasting a few weeks. Acute insomnia tends to resolve fairly quickly on it’s own. This is usually in reaction to a life event causing stress, or a big change, for example starting a new job, losing a loved one, or travelling into a different time zone.
Chronic insomnia is a more long term problem which may require improved sleep hygiene and treatment to overcome. The National Sleep Foundation explains that insomnia is classed as chronic if, “a person has trouble falling asleep or staying asleep at least three nights per week for three months or longer.”
If insomnia occurs as a result of (or alongside) another physical or mental health condition, it can be classed as comorbid insomnia. This simply means that the two conditions occur together.
Onset insomnia refers to having issues falling asleep at the beginning of the night when you first go to bed. If you struggle with onset insomnia, you will find that you’re lying awake and can’t drift off to sleep.
Maintenance insomnia refers to issues staying asleep. You might wake up multiple times during the night and find it really difficult to fall back asleep.
Insomnia in children and teens
Children and teenagers can suffer from insomnia too. Symptoms you might notice in your child or teen can include:
- Feeling constantly tired or lacking in energy
- Trying to avoid going to bed: this might involve making excuses, trying to distract you, or asking for ‘just another 10 minutes’
- Taking a long time to get to sleep
- Getting up a lot during the night: depending on their age this might involve them asking for drinks of water, snacks, or attention
- Regularly struggling to wake up in the morning
- Napping during the day (outwith what is normal for their age)
- Falling asleep at school or at home while doing normal activities (such as watching TV, reading a book or doing crafts)
- Cognitive issues: this might involve problems with memory, concentration and focus.
It’s important to bear in mind that these symptoms might indicate another problem rather than insomnia. If you do notice symptoms of insomnia in your child, don’t panic! There are plenty of ways you can improve their sleep and get them help if you feel they need it.
Causes of insomnia in children and teens are similar to that of adults. Likewise, so is the diagnostic process and available treatments.
Causes of insomnia
There isn’t one specific cause of insomnia. Rather there are multiple factors which can contribute to someone developing insomnia, and which can keep the cycle of insomnia going. We’ll take a look at all of the possible causes of insomnia.
Models of insomnia
Models of insomnia simply refer to scientific theories about how insomnia is caused and perpetuated. These have developed over the years as more knowledge has been gained, and as different scientists have shared their viewpoints.
The Stimulus Control Model
The stimulus control model was developed by a scientist called Richard R. Bootzin in 1972. This model suggests that the stimuli within our environment can create an association in our mind with a state of wakefulness or sleep, therefore either encouraging us to sleep or causing insomnia.
For example, if the bedroom is used for activities that aren’t sleep related and promote wakefulness, such as watching TV, then our brain associates the bedroom with being awake and in a stimulated state, rather than with sleep. This can result in the development of insomnia.
The 3P Model
The 3P model is also known as, “the Spielman model, the three-factor model, or the behavioral model”. You might also hear it referred to as the diathesis-stress model. It was developed in the 1980s by a scientist called Dr Art Spielman. The 3 P’s stand for ‘predisposing’, ‘precipitating’ and ‘perpetuating’ factors. Let’s take a look at what these mean:
- Predisposing factors: These are factors which increase the likelihood of an individual developing insomnia. This could include things like genetic predisposition to sleep disorders or having a generally more anxious personality.
- Precipitating factors: These are things which happen in your life which trigger the onset of insomnia. This could be loss of a loved one, a big lifestyle change, or a stressful situation at home for example.
- Perpetuating factors: These are factors which keep you struggling with insomnia or make it worse, such as bad sleep hygiene.
A number of scientists have developed their own cognitive models over the years as research has expanded. These models all vary slightly but center around the same concept: that our feelings and beliefs around sleep lead to behaviours which can affect how we sleep.
For example, if we are very worried about lack of sleep, this can lead us to becoming stressed. In this state of alertness, it’s even harder to get to sleep: this exacerbates insomnia. We might then try to ‘catch up’ on sleep by taking naps during the day, which actually perpetuates the cycle of insomnia. This study explains that: “The unfortunate consequence of this sequence of events is that the excessive and escalating anxiety may culminate in a real deficit in sleep and daytime functioning.”
The Neurocognitive Model
The neurocognitive model expands on the 3P model. This model suggests that those who struggle with insomnia experience higher brainwaves than others, stopping them from reaching a deeper state of relaxation and therefore resulting in a disturbed sleep. Since they’re not in a deep sleep, this would also mean that they are disturbed more easily from their sleep by external stimuli, such as noises.
This study explains that, “the neurocognitive model proposes that insomnia leads to conditioned cortical arousal, manifest as increased high-frequency (beta and gamma) EEG activity during sleep. High-frequency EEG activity is thought to be associated with enhanced sensory processing, memory formation, and conscious perception.”
The Psychobiological Inhibition Model
This model theorizes that those with insomnia become very focused on stress, meaning that they’re on high alert: this prevents them from achieving the relaxed state needed for sleep. This is like a cycle, with stress making it tough to sleep, then the individual focusing on the trigger for the stress and worrying about it, which in turn makes the stress more pronounced.
This study explains that the psychological inhibition model suggests that: “Psychological and/or physiological stress is posited to lead to selective attention toward stressors, and inhibition of the “de-arousal” that normally accompanies sleep.”
The Drosophila Model
This model focuses primarily on predisposing factors causing insomnia. Essentially the model suggests that factors which are genetic, such as being genetically prone to stress, anxiety and sleep disorders, are the cause of insomnia.
This detailed study explains that: “This fundamental tenet of the behavioral model suggests that chronic insomnia may have a genetic component and that a portion of the variance in the incidence of insomnia should be related to factors that are heritable”.
Now we’ll take a look at the many factors which can play a part in causing insomnia. An individual might struggle with one or more of these factors.
When we’re stressed, we’re in a state of ‘fight or flight’. This means that we’re on the lookout for threats and our body and mind are ready for action. This article from Harvard Medical School explains that: “This combination of reactions to stress is also known as the “fight-or-flight” response because it evolved as a survival mechanism, enabling people and other mammals to react quickly to life-threatening situations.”
In the short term, this is a protective, helpful state. However, when stress becomes prolonged it can cause many problems: we’re simply not designed to deal with prolonged stress! Prolonged stress can lead to many physical health issues as well as impacting our mood and mental wellbeing. One of the issues stemming from prolonged stress (or high levels of short term stress) is insomnia. When we’re ready to take action and are wound up, it’s very difficult to reach the relaxed state you need to be in to get to sleep. This can result in problems with onset insomnia.
Stress doesn’t only lead to onset insomnia though! As we mentioned, in this stress state we’re on the lookout for threats. You might hear this referred to as hyperarousal. This hyperarousal continues even unconsciously. This combined with the fact that those who struggle with sleep often find it harder to reach deep levels of sleep, can result in maintenance insomnia. You’re far more likely to wake up in response to external stimuli like a noise outside or your partner moving, because you’re in that stressed mindset. It’s also likely that once you’re woken up, you’ll find it more difficult to get back to sleep.
Unfortunately, when we experience insomnia we can become worried and anxious. We might start to worry about what will happen if we don’t get the sleep we need. We might be concerned about the impact on our health, and on our levels of functioning. This can all contribute to stress, creating a vicious cycle. The more stress is piled on, the less likely you are to be able to get to sleep.
The National Sleep Foundation explains that: “A growing body of research studies supports this anecdotal experience, finding that all types of stress can harm sleep quality and that sleep deprivation can fuel further stress and irritability.”
Stress is a natural part of life. Prolonged stress can stem from a big change in your life; a job loss or job change; loss of a loved one; a house move; an argument with a loved one; and so on. People’s stress threshold will vary: what one person may find extremely stressful, another may cope with calmly.
You might hear this stress threshold referred to in terms of resilience. Resilience can be defined as, “a person’s ability to adapt and “bounce back” after stressful episodes.” This doesn’t mean that if you get stressed more easily or find it harder to cope with stress that you are weak by any means. Everyone’s struggles are valid and everyone’s emotions in reaction to those struggles are worthy. Scientists believe that ‘resilience’ in terms of stress can be based on many factors, including genetics.
Essentially it doesn’t matter what has caused the stress or how resilient to stressful situations you are: any event which you find personally stressful can contribute to insomnia.
As we age, it becomes increasingly likely that we will experience insomnia. As we mentioned earlier, we’re less likely to be woken up from deeper stages of sleep (N3), and more likely to be woken easily from lighter stages of sleep. Once we reach the age of 65, the amount of slow wave, deep sleep decreases: this means that older people are more likely to be woken up during the night. Since deep sleep is vital to feel refreshed in the morning, this can also leave you finding it more difficult to get up in the morning and feeling more tired throughout the day.
Our circadian rhythms also tend to change as we age, meaning that we sleep at different times than we used to. The National Sleep Foundation explains that, “older people tend to become sleepier in the early evening and wake earlier in the morning compared to younger adults. This pattern is called advanced sleep phase syndrome.” Essentially their sleep routine is shifted forward by a few hours.
Advanced sleep phase syndrome in theory isn’t an issue: if their routine allows them to go to bed early and get the amount of sleep they need, this isn’t a problem. However, if commitments and routines mean that they can’t go to bed early, they are likely to still wake up very early, meaning they aren’t getting the amount of sleep they need.
As we age (depending on the individual of course), we may become less active. For example we might do less exercise or not go out as much socially. We may not be working and therefore have a lot more time to relax. This can mean that we’re not as tired when bedtime rolls around, because our minds and bodies haven’t been active during the day..
As we get older, our physical and mental health is often affected and health issues are generally more common. The symptoms of these health issues can make it more difficult to get comfortable and fall asleep at night, and may also wake you up more frequently. Medications taken to try to cope with these health issues often make the individual tired during the day, or have side effects which interrupt restful sleep. Snoring, which is one of the biggest causes of sleep disruption, is known to worsen with age. Whether it’s in yourself or a partner, snoring can cause you to have a disturbed sleep.
Poor sleep hygiene
The National Sleep Foundation describes sleep hygiene as, “a variety of different practices and habits that are necessary to have good nighttime sleep quality and full daytime alertness.” Basically any positive habits that we carry out to ensure we can get to sleep and sleep restfully throughout the night, are sleep hygiene. This might include things like keeping a regular sleep schedule and having a good environment for sleep.
When we have poor sleep hygiene, it means that we’re not doing these positive things to ensure we sleep. Poor sleep hygiene habits are typically things which play an active part in preventing us sleeping. Sometimes those who struggle with insomnia have tried to cope with it but instead have actually introduced habits which are making the problem worse.
Poor sleep hygiene can include things like:
- Staying up late and waking up late
- Not having a consistent bedtime
- Having a poor sleep environment (for example, too cold, too hot, too noisy, uncomfortable, etc)
- Consuming stimulants late at night (eg. coffee and nicotine)
- Drinking alcohol close to bedtime
- Taking long or frequent naps during the day
- Using their bedroom to work, play computer games or do other stimulating activities (this breaks the brain’s association between the bedroom and sleep)
- Being inactive during the day
- Eating large or heavy meals close to bedtime
Our working schedules can vary so much depending on our job. Many of us work shifts, meaning that our working hours change regularly. Some of us might start work really early in the morning, and others might work night shifts, meaning they start work late and work throughout the night. This is becoming increasingly common as more jobs require their employees to work in shifts.
Working varying shifts can make it difficult to maintain a regular sleep schedule. You might need to regularly change the time you go to bed, and when you set your alarm to get up. We know a regular sleep schedule is an important part of sleep hygiene: when this is disrupted it can lead to insomnia.
For those who do night shifts, it can be very difficult for them to sleep during the day because their body clock is telling them they should be awake. There are also likely to be far more distractions and interruptions (such as noise from outside) during the day, which can make it tough to sleep restfully. This can result in lack of sleep and it’s associated results.
The bedroom environment plays an important part in how well you sleep. If you have an uncomfortable bed or mattress, it makes it more difficult to get comfortable enough to sleep. If your curtains let in light, this can disrupt your circadian rhythm
Temperature plays an important part in sleep regulation: if the bedroom is too hot or too cold, it can disturb your sleep. If there are noises from outside, from another room in your home, or from a partner who is snoring for example, this can keep you awake.
Associating the bedroom with being awake
If you carry out stimulating activities, such as watching TV or working in your bedroom, your brain begins to make the association between the bedroom and being awake. This can cause you to feel awake instead of relaxed and ready for sleep when you go to bed.
Low activity levels
How much activity you engage in during the day can influence how well you sleep. If you are very active, for example working and exercising, your mind and body will be tired and ready for sleep at bedtime. However, if you are inactive during the day, your mind and body don’t get tired in the healthy way they need to in order for you to have a restful sleep.
Research has also shown that if you exercise during the day, you get more slow wave, deep sleep during night. Therefore when you’re inactive, you get less deep sleep which you need to feel refreshed in the morning. Exercise also helps to keep your mood stable as well as keeping you physically healthy, which reduces the likelihood of comorbid health conditions causing insomnia.
Comorbid health conditions simply means those which occur alongside insomnia. Other health conditions can have symptoms which can cause or worsen insomnia.
A range of mental illnesses can lead to insomnia. Harvard Medical School explains that: “Sleep problems are particularly common in patients with anxiety, depression, bipolar disorder, and attention deficit hyperactivity disorder (ADHD).”
When you have a lot on your mind and your emotions are high, it can be hard to relax enough to sleep at night. Often at night when other distractions of the day fade away, your thoughts feel louder and much harder to ignore. We already know that stress can cause insomnia and living with mental illness is certainly stressful!
Many mental illnesses make you feel lethargic and tired during the day: this can lead to less activity and often naps, which interrupt sleeping patterns. Some medications which are prescribed for mental illness can cause fatigue during the day, and some make it tough to sleep at night (often as a result of medication side effects).
For those with ADHD or bipolar, they may experience high energy at times which can make it impossible to relax. Those with bipolar will have episodes of mania or hypomania, a symptom of which is reduced need for sleep. If you have experienced trauma, you might experience flashbacks and nightmares which can make it tough to sleep.
For those with mental illness with symptoms of psychosis, this can leave you in a frightened, wound up, confused state much of the time: of course, this makes it difficult to sleep. The charity Mind explains that: “Paranoia and psychosis may make it difficult to sleep. You may hear voices, or see things you find frightening or disturbing.”
Many physical health issues have symptoms which cause and markedly worsen insomnia. This can be because symptoms make it hard to get comfortable at night or wake you up frequently during the night.
These illnesses may be short term and once treated, insomnia can resolve. However, sometimes the individual has turned to poor sleep hygiene to try to cope with their insomnia, and these habits continue which perpetuates the insomnia. In other cases, the illnesses are chronic (meaning long-term), and so the insomnia continues along with the illness.
Let’s take a look at some physical health conditions which are frequently associated with insomnia:
- Chronic pain (such as arthritis, fibromyalgia, ME, etc)
- Heart disease
- Gastroesophageal reflux disease (GERD)
- Parkinson’s disease and Alzheimer’s disease
- Irritable bowel syndrome (IBS)
- Common virus and infections (such as the common cold, the flu, or a stomach bug)
- Endocrine issues
- Traumatic brain injury (TBI)
Often medications which are taken to treat these health conditions can cause insomnia. The National Sleep Foundation explains that: “Medications such as those taken for the common cold and nasal allergies, high blood pressure, heart disease, thyroid disease, birth control, asthma, and depression can also cause insomnia.”
Other sleep disorders
There are a wide range of sleep disorders an individual can struggle with. Other sleep disorders can cause and worsen insomnia. Sleep related movement disorders (SRMDs), cause involuntary movements which disrupt sleep. This can include restless legs syndrome which is defined as, “a neurological condition in which a person has an uncomfortable sensation of needing to move his or her legs”. This uncomfortable sensation along with the frequent leg movement can of course disrupt sleep.
Another SRMD is Periodic Limb Movement Disorder (PLMD) which can cause periodic movements in any of your limbs (most commonly in the lower legs). This can happen every 20 seconds or so during an hour long episode. These movements can start you out of sleep and make you very uncomfortable.
Sleep apnea is a sleep disorder causing an individual’s airway to become partially or fully blocked during sleep. This leads to pauses in breathing which can happen multiple times a night, and in turn reduced oxygen levels. When you aren’t able to breathe, you wake up. Sometimes this can happen up to 30 times every hour, depending on the individual and the severity of their disorder.
Parasomnias are sleep disorders which cause abnormal movements or behaviours during sleep. These can include sleepwalking and night terrors among many more. Parasomnias can understandably disturb an individual’s sleep. Nightmares and night terrors can even make an individual scared or anxious to go to sleep, which lead to stress around bedtime, contributing to insomnia.
There are substances, both illegal and legal, which can cause insomnia. The use of alcohol, nicotine, and caffeine, particularly in excess or in the hours before you go to bed, can cause insomnia. This is because these nicotine and caffeine are stimulants, meaning that they make your mind and body feel more awake. Although alcohol can help you to drift off to sleep at first, as your body processes it throughout the night, it actually disturbs your sleep and means you wake up feeling unrefreshed.
Among other issues illegal drugs cause, they can lead to insomnia. This 2020 article states: “Disturbances in sleep have been found to be prevalent in people who use illicit drugs as well. Researchers also report that the length of drug use plays a significant role.” This can include all classes of illegal drugs, as they affect the chemicals within our brain and can actively interrupt our sleep-wake regulation.
As science advances, more about the brain is being understood. Researchers are starting to realise that chemical imbalances within our brain can cause insomnia. Neurotransmitters are like chemical messengers: there are many different types, all of which pass on vital messages to control our biological processes.
Gamma-aminobutyric acid (GABA) is a neurotransmitter known as an inhibitory transmitter. This means that it inhibits (stops or slows down) nerve impulses, to regulate specific processes. GABA plays a part in quieting our mind down ready to sleep, and shutting down ‘waking signals’. Research shows that GABA levels are reduced by 30% in those with chronic insomnia.
When levels of GABA are low, the brain is unable to reduce its activity to relax for sleep. Dr. John Winkelman explains that: “low GABA levels create an imbalance of brain activity. This may lead to an inability to shut down waking signals in the brain. If your GABA levels are low, then your mind can’t slow down. It may race forward at full speed even when it is time to sleep.” Essentially this means your mind is overactive or hyper aroused. This hyperarousal makes it very difficult to fall asleep.
When we travel to another country with a different time zone, especially when we do so fairly quickly (such as by plane), we can experience jet lag. Jet lag is defined as, “a temporary mismatch between sleep-wake cycle timing generated by the person’s internal circadian clock, and the external cues at the new destination.”
Being in a different time zone means that you might usually be getting ready for bed or sleeping, when it’s actually bright light outside and the middle of the afternoon in your chosen holiday destination. Your circadian rhythm can struggle to adjust, meaning you might struggle to sleep and may feel very tired during the day.
Often the excitement of being in new surroundings combined with a different sleeping environment can also contribute to insomnia. Thankfully, this is a temporary problem which typically resolves fairly quickly.
As research has developed it’s becoming more clearly understood that insomnia has genetic components. This research suggests that we are able to inherit a predisposition for insomnia. As the research progresses, scientists are beginning to identify the specific genes involved in insomnia. They’re also pinpointing genes which connect insomnia with other comorbid conditions.
A scientist involved in the research, Murray B. Stein, explains that: “The genetic correlation between insomnia disorder and other psychiatric disorders, such as major depression, and physical disorders such as type 2 diabetes suggests a shared genetic diathesis for these commonly co-occurring phenotypes.” As research develops further and more knowledge is gained, the potential for even more successful treatments grows.
There are lots of ways an individual’s menstrual cycle can affect their sleep. It’s very common to experience insomnia in the few days before your period. The Sleep Health Foundation states that 7 out of 10 people experience sleep issues just before their period. During this stage of the menstrual cycle our sleep cycles literally change: the amount of REM sleep specifically is reduced. Hormonal changes also affect our temperature regulation, which can interfere with our sleep.
Hormones released at various stages of the menstrual cycle can lead to changes which perpetuate insomnia. During our period we might experience discomfort, cramping, bloating, headaches, back ache, hot flushes, and more, all of which can make it tough to get comfortable enough to sleep. If you have particularly period symptoms, they might even wake you up out of your sleep during the night.
Pregnancy can cause you to be very fatigued during the day. Unfortunately, it can sometimes lead to insomnia. Your body and mind are going through so many changes during this time and experiencing an influx of hormones, so it’s natural that this can also affect your sleeping habits.
Some of the ways pregnancy can lead to insomnia include:
- General discomfort as your stomach size increases
- Stress, anxiety and worries about the prospect of being a new mother
- Nausea and vomiting
- Needing to urinate frequently during the night
- Back pain
- Tender breasts
- Leg cramps
- Vivid dreams
- Changes in mood
- Shortness of breath
- Napping during the day due to fatigue
Menopause is another time of big hormonal and physical changes. These changes lead as many as 61% of post-menopausal individuals to experience insomnia. One of the primary reasons for sleep disruption is the hot flashes which are caused by menopause. Hot flashes are periods of increased (and often distressing) levels of heat all over the body, often accompanied with sweating. They affect up to 85% of people going through menopause, and can happen at any time, including during the night.
Medicines and supplements often taken during menopause to try to ease discomfort can also contribute to insomnia. Stress levels can rise during this period and your mood can change, both of which we know can cause insomnia.
What to do if you have symptoms of insomnia
If you have symptoms of insomnia, you might be feeling really frustrated and of course, exhausted. You might be unsure what to do next or where to turn. Don’t panic! There are ways you can start trying to tackle insomnia.
Improve your sleep hygiene
One of the first things you can do if you’re struggling to sleep, is improve your sleep hygiene. Some of these tips may sound simple, but they truly can make a huge difference.
Have a consistent sleep schedule
Keep a regular sleep schedule as much as possible: this simply means going to bed at roughly the same time each night and getting up around the same time every morning. This helps to regulate your body clock. Once your body and mind are used to going to sleep and waking up at that time, they will get into their own routine and you’ll begin to feel tired as you head to bed.
Of course, realistically there are going to be days when you might want to have a lie in, or nights when you’ve been out with friends and go to bed late. That’s completely fine. Being as consistent as possible, when possible, is key.
Keep your bedroom for relaxation only
As we mentioned earlier, it’s so important that your brain makes the association between the bedroom and sleep. Therefore, it’s vital to keep your bedroom for sleep, sex, and relaxation only. It’s important you don’t do stimulating activities in your bedroom, such as watching TV, doing work, or listening to music, as this can break this vital association and lead to insomnia. By working on consistently making your bedroom for relaxation only, your mind will start to automatically shift into that relaxed state when you head to bed.
Make your bedroom comfortable for sleep
It’s important that your bedroom is comfortable to improve your sleep quality. You should have a good bed and mattress: if you don’t, it’s well worth investing in one if your resources allow. If you are unable to invest in a new bed and mattress, a mattress topper can be useful to increase the comfort of your bed, and can be bought for a reasonable price.
The temperature in your bedroom is important. If you’re too hot or cold it can be difficult to sleep. You could consider adding blankets for more warmth and comfort if your bedroom is too cold. If it’s too hot, consider using a fan or a humidifier to reduce the temperature. The National Sleep Foundation states: “The bedroom should be cool – between 60 and 67 degrees – for optimal sleep.”
The lighting in your bedroom is also vital, as our circadian rhythm uses light (among other factors) to regulate itself. Using dimmed lighting in your bedroom when you’re awake can help to encourage relaxation and prepare you for sleep. Ensuring your bedroom is dark when you’re going to sleep is important. You could add blackout curtains or blinds, or even use an eye mask to block out any light.
If possible, try to reduce noise in your bedroom so that you are less likely to be disturbed from your sleep. This might involve investing in double glazing, or asking others in your house to keep the noise down so you can get to sleep. A simple way of doing this (and helpful tip if you have a partner who snores), is to wear earplugs to block out external noise.
The NHS explains that keeping your bedroom tidy can also help you to feel more relaxed. Even if you might not realise it, a cluttered bedroom can often make us feel stressed or anxious.
Aside from other more standard aspects, you can also add personal touches to make your bedroom feel comforting and welcoming. These will vary depending on your personal taste and preference: you could add pictures of family; a soft toy to cuddle; colours you find calming; or extra pillows and blankets to make it feel more cozy.
Wind down before bed
Making time to wind down from your day and gently encouraging your mind into a more relaxed mindset ready for bed is helpful. Having a bedtime routine also helps your mind and body to make the association that it’s bedtime.
You could set aside 20 minutes to half an hour each night before bed to relax. This could involve taking a bath, reading a book, doing some skincare, listening to relaxing music, practicing relaxation exercises, or doing some light stretching.
During this time you should avoid watching TV or using your phone, as this can make you feel more awake. This article explains that: “Electronic screens emit a blue light that disrupts your body’s production of melatonin and combats sleepiness.” You should also try to avoid stressful conversations or actively planning for the next day. If you find your mind wandering to stressful thoughts, try to bring it back to the present to aid you in fully relaxing.
Reduce or eliminate naps during the day
Short naps of up to 30 minutes can help to boost your mood, concentration, and energy levels. However, regular longer naps can actually contribute to insomnia. If you’re experiencing regular insomnia, try to reduce the amount of naps you take as much as possible. If you can, you could even cut them out all together. This will help your body and mind to be more tired at bedtime and aid you in sleeping restfully.
Don’t go to bed full
Going to bed on a full stomach can make you feel bloated and uncomfortable. Try to avoid eating heavy meals in the few hours before you head to bed. You should also avoid, “heavy or rich foods, fatty or fried meals, spicy dishes, citrus fruits, and carbonated drinks,” close to bedtime as these can cause indigestion and heartburn which can affect your sleep.
Don’t go to bed hungry
Just as you shouldn’t go to bed full, you also shouldn’t go to bed hungry. If you’re lying there with your stomach grumbling, you aren’t going to be able to get comfortable enough to sleep. If you find yourself regularly feeling hungry in bed, consider a light snack close to bedtime: this can help you find the right balance.
Don’t drink too much before bed
Drinking too much before you go to bed can result in you needing to get up to go to the toilet during the night. Not only can this disturb your sleep, but if you already have sleeping problems, once you’re awake it can be really difficult to fall back asleep. Try to slow down and sip drinks as you near bedtime to combat this issue while remaining hydrated.
It’s also important you don’t regularly drink alcohol close to bedtime. As we mentioned earlier, this can actually disturb your sleep during the second half of the night. While it’s linked with more deep sleep, alcohol also activates a type of brain activity called alpha activity, which isn’t usually turned on during sleep. This can contribute to insomnia: “Together the alpha and delta activity in the brain after drinking may inhibit restorative sleep.”
Cut out stimulants close to bedtime
You should avoid stimulants in the hours before you go to bed, as these make you feel more awake and make it more difficult to sleep. Stimulants include caffeine and nicotine. Although it can be difficult to cut these down, doing so in the hours before you head to bed can make a big difference in tackling insomnia.
Exercise during the day
Doing exercise during the day has many benefits which can improve your sleep quality (as well as being good for your overall health). Exercising helps your body and mind to be tired out in a healthy way ready for sleep. It also reduces stress, promoting relaxation which can aid sleep. The Sleep Council explains that research has shown: “Exercise promotes the quantity and quality of your sleep, making it deeper and more refreshing.”
However, it’s important not to do intense exercise close to bedtime as this can make you feel more awake. In the 2 to 3 hours before you head to bed, you should stick to light exercise such as stretching.
Get out in natural light
We know that sunlight helps to regulate our circadian rhythm. By ensuring we’re getting out in natural light during the day as much as we can, we help to regulate our body clock. Getting out in natural light as close to waking up as possible can be even more helpful. It doesn’t matter if the weather is cloudy or dull; as long as you’re outdoors, you’ll feel the benefits.
Sleep hygiene and shift work
As we’ve discussed, if you do shift work it can be really difficult to get the amount of sleep you need. Some of the sleep hygiene habits we’ve discussed can still work for you, if you apply them to the time you go to sleep. Others can be adapted to suit your shift work. Here are some ways you can adapt sleep hygiene to make your schedule more conducive with restful sleep:
- Wind down before you go to bed: No matter what time you’re going to bed, making the time to wind down as we mentioned can help you to get ready for sleep.
- Wearing sunglasses: Wearing dark sunglasses on your way home from work can help your mind to start preparing for sleep.
- Make your bedroom as dark as possible: If you’re sleeping during the day, the daylight can make it really tough to sleep. Consider black out curtains or an eye mask to help your body clock realise it’s time to sleep.
- Reduce noise: There are going to be more noises if you are sleeping during the day. This can understandably disturb your sleep. Using ear plugs can be a great way to combat this. It’s also important you talk to other people in your household so they understand that trying to be quiet can make a big difference in you getting the sleep you need.
- Napping: Taking a short nap just before you start a long shift, particularly a night shift, can help you to catch up on sleep and make you feel more awake during your shift. The UCLA Sleep Disorders Centre also suggests that: “Naps during work hours may also help you stay awake and alert. You may also want to take a nap during the night shift ‘lunch hour.’”
- Eating regular meals: Eating well and sticking to eating regular meals, even if they’re at different times than you would usually eat, can help your body by giving it clues as to when it should be awake and when it should be asleep. It also ensures you have the energy you need to function at work.
- Light therapy: Research shows that using artificial bright light can help to regulate your circadian rhythm in the same way as sunlight. This is typically done through light boxes, which are specialised devices which produce very intense (but safe) amounts of light.
Sleep hygiene during pregnancy
As we mentioned, insomnia is common during pregnancy. All of the regular sleep hygiene habits we’ve mentioned can still be useful, but there are additional things you can do to help yourself sleep more peacefully.
- Moderate exercise: It’s still a great idea (unless your doctor tells you otherwise) to do some moderate exercise each day to help improve your sleep.
- Sleep on your left side: The National Sleep Foundation explains that lying on your left side helps to improve, “the flow of blood and nutrients to your fetus and to your uterus and kidneys.”
- Cut down on fluids before bedtime: Staying hydrated is vital but trying to cut down your liquids as you near bedtime still be useful.
- Reducing heartburn: Raising your pillow at night and avoiding spicy, acidic and fried foods can help to reduce heartburn and make you more comfortable.
- Take pressure off your lower back: You can do this by bending your knees and hips, and placing a pillow between your knees. This makes you more comfortable and more likely to sleep restfully.
- Use dim lights if you’re awake at night: If you can’t sleep during the night, ensure you use dim lighting to help you transition more easily back into sleep. You could even use a nightlight in the bathroom rather than turning on the main light.
- Nap earlier in the day: Fatigue can be high during pregnancy so it’s likely you’ll need to nap during the day. Napping earlier in the day where possible can help you to sleep better at night.
Sleep hygiene during menopause
The general sleep hygiene practices we’ve discussed can still be useful during menopause. However, just like with pregnancy, there are some additional things you can do to improve your chances of sleep.
- Keep a cool temperature in the bedroom: This can help to combat night sweats. You could do this by wearing cooler nightwear and lighter bedding. You could also use a fan, humidifier or cool pack to help keep you cooler.
- Avoid raising body temperature before bed: Try to avoid doing exercise before bed, as well as eating heavy, spicy meals or drinking alcohol: these are all things which can increase your body temperature and worsen hot flashes.
- Practice relaxation techniques: Stress can often build around bedtime as you worry about night sweats and not being able to sleep. Trying to promote relaxation can be beneficial.
Insomnia and work
We know that lack of sleep can significantly affect your performance at work, so the question is, how should you cope with this? Let’s take a look.
Decide whether to be open about your insomnia
Your first step should be to decide whether you want to tell your boss and others at work about your insomnia. You should take into account whether you feel comfortable expressing yourself with your boss. You should also take into account how severely you feel your insomnia is affecting your working ability. This choice is completely down to you: you do not have to communicate about your insomnia with your work. However, if you do so, it may help your workplace to be a bit more understanding and flexible.
Understand that insomnia is nothing to be ashamed of. Many people struggle with it, and the fact that you are opening up means that you are trying to do something proactive about it. Remember that by law your employer has a duty of care for your health, which means that they, “should take all steps which are reasonably possible to ensure their health, safety and wellbeing.”
Come up with a plan
It’s a great idea to come up with a plan as to how you’re going to tackle your insomnia. You could start by keeping a sleep diary, improving your sleep hygiene, and seeking treatment. You could write this plan down to keep you on track. It can be really useful to have this plan ready and take it with you if you are going to be open with your employer, so they can see the steps you are actively taking to deal with the problem.
Keep up with sleep hygiene
Even if you are struggling at work and you are exhausted when you come home, do your best to keep up with sleep hygiene. This is vital in helping to get your sleep back on track. Don’t turn to unhealthy coping strategies which, although they can seem like a good idea in the short term, actually perpetuate the problem in the long term.
Improving alertness at work
While you’re working on tackling your insomnia, there are some ways you can help yourself to feel a bit more awake and alert at work in the meantime.
- Eat regular mealsIt’s important to eat regular meals to keep your energy up as much as possible. It’s also a good idea to keep snacks handy as much as is possible, to keep your blood sugar at a steady level and boost your energy. Good choices for healthy snacks include, “a mix of protein, carbohydrates, and healthy fats.” This could include fruits, vegetables, yogurt or nuts.
- Reduce your sugar intakeAs much as it’s important to keep your blood sugar steady, it’s vital not to eat too much sugar which causes unhealthy spikes in your blood sugar. While this might help you to feel more energized in the short term, it actually causes you to crash down to feel very low in energy shortly afterwards. This can make you feel worse. Try to avoid high sugar snacks like junk food while you’re working.
- Stay hydratedMake sure you stay hydrated to keep your body functioning optimally. Fluids help to keep your circulatory system working properly which helps you to feel more awake.Dehydration actually makes you feel more fatigued. Drinking enough liquid also helps you to be more alert and allows you to think more clearly.
- Drinking caffeineIf you’re struggling with tiredness at work, sometimes drinking caffeine can help to get you through the day. This is completely fine, but try to drink caffeine earlier in the day and reduce it as you reach late afternoon into evening. This ensures it doesn’t interfere with your sleep hygiene and keep you awake at night.
- Keep movingWhen we’re sitting still, we’re far more likely to feel drowsy and even start to drift off. If you have a physically active job, this is great as it will help to keep you more awake. If you have a desk job, it’s a great idea to get up and walk around as much as you can, to help keep you awake and alert.You can do this by getting up and walking around on your breaks; going for a short walk before work or on your lunch hour; walking over to talk to someone instead of messaging them; and even pacing back and forth while you’re on a phone call.
- Take regular breaksTake breaks as much as you can to give you a chance to refocus your attention. If you aren’t able to take a break, try focusing on a different task for 5 minutes then going back to what you were doing. This variety helps to keep your mind busy and active, keeping you on your toes.
- Use energizing scentsStrong and energizing scents can sometimes help to invigorate you. You could use an essential oil spray, or rub essential oils on your pulse points. You could also use an oil diffuser at your desk if possible.
- Listen to musicIf your work allows, listening to music can be a great way to make you feel more alert. Pick something energizing and fun which makes you feel upbeat.
- Use cold wipes, water, or facial spraysRegularly splashing your face with cold water, or freshening yourself up with some face wipes or a facial spray can be really helpful. Putting the face wipes and facial spray in the fridge is a great tip: it makes them nice and cold and really jolts you awake.
Reduce stress in your life
We know how significantly stress can impact your sleep quality. Therefore, reducing stress in your life as much as is realistic can really help to tackle insomnia. There are a few simple ways you can do this.
Making time for self-care
Self-care refers to anything we do to take care of our physical or mental health. This might be things like eating well, keeping up with personal hygiene, doing exercise, doing things we enjoy, and making time to relax. It can sometimes be tough to make time for self care, especially if you have a very busy life, but it’s vital to make it a priority to keep yourself healthy and to reduce stress levels.
Doing regular exercise actively reduces your stress levels. Hormones known as endorphins which boost your mood and reduce stress, are released every time you exercise. At the same time adrenaline and cortisol (known as the stress hormone) are reduced during exercise.
You’ll also find that your energy levels are increased during the day, and that you find relaxation at night easier. Exercise also provides a great distraction from worries, as you focus on the task at hand and feel tension slip away. The great news is that any type of exercise has these effects, and there are so many varieties that you can find something you actually enjoy!
Making time to relax
Setting aside to relax is just as important as anything else you do for your health. Even if your life keeps you very busy, it’s essential you make some time to relax each day, even if it’s just 10 minutes. You could practice relaxation techniques or do something simple that you enjoy, such as reading a book, watching a programme, getting a massage, pampering yourself, or just having a few moments of quiet reflection.
Setting boundaries with others
Sometimes setting boundaries with others, especially those you love, can feel tough. You might feel guilty or feel that you need to do things out of duty: it’s vital to remember that your mental and physical health are important too. You are allowed to put yourself first sometimes.
If there’s something a loved one is doing which is causing you stress, voice your feelings while keeping calm and being open. You can set clear boundaries, for example: “please don’t say this,” or “please don’t do this”. If you feel like it, you could offer them more helpful alternatives.
If you need to take time for yourself and say no to socializing or cancel plans, you can do so. Sometimes you need time to relax, especially if your stress levels are high, and you can make that a priority.
Ask for support
We all need support at some point in our lives. It’s nothing to be ashamed of and you are not a burden. Ask a loved one support if you need it, whether it just be having someone to talk to and get things off your chest, or asking for help with practical tasks. If you don’t have loved ones you trust, you could call a hotline to talk to someone about your feelings. You could even find a support group or seek support from like minded people through social media.
How to cope if you wake up in the middle of the night
We’ve covered how to improve your sleeping patterns and prevent insomnia, but what should do if you wake up in the middle of the night? When we’re lying in bed and we can’t sleep, it’s common to start feeling really worried about it and find anxiety levels rising. It can be frustrating when you feel tired or need to sleep, but it’s just not happening.
Unfortunately, as frustration rises so do your stress levels, which makes you even less likely to sleep. This creates a vicious cycle. Don’t worry though, there are ways that you can help yourself get back to sleep.
If you are unable to sleep because of a disturbance in your environment, try to tackle it head on rather than lying there restlessly. If there’s too much light, you could wear an eye mask. If there’s too much noise, you could put in earplugs. If you’re too cold, you could close windows and get extra layers. If you’re too hot, you can turn on a fan. Sometimes something simple is disturbing us and it can be a quick fix.
Focus on relaxation
Instead of focusing so much on trying to get back to sleep, shift your focus to relaxation. You could practice some deep breathing or relaxation exercises. You could listen to some relaxing music or sleep sounds. You could also distract your mind by focusing on happy thoughts or a memory which makes you smile.
Instead of becoming worried about the fact that you can’t sleep, instead focus on the fact that if you’re lying in bed and are relaxed, your body is still getting rest. Sometimes knowing this can help you to relax and takes the pressure off.
Don’t look at the clock
It’s really common to keep looking at the clock when you can’t sleep. We’ve all been there! You start thinking: ‘if I fall asleep now I’ll only get five hours of sleep’, or ‘now there’s only 3 hours until my alarm’. This only makes you more aware of your insomnia and more stressed, which makes you less likely to sleep.
Instead, turn the clock away from you so that you can’t see it from your bed. You could even remove clocks from your bedroom altogether. If you use your phone to check the time, place it a little way from the bed so you can resist the urge to keep checking it.
Change your environment
If after 20 to 30 minutes you’re not getting any closer to sleep, you should get up and change rooms. As we mentioned earlier, it’s vital for your brain to associate the bedroom with sleep, and if you can’t get to sleep, this can break that association. Instead, head to another room for a little while until you feel tired enough to go back to bed.
When you move to another room, try to keep the lights dim so that it doesn’t wake you up further. Don’t do anything stimulating, like watching TV or looking at your phone. Instead, do something relaxing like reading a book or listening to calming music. If you find your mind wandering to worries or planning for the next day, bring it back to the present to try to encourage yourself to relax.
Challenge negative thoughts
It’s common (and natural) to have negative thoughts when you’re lying in bed awake at night, such as ‘I’m never going to get to sleep’ or ‘I’m the only who ever struggles with going to sleep’. Unfortunately, these negative thoughts are unhelpful and actually fuel the stress and anxiety you’re feeling, contributing to insomnia.
Challenging these negative thoughts can help to break this cycle and allow us to feel more positive and relaxed. In our example, you could replace those negative thoughts with: ‘I can’t predict what’s going to happen, maybe I will get a very restful sleep tonight’, or ‘everybody struggles to sleep sometimes, it’s nothing to worry about’.
Practice relaxation techniques
If you are learning relaxation techniques through therapy or already know how to practice them, now is a really good time to make use of them. You could practice a meditation or some breathing exercises to help you drift back off to sleep. If you have moved to another room, you could use relaxation techniques to help you feel sleepy before you head back to bed.
We all need comfort sometimes, especially when we can’t sleep and we’re feeling emotional. You could make yourself a hot drink or use a hot water bottle to relax yourself. You could consider using essential oils or a pillow spray. You could even snuggle up with an extra blanket to give you that sense of comfort. Sometimes a simple act of self-comfort can help you to unwind.
Changing your diet
Changing what you eat can help you to sleep more restfully. We already know what we should avoid consuming as part of sleep hygiene to help us get a more restful sleep. Now let’s take a look at some foods which you can add into your diet to help improve your sleep.
- Bananas: Bananas include magnesium and potassium, which help to relax muscles. They also contain tryptophan, which is an essential amino acid which plays a vital part in sleep. The Sleep Council explains that tryptophan, “is the amino acid that the body uses to make sleep-inducing serotonin and melatonin, the relaxing neurotransmitters that slow down nerve traffic and stop the brain buzzing.”
- Nuts: Nuts, in particular almonds and walnuts, contain melatonin which helps to regulate the sleep wake cycle.
- Fish: Most fish contain vitamin B6 which helps with the production of melatonin. Oily fish also contain vitamin D: it’s vital we have the right levels of vitamin D in our diet as a deficiency can contribute to insomnia.
- Whole Grains: The National Sleep Foundation explains that, “white bread, refined pasta, and sugary, baked goods, which may reduce serotonin levels and impair sleep.” Whole grains prevent this happening and are a much healthier choice. They also increase the availability of tryptophan, which we know helps us sleep.
- Milk: Milk is rich in calcium, which helps with stress relief and relaxation. There’s also a strong link in our memory between milk and being comforted as a child, so a warm glass of milk at bedtime can really help us to feel relaxed and sleepy.
- Lean protein: Lean proteins, such as cottage cheese, fish, lean beef and so on, help us to maintain stable blood sugar while we’re sleeping. They also contain the all important tryptophan.
- Fruits: Some fruits contain melatonin and therefore can aid in a more restful sleep. The National Sleep Foundation lists these fruits as tart cherry juice and whole tart cherries, bananas, pineapple, and oranges. They also state that: “Other fruits and vegetables that are rich in antioxidants (like berries, prunes, raisins, and plums) may have a similar effect by helping to counteract the oxidative stress caused by a sleep disorder.”
- Meat and shellfish: Meat and shellfish include a mineral called selenium. When selenium is deficient, it can contribute to sleep disorders. It’s important to ensure you have enough selenium in your diet.
Keep a sleep diary
If you’re struggling to sleep, keeping a sleep diary can be really useful. This can help you to see patterns in how much you’re sleeping and how severe your insomnia is. It can help you to identify any potential triggers that you might have missed, and any poor sleep hygiene habits which may be contributing to insomnia.
This is also something your doctor might ask you to do in the future anyway if you seek a diagnosis for your sleep issues, so it’s really proactive for you to take your sleep diary with you to your first appointment. It can also help you to keep track of any treatments you try to see how effectively they’re working for you. Try to be as consistent as possible and use your sleep diary every day, to get the most out of it.
Your sleep diary should include:
- When you went to bed and when you woke up
- If you woke up in the night
- How long you slept (an estimate is fine)
- How well you slept
- Any disturbances you noticed
- What you ate and drank during the day
- How you were feeling and any stress you were experiencing
- How many naps you took during the day
- How active you were during the day
- Any medications or other substances you took
- Any exercise you did and for how long
- Any comorbid physical or mental health conditions and how they affect your sleep each night
You can choose to make up a chart or jot these down in a diary, or on a spreadsheet on your phone or computer. You can also download sleep diary templates which help you to stay organised. This is a sleep diary from the National Sleep Foundation. Some people use apps to record their sleep, or smart watches which monitor their heart rate, activity during sleep, and note their sleep cycles.
Do I need to see a doctor?
Deciding whether you need to go to your doctor about your insomnia is a very personal issue. If you feel that your insomnia is related to an untreated physical or mental illness, then it’s very important you seek help from your doctor to figure out what’s going on and enable you to get the help you need.
If you are unsure whether your sleep problems stem from insomnia or another sleep disorder, getting an accurate diagnosis can be useful. This can be especially helpful if you aren’t sleeping well but feel your symptoms aren’t fitting in with insomnia.
If you have insomnia, there are self-help options you can try at home such as improving your sleep hygiene, before you seek professional guidance. You could even seek treatment online, through an insomnia treatment programme. If you are able to tackle your sleep issues at home, you don’t necessarily need to go to the doctor.
However, if you prefer to see a professional face to face and get your health checked, going to the doctor might be the right choice for you. If your insomnia has been going on for weeks, you’ve tried self help techniques, and things aren’t getting better, then going to your doctor can be a positive choice.
When you first visit your GP you will discuss your concerns, your symptoms, and chat about what you’ve done to try to improve your sleep. If you have kept a sleep diary, you can give that to your doctor to give them a clear view of what has been going on. It’s always a good idea to write down points you want to cover and take them with you: it’s easy to get flustered in a doctor’s office and forget what you wanted to say.
Your doctor will likely first do a basic physical exam to rule out any health issues or other causes for your insomnia. Harvard Medical School states that: “There are no specific tests to diagnose insomnia. Still, it’s very important for you to have a thorough medical evaluation.” If they feel there is a comorbid condition causing your insomnia, they will order more tests and investigate further to get to the root cause.
Sleep habits review
The doctor will talk over your sleep habits to ensure that you have good sleep hygiene. If they’re able to identify sleep habits which could be contributing to your insomnia, they will provide guidance on how to alter these to get a more restful sleep.
Most of the time your doctor will make the determination that you have insomnia after reviewing your sleep habits, sleep diary, physical exam and any other information that you have provided.
In some cases, particularly if the doctor feels the cause of insomnia is unknown; if your symptoms are very severe; or if they suspect another comorbid sleep disorder, they will refer you to a sleep specialist. This is someone who specializes in all things sleep and sleep disorders, and who will be able to help give you an accurate diagnosis.
You will usually see a sleep specialist in a sleep clinic. This can be a seperate clinic building or a clinic within a hospital department. The clinic will be set up to fully investigate sleep issues. This often entails getting a sleep study known as a polysomnography. Mayo clinic explains that: “Polysomnography records your brain waves, the oxygen level in your blood, heart rate and breathing, as well as eye and leg movements during the study.”
Monitors are attached to your skin via long wires with adhesive sensors, placed in specific areas on your body. These are typically placed on your scalp, temples, chest and legs. The polysomnography monitors your sleep cycles, as well as how restfully you sleep, to identify any disruptions and pinpoint any causes.This helps the sleep clinic to give you an accurate diagnosis. This is a non-invasive procedure and doesn’t hurt.
Usually you will be asked to stay overnight at the clinic, although occasionally you will be shown how to use more simple monitoring equipment at home and return to the clinic with your results. If you stay in the clinic, you will be in a quiet room on your own, in a comfortable bed. It’s likely you will also be monitored via camera and audio system, so the specialists can get as detailed a view as possible of what happens while you’re sleeping.
In the morning, you will go home and the results will be passed onto your doctor. Your doctor will then call you to make an appointment to discuss your results. From there you will be able to get an accurate diagnosis and potentially identify causes of your sleep issues.
Treatment for insomnia
As well as improving sleep hygiene, there are also professional treatments you can access. There are a wide range of treatment options for insomnia, from psychological therapies and medication, to alternative treatments. We’ll cover all of them and the details of how they treat insomnia, to help you make an informed choice when seeking treatment.
Cognitive behavioural therapy for insomnia (CBT-I)
CBT-I is the first line of treatment for insomnia. The National Sleep Foundation states that CBT-I, “is aimed at changing sleep habits and scheduling factors, as well as misconceptions about sleep and insomnia, that perpetuate sleep difficulties.” The National Institutes of Health say that CBT-I is an effective and safe treatment, recommending it as the go-to treatment for treating sleep disorders.
Essentially CBT-I works by changing thought patterns and behaviours which are making it hard for you to sleep. Instead, you’ll learn to replace them with thoughts and behaviours which actively help you to sleep more restfully. There are a few methods which can be used during CBT-I to achieve this.
Stimulus control therapy
A stimulus is something which causes a response. Stimulus control therapy goes back to that association we mentioned between the bedroom and sleep. This method works on the basis that if your brain associates the bedroom with being awake, you’ll struggle to fall asleep. This might happen because of external stimulus, or because you’re lying awake tossing and turning at night. So instead, you’ll work to build up a strong association between your bedroom and relaxation only.
You’ll be encouraged only to go to bed when you are very tired. You’ll be taught to get out of bed after 20 minutes if you are unable to sleep, to change rooms and then return back to bed when you’re tired. This method focuses very strictly on you only using the bedroom for sleep and sex, to ensure the right simutli are associated with the bedroom. Over time, this will result in a state of relaxation when you enter the bedroom, and help you to sleep more restfully.
Sleep Restriction Therapy uses a strict limit on the amount of time you can spend in bed, no matter how well you’ve slept. The idea of this is to help you reset your body clock and to help you feel tired enough to fall asleep at bedtime. At first, the limit will usually be equal to the hours of sleep you usually get (not the total amount of time you spend in bed). So if you’re usually only getting 4 or 5 hours of sleep, that’s how long you will be allowed to be in bed.
At first you will feel a lot more tired than usual. The American Academy of Sleep Medicine explains that this method will, “help you fall asleep faster and wake up fewer times in the night. This gives you a solid period of sleep and a more stable sleep pattern.” Once you begin to sleep peacefully, the limit time will be gradually increased, until you are getting the correct amount of sleep you need.
You might also hear this referred to as remaining passively awake. Paradoxical means something which is the opposite or seems contradictory. The aim of this method is to lie awake in bed for as long as you can (you’ll usually end up falling asleep). The point is to face fears or anxieties around being in bed and not being able to sleep. By facing this fear head on, you can reduce anxiety and realise that you can sleep.
This article explains: “Paradoxically, if a patient stops trying to fall asleep and instead stays awake for as long as possible, the performance anxiety is expected to diminish; thus, sleep may occur more easily.”
This method will be used to help you pinpoint negative thought patterns which are contributing to insomnia, and instead replace them with positive attitudes and beliefs. This might involve being taught to actively replace a negative thought with a positive, logical one when it crops up.
Cognitive control can also involve methods such as setting aside 10 minutes of ‘worry time’ in the evening. During this time you will write down or talk about all of your worries to get them ‘out of your head’. You’ll then be able to let them go. The American Academy of Sleep Medicine explains that: “You focus on getting all of your worries out of your system. At the end of this time you feel “free” to relax. This helps your mind to be at rest when you go to bed.”
Instead of replacing negative thoughts with more positive ones, thought blocking focuses on blocking negative thoughts. When you’re lying in bed at night and you find yourself getting stressed about not being able to sleep, or worrying about how much you have to do the next day, you can distract yourself from these thoughts by using thought blocking. Sleep Station explains that: “The core of these strategies is that they enable a person to substitute thoughts that might keep them awake (arousing thoughts) with non-arousing thoughts.”
There are a couple of thought blocking methods which may be taught during CBT-I, which are discussed below. While these can be tried on your own, they are much more effective as part of a structured CBT-I programme.
- Articulatory suppressionThis simply means mouthing a short word repeatedly at a fast rate, usually every 3 to 4 seconds. The idea is that this makes formulating any thought difficult, and so stops your mind from wandering. The word should be something without any special meaning and which doesn’t evoke any emotion. Sometimes people use simple words like ‘the’ and ‘and’.This article on the topic explains that: “The underlying psychology is complex, but the theory is that mouthing a word requires a lot more mental power than just thinking it and the use of that mental power causes a blocking of the original intrusive thought.”You can add to this technique further by visualizing an object (such as a simple shape) in your mind at the same time as you mouth the word. You could really step it up and add a mental puzzle, such as counting backwards by a specific multiple. Evidence shows that articulatory suppression can help you to fall asleep far more quickly.
- Imagery distractionThis method involves distracting yourself by thinking about a happy memory, or a pleasant imaged scenario. You will engage all of your senses to make this imagined scenario as detailed and vivid as possible. The more detailed, the better, so that you keep your mind as busy and distracted as possible.The scene shouldn’t be anything which will evoke excitement or stress, but rather something you find relaxing and happy. This might be remembering a beautiful walk you took, or a holiday which really allowed you to unwind for example. You could picture a quiet, calming forest scene, or the waves hitting the shore at the beach.Although evidence suggests imagery distraction doesn’t help you to fall asleep as quickly as articulatory suppression, it can help you to get to sleep. It’s also shown to increase sleep quality once you are asleep, allowing you to sleep for longer and more peacefully.
You will be taught a range of relaxation techniques (these are often based in mindfulness) to help you combat stress and tension. This might include meditation and breathing techniques for example. These relaxation techniques can be used during the day to lower general stress levels, or can be used just before bed (or even in bed) to lessen anxiety around insomnia and to help you drift off to sleep.
Once you’ve gone through CBT-I and learnt tools to help you maintain a restful sleep routine in the long term, you will be reminded how to combat relapse. This will involve teaching you that if you start struggling with insomnia, you should use the positive tools you’ve learnt to cope, rather than turning to negative coping habits.
Acceptance and commitment therapy (ACT)
ACT focuses on accepting negative thoughts and understanding that they do not need to lead to actions, and do not need to hold significance. The therapy then guides you through committing to positive actions. ACT for insomnia is particularly helpful for those who struggle with a lot of stress and anxiety around not being able to sleep. Let’s take a look at how this works.
This report explains that: “The vicious cycle of insomnia demonstrates that it is the unwillingness of patients to experience the unwanted thoughts, emotions and physical sensations associated with not sleeping and the ensuing struggle with them that heightens arousal levels and perpetuates sleeplessness.”
What this is saying, is that the stress and frustration around not being able to sleep actually makes you feel more awake and makes it tougher to sleep. So instead of panicking when you can’t sleep, ACT teaches you to acknowledge and accept those feelings of discomfort, without attaching significance to them.
Defusion refers to being aware of the negative thoughts you are having around insomnia, and to allow them to simply exist. Instead of attaching meaning to them, you simply acknowledge you feel that way. You don’t ‘fuse’ them (or connect them) with great meaning, or see them as something you need to get rid of before you’re going to be able to fall asleep.
The thoughts themselves don’t have the power to stop you sleeping. You’re changing your relationship with these negative thoughts.
Valued sleep actions
This is the commitment part of the ACT. Once you’ve learnt that negative thoughts don’t need to lead to action, you can focus on implementing helpful behaviours which will enable you to tackle insomnia. These might include relaxation techniques and improved sleep hygiene.
Mindfulness focuses on engaging all of your senses and being grounded in the present, rather than worrying about the past or future. The practice of mindfulness allows you to reach a state of relaxation. Mindfulness has so many benefits, including being wonderful for stress reduction. Since we know that stress is a significant cause of insomnia, it’s easy to see how mindfulness can be so useful. Let’s take a look at some of the other benefits of mindfulness in treating insomnia:
- Relaxation: Mindfulness can help you reach a state of relaxation which combats worries about sleep, and helps you to sleep more peacefully.
- Safety: Mindfulness is completely safe and has no side effects. It’s even been shown to reduce the need for sleeping tablets.
- Other health benefits: As well as treating your insomnia, mindfulness is also great for your general health. Mindfulness is proven to be good for mental health and boost your mood, as well as to reduce your risk of other physical health conditions.
- Everyone can do it: You don’t need any special equipment, it’s cost-friendly, and accessible for all.
- Can be combined with other therapies: Mindfulness is often combined with other therapies (such as with the relaxation techniques in CBT-I we mentioned), to bring the best results for those struggling with insomnia.
- Proven results: Research has shown that mindfulness improves both sleep quality and duration of sleep.
Mindfulness can be guided, meaning you will be guided by a recorded voice, or by an in-person mindfulness therapist. Once you have picked up the skills of mindfulness, it can be done on your own, allowing you to continue managing your insomnia in the future. There are different ways you can practice mindfulness, each with individual benefits in treating insomnia.
During meditation you will sit comfortably or lie down: you don’t have to be in a specific position, whatever is most comfortable for you is what is important. You’ll close or relax your eyes, so that they’re not focused on anything. You’ll then guide yourself, or be guided by a voice, into a deeply relaxed state.
You’ll focus on breathing in and out slowly while keeping your mind in the present. As thoughts pass you by, you’ll acknowledge them and let them drift past you. If you start worrying about the future or dwelling on the past, you’ll bring your mind back to the present. If your meditation is guided, they’ll take you through this step by step. In this state, you’ll feel stress and tension leave your body and will feel at peace.
You’ll typically start out with around 5 minutes of meditation and work your way up as you practice more. Don’t worry if it takes you a little while to get the hang of, it’s a skill and therefore takes time and dedication. Setting aside a short time each day to meditate can help you to get the most out of it. You can choose to meditate in the evening before bed, or you could do it in bed before you fall asleep.
As well as reducing sleep, meditation can also help you to sleep by increasing melatonin, reducing your heart rate and breathing rate, and activating the parts of the brain which control sleep. Research suggests that meditation even enhances control over the autonomic nervous system, which affects how easily you are awakened from your sleep.
Progressive muscle relaxation (PMR)
PMR involves tensing and then relaxing each area of your body in turn, to achieve complete relaxation. This article states that: “Most practitioners recommend tensing and relaxing the muscle groups one at a time in a specific order, generally beginning with the lower extremities and ending with the face, abdomen, and chest.”
You can carry out PMR sitting or lying down. Just as with meditation, you could choose to do this before you go to bed, or while in bed to help you fall asleep. Guided PMR involves a calming voice telling you which areas to tense and relax. This will typically involve inhaling as you tense your muscles, and then exhaling as you relax them. Often PMR is combined with visualization, for example imagining tension leaving each area of your body and you sinking into the bed as you relax your muscles.
Guided visualization (or guided imagery) involves being guided into a relaxed state, and then engaging all of your senses to imagine a specific scene. You’ll be asked to picture the scene and to imagine what you hear, see, smell, taste and feel. This helps to make the scene more vivid and easier to imagine.
As with our other mindfulness practices, you can choose to either sit or lie down. You can also choose to do this before bed, or while you’re in bed. If your mind wanders, you’ll simply bring it back to the scene you are visualizing.
Often guided visualization will be used simply to relax you, using a relaxing scene such as being at a beautiful waterfall, or lying on a peaceful beach with the sun on your face. This can be really helpful for sleep. However, sometimes specific themes will be used to treat specific problems. For example, if you have a great deal of anxiety around not sleeping, you might be asked to picture yourself lying in bed and feeling a complete sense of calm. You might be told to visualize a warm, white healing light washing over you, taking all of the tension away from your body and ensuring you get a deep sleep.
Breathing exercises focus on your breathing to keep you grounded in the present. You may be asked to take deep breaths in, to hold them for a few moments, then slowly breathe out. This deep breathing helps you to slow your heart rate and respiratory rate to promote relaxation.
Sometimes you will be asked to combine breathing exercises with visualization, such as imagining all of the tension leaving your body as you exhale, and imagining a sense of calm entering your body as you inhale. There are a range of different breathing exercises which can be used, but all are based on the same principles of focusing on your breathing, being present in the moment, and reaching a state of relaxation.
Mindful movement incorporates slow, flowing movements with a focus on being mindful and in the present. Tai chi, yoga and pilates are types of mindful movement you might have heard of. However, any exercise can be done mindfully if you engage your senses. For example, if you went for a run you would notice how your feet feel as they meet the floor. You’d notice your breathing, along with what you can smell, see and hear around you.
Mindful movement brings all the benefits of mindfulness, combined with the benefits of exercise. This can be a great alternative for those who find it hard to stay focused in the present when they’re sitting or lying still. In treating insomnia, mindful movement can help to promote stress reduction and relaxation, while the exercise aspect helps to tire the body in a healthy way resulting in more restful sleep.
Sleep sounds can have two uses: they can be used to help soothe you to sleep, and can be used throughout the night to help you remain asleep. When we hear sounds, our brain interprets them and assesses whether or not there is a threat. Startling, sudden sounds or high pitched sounds can alert the brain and cause us to start out of our sleep. Rhythmic, steady sounds can help us to relax, as well as masking more harsh sounds: this reduces the likelihood of us waking up. Some sounds can even improve the quality of your sleep.
Sleep sounds can be accessed online, through online insomnia therapy, or sleep apps. Some people choose to buy sleep machines, which are machines specifically programmed to play sleep sounds throughout the night. There are a variety of sounds which can aid in relaxation and sleep. These are typically categorized using colours. Noises which are useful for sleep include:
- White Noise: This noise combines all noise frequencies. It creates a steady steady hum which masks other sounds in the environment and can help you to sleep more peacefully.
- Pink Noise: Pink noise are sounds with one consistent frequency. These include natural sounds, such as falling rain, waves crashing on the beach, or wind passing you by. The National Sleep Foundation explains that pink noise has, “been found to improve sleep quality by slowing and regulating brain waves, so that you wake up feeling more well rested.”
- Relaxing music: Music which is relaxing and doesn’t include words (as these can stimulate you), can be a great choice to help you fall asleep. Typically classical music is the best choice. Research also suggests that listening to music while you’re asleep improves memory and cognitive function.
Biofeedback is a therapeutic technique which helps you learn to control some of your bodily functions through the use of monitoring equipment. You will be attached to monitors using electrical sensors, which monitor specific bodily functions. This is completely non-invasive and not painful.
The aim of this is to teach you to be self-aware of how your body reacts when you’re under stress. For example, when you’re stressed your heart rate and respiratory rate will increase. Once you have gained this self-awareness, you’ll then be taught relaxation techniques to learn to control and calm these bodily processes. As you see the results on the monitors, you’ll realise how big a difference this can make and your confidence will grow. You can then use these stress relief techniques and your new found sense of control to continue tackling insomnia.
Monitors used during biofeedback might include:
- Electroencephalograph (EEG): This measures your brain waves.
- Respiratory monitors: Typically bands are placed around your chest and abdomen to measure breathing rate.
- Electrocardiograph (ECG): To measure heart rate.
- Electromyograph (EMG): This monitors muscle contractions.
- Electrodermograph (EDG): To monitor how much you sweat.
- Temperature sensors: To keep track of temperature drops which indicate stress.
Biofeedback can be carried on in a clinic setting. Alternatively wearable devices which connect to computer programmes and mobile phones can be used at home. Biofeedback will often be used in conjunction with other therapies, such as CBT-I and mindfulness, to bring optimal results for insomnia patients.
During light therapy you sit near a ‘light box’ which emits very bright light, for a certain number of hours per day. This light is mimicking natural outdoor light. It helps to reset your circadian rhythm, so that you feel appropriately tired at night and are able to sleep more restfully. You might also hear this referred to as phototherapy.
Light therapy boxes can be bought for home use, or can be used in a clinic setting. It’s recommended that light therapy is used under the supervision of a doctor as it can have side effects, including “eye irritation and dryness, headache, nausea, and dryness of skin.” Therefore, light therapy is typically only used for insomnia if other treatment methods have failed, or is used in conjunction with other therapies.
Medications for sleep are only a short term solution and typically have a number of side effects, such as making you tired the next day even if you’ve slept restfully. They’re not designed to be taken in the long term because of these side effects, and because they become less effective the longer you take them.
You can become dependent on medication for sleep if you take it for longer than a few weeks, which brings another set of health challenges. For all of these reasons, “doctors only recommend medicines for insomnia (sleeping pills) as a last resort, if you’re unable to function during the day because of insomnia.”
Prescription medication for sleep are those which are prescribed by your doctor. Your doctor might prescribe these if all other treatments have failed and your insomnia is stopping you from functioning in your daily life.
The dose and how long you take them for will depend on your individual situation, but will be a few weeks at the most. Your doctor might suggest psychological therapy at the same time as taking the medication, to give you healthy tools to manage your insomnia in the longer term.
Prescription sleeping tablets can help you to fall asleep more quickly, to have a more restful sleep, to allow you to sleep for longer, and reduce the risk of waking up during the night. Side effects can include:
- Increased daytime fatigue
- Problems with cognitive function: issues with focus, memory, and a general sense of confusion
- Night time wandering
- Agitation and irritability
- Mood changes
- Balance issues
- Joint pain
Sleeping medications you may be prescribed include:
- Antidepressants: Some antidepressants can help you to sleep more peacefully. They can also help to ease anxiety and treat comorbid mental illness.
- Benzodiazepines: These are sedatives which slow down the body’s functions and help to relax you.
- Nonbenzodiazepines: These are sedatives (sometimes known as ‘hypnotics’). They work in a very similar way to benzodiazepines and have similar effects. However, they “tend to act more quickly and to leave the body faster.”
- Melatonin receptor agonist: This medication acts on the same receptors in the brain as the hormone melatonin, and so helps to regulate the sleep-wake cycle.
Over the counter sleep aids
Over the counter sleeping aids are those you can buy and don’t need a prescription for. However, it’s always a good idea to consult your doctor first to ensure they’re safe for you and don’t negatively interact with any other medications you’re taking.
Side effects of over the counter medication can vary, but include:
- Dry mouth
- Daytime drowsiness
- Blurred vision
- Problems urinating
Choices of over the counter sleeping aids include:
- Antihistamines: These are designed to treat allergies but are often used to treat other health conditions. They can have a sedating effect which can help with sleep.
- Melatonin supplements: These are a natural version of melatonin, the hormone which regulates our circadian rhythm. This is typically available as a dietary supplement.
Alternative therapies are those which aren’t included in mainstream or ‘conventional’ healthcare. You might also hear them referred to as complementary therapies when they are used alongside a mainstream treatment. Research and results for alternative therapies vary depending on the individual treatment and the condition being treated. There are a few alternative therapies which can be used to treat insomnia.
Acupuncture is an ancient Chinese practice during which very fine needles are inserted into specific points in your body. The procedure is not painful, and will be done while you are lying down on a table in a relaxing environment. The specific points used on your body are said to stimulate nerves and muscles. The result is said to ease pain, increase blood flow, increase sleep quality, and more.
The risks of acupuncture are low, however research shows mixed results for treating insomnia. The British Acupuncture Council state that: “Stimulation of certain acupuncture points has been shown to affect areas of the brain that are known to reduce sensitivity to pain and stress, as well as promoting relaxation and deactivating the ‘analytical’ brain, which is responsible for insomnia and anxiety.”
You’ll likely have heard of hypnosis, but don’t worry, it’s not like the stage shows where you are out of control of your own actions! Quite the opposite is true. A qualified hypnotist will guide you into a state of deep relaxation, usually using verbal cues as you sit comfortably with your eyes closed. This article explains that: “Hypnotherapists use different approaches to induce relaxation, such as focused attention, symptom control, and guided imagery.”
The hypnotic state is described as a trance-like state: it’s similar to that of meditation and other states of very deep relaxation. When you’re in this state, you are more suggestible and more open, but you are always in control of yourself. You can’t be forced to do anything you don’t want to do.
Not only does this state promote relaxation and stress relief, it also allows the hypnotherapist to tackle your sleep issues. In this open state, the therapist may be able to help you pinpoint what is causing your sleep issues. Through the power of suggestion, they may be able to help change negative thought patterns or negative habits which are leading to your insomnia.
Your hypnotherapist may also teach you the skill of self-hypnosis, which simply allows you to guide yourself into this deeply relaxed state. You can use this to continue the work done with your therapist at home. You can even use this skill in bed at night, to help you fall asleep.
Hypnotherapy for insomnia has mixed results. For some people who are more open and suggestible to begin with, it may be very effective. For others, they may not be able to reach that hypnotic state, and so the therapy cannot work. Up to a quarter of people can’t be hypnotized. However, when it does work it can be helpful in tackling sleep disorders. The National Sleep Foundation states that hypnosis may: “increase the amount of time that you spend in slow-wave sleep (deep sleep) by as much as 80 percent. That’s key because deep sleep is important for memory and healing so you wake up feeling restored.”
There are many types of massage therapy but all involve a massage therapist putting pressure on specific areas of your body to invoke a relaxed state. This may involve stroking, kneading, pushing, and rubbing motions. Massage can relieve muscle tension and stiffness, reduce stress, and help your body and mind to fully relax. This relaxation can improve your ability to sleep.
Beata Maciejewska, a massage expert, explains that it: “stimulates serotonin production, which can later be converted to Melatonin.” Since we already know that melatonin helps to regulate our circadian rhythm, it’s easy to see how massage could be helpful in improving sleep quality.
The results for massage are mixed but do suggest great promise in treating insomnia. When done by a professional massage therapist, there are no side effects or risks to massage, so it could be worth a try.
Aromatherapy can be defined as, “a holistic healing treatment that uses natural plant extracts to promote health and well-being.” Essential oils are used to promote improved physical and mental health. Humans have used aromatherapy for many years. However, essential oils aren’t regulated and research is lacking.
Essential oils can be used in many forms. To treat insomnia you could use essentials oils:
- In a room spray to spritz your bedroom
- A pillow spray
- On your bed linen
- In your bath before bed
- In a diffuser in the bedroom
- In a massage oil applied to your skin before bed
There are a number of essential oils which are traditionally used for sleep, the most commonly known being lavender. Others include jasmine, bergamot, chamomile, ylang ylang, and valerian. It’s thought that the smell of these oils promotes relaxation, healing, and calm, which can help you to have a more restful sleep.
Herbal supplements are dietary supplements which come from plants. They are sometimes referred to as botanicals. It’s important to bear in mind that they are not regulated by the Food and Drug Administration (FDA), so if you do use them, ensure you do your research and get them from a reputable source. Depending on the supplement and the other ingredients used, side effects may vary. It’s always a good idea to check with your doctor that any new medication you take (whether it’s natural or not) is safe for you.
Herbal supplements which can be useful for treating insomnia include:
- Valerian: This is a supplement from a mild herb. You might also hear it called valerian root. This has mixed results and for some people, could help them to combat insomnia.
- Chamomile: Chamomile seems to be safe to use but there isn’t much research on it’s effects on insomnia.
- Passionflower: This is included in many natural remedies for sleep.
- Lemon Balm: You may also hear this referred to under many different names such as, “Dropsy Plant, Honey Plant, Sweet Balm, and Toronjil.” It’s thought to have a calming effect.
- Ginkgo biloba: Very little research has been done into this herbal supplement. It’s thought that taking it between 30 and 60 minutes before you go to bed can reduce stress and increase relaxation.
Some other supplements are sometimes used to improve sleep. As with herbal supplements, these are not regulated, so you need to ensure you do your research and buy from a reputable source if you decide to try them. Ensure you look into individual side effects listed for each supplement before you take them. Other supplements which can be used to treat insomnia include:
- MagnesiumMagnesium is an essential mineral our body needs to function. When it’s lacking, it can contribute to a lot of health issues including insomnia. Magnesium levels can be increased both through diet and through supplements.Magnesium is thought to help stabilize mood and reduce stress, which can help with more restful sleep. It can also help in treating restless leg syndrome, which we’ve mentioned can be a cause of insomnia.This article from The Sleep Doctor states that: “Magnesium plays a role in supporting deep, restorative sleep by maintaining healthy levels of GABA, a neurotransmitter that promotes sleep. Research indicates supplemental magnesium can improve sleep quality, especially in people with poor sleep.”
- GlycineGlycine is an amino acid which studies show can improve sleep. It can be gained through dietary choices, or taken in a supplement as a tablet or a powder which is dissolved in water.Not a great deal of research is done into how exactly glycine helps improve sleep, but it’s thought that it helps to lower body temperature, which signals to the brain that it’s time to sleep.
- Gamma-Aminobutyric acid (GABA)GABA is a neurotransmitter already created by our body, which helps to pass on messages in our brain. It’s known as an inhibitory neurotransmitter, which means it slows down or stops certain functions in the brain to help regulate them. This enables our body and mind to function properly.GABA has many vital roles including facilitating, “increased relaxation, reduced stress, a more calm, balanced mood, alleviation of pain, and a boost to sleep.” As well as being produced naturally, GABA can also be taken as a supplement to enhance sleep.
- tryptophanThis is an essential amino acid which is thought to help you fall asleep faster. However, there is very little research done into its effects.
- L-theanineThis is another amino acid which may be able to help with sleep, but very little is known so far. It’s thought that it might be more successful when combined with other medications.
Where to access treatment
Now we’ve covered all the different types of therapy available to treat insomnia, you might be wondering where to access them. You have a number of options, so you can find something which works for you.
Through your doctor
As we mentioned earlier, you can go to see your GP about your insomnia. As well as ruling out other health issues and giving you a diagnosis, your GP can also help you with treatment for your insomnia. They may directly prescribe sleeping tablets, although as we mentioned earlier this tends to be a last resort. They can also refer for psychological therapy.
Depending on where you live, different psychological therapies may be available through your health service. The therapy offered will typically be mainstream treatment approaches, rather than anything alternative. You may be put on a waiting list and then attend your therapy in a therapist’s office, separate clinic, mental health facility, or within a department of a local hospital.
You will typically attend your therapy once a week for a set number of weeks, as an outpatient. You will likely be given ‘homework’ between sessions, which are simply exercises to try out at home. You’ll be asked to monitor your progress, often using a sleep diary or a chart, to allow the therapist to see how the treatment is helping you. The aim of treatment is to give you the coping tools you need to continue having a restful sleep in the long term.
In some cases, you may need to advocate for your own treatment. You can do this by being clear, firm, and persistent. Taking a sleep diary with you, doing your own research and being prepared for your appointment can be really useful.
We mentioned sleep clinics earlier in regard to getting a diagnosis and having a sleep study. Sleep clinics can also provide treatment after your diagnosis. This will entail a detailed talk with the specialists at the clinic about your sleep habits. This will be combined with your other results (such as that of your sleep study) to tailor treatment specifically for you.
You will likely attend treatment as an outpatient at the sleep clinic. This often happens once or twice a week for a number of weeks (6 to 8 weeks is common). You may attend therapy one on one, or as part of a group. A number of therapy approaches may be used in the sleep clinic, depending on your needs and what is available.
If your resources allow, you could seek insomnia treatment privately. This involves paying for your treatment from a private therapist. You’ll pay per session and will attend sessions regularly at your private therapist’s office or sleep clinic. While this is expensive, it means you don’t need to wait for your treatment, and you have more control over what type of treatment you try out.
For alternative therapies which need to be carried out by a professional, such as massage, hypnosis, and acupuncture, you will likely need to seek them privately as they aren’t typically offered as standard through local health services.
Online insomnia treatment typically involves an app or website based treatment programme which will incorporate multiple treatment methods to bring the best results for patients. Depending on the platform you use, you may enter your details and have a treatment programme tailored specifically for you. Typically psychological therapies are used, such as CBT-I and mindfulness.
Online treatment can be really beneficial because it’s much more cost effective than private in person therapy, but you still have a lot of control. You can carry out your therapy where and when you like, as it suits you. You can even use their resources (such as guided meditations) when you’re in bed at night to help you drift off to sleep.
Choosing the right option for you
Having a range of options is beneficial because it allows you to figure out what best suits you. When you’re making this choice there are a few things you should take into account:
- Your budget and how much therapy costs
- What is convenient for your lifestyle
- Whether you feel you need a diagnosis as well as treatment
- Whether you prefer in person therapy, or are happy with online treatment
Take your time to do your research and work out what is best for you, your lifestyle, and your individual preferences. Remember that even though insomnia can be frustrating and be detrimental to your life, there are treatments which can help you to get the sleep you need!
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