Science of sleep spotlight: Insomnia
“Insomnia - a glamorous term for thoughts you forgot to have in the day”
~ Alain de Botton
For far too long, too many of us have been living with and suffering from symptoms caused by Insomnia. Here, our resident sleep expert, Natalie Pennicotte-Collier, shares her knowledge on this problematic sleep problem and how we can switch our mind set to help us conquer sleep issues rather than exacerbate them.
“It’s estimated that a third of British adults suffer from chronic insomnia and it can be one of the loneliest afflictions to have, with quite profound effects on the body and our minds.
“In some cases we can be caught up in an insomnia loop whereby not being able to sleep causes us to feel stressed and in turn the stress causes us not to sleep. It can become a real nightmare and for some, this can continue in a cycle for years without much respite.
“However, there are proven ways to reduce insomnia and improve your symptoms and the way we approach the issue of getting to sleep and staying asleep.
Firstly, what is insomnia?
“Chronic insomnia is defined as having adequate opportunity to sleep but inadequate ability to sleep, for a period of at least six months.
“Most people encounter sleep difficulties from time to time, often related to stress or pain, and many of these bad sleep bouts get better without the need for treatment.
“Unfortunately, for some people, sleep problems progress into ‘lifestyle insomnia’, which is defined as the chronic inability to fall asleep or to enjoy uninterrupted sleep alongside experiencing mental stress and anxiety too.
What causes it?
“There are many variables that work together to help promote good healthy sleep such as:
- Good vitamin and nutrient levels
- Ideal room temperatures
- The amount of sunlight we are exposed to before noon
- The amount of technology we are exposed to throughout the day and before night time
- Gut bacteria levels and how balanced our diet is
“Just one or two of the above needs to be out of kilter for you to subsequently experience an acute phase of Insomnia.
Insomnia and your health
“Before we tackle insomnia, it’s important to establish if there is a medical cause causing it, so it’s worthwhile making a doctor’s appointment if you start to experience this problem.
“The issues of insomnia are complex. Sometimes insomnia is a symptom of another condition or a side-effect of a medication and a few kinds of insomnia have biological origins that will defy any attempt at self-help, such as delayed sleep phase disorder or narcolepsy.
What are the side effects of Insomnia?
“Sleep deprivation is a major unsuspected factor in the experience of pain, and I have noticed this extensively in my work as a sleep expert and therapist.
“As the levels of reported Insomnia continue to rise; scientists continue to learn about the function and regulation of sleep.
“A lot of sleep research that’s carried out tries to understand the subsequent risks involved with being chronically sleep deprived and the relationship between sleep and disease.
- Insomnia saps your migraine defences. A study of 1,869 migraines clearly showed that “sleep obviously protects against [migraine] attacks rather than provokes them,” while a whopping 29% were actually caused by insomnia
- Insomnia can wreck your mood. 40% of psychiatric mood disorders are preceded by insomnia, and insomnia sets in at the same time as another 20% of mood disorders
- People who are chronically sleep deprived are more likely to be overweight, have strokes and cardiovascular disease, infections, and certain types of cancer than those who get enough sleep
“Many mysteries remain about the association between sleep and these health problems. Does the lack of sleep lead to certain disorders, or do certain diseases cause a lack of sleep? These, and many other questions about sleep, represent the frontier of ongoing sleep research.
Is there a link between Depression and Insomnia?
“Although many people believe that psychiatric disorders such as depression and anxiety cause insomnia, the reverse may actually be true.
“The National Institute of Mental Health Epidemiologic Catchment Area study found that the risk of developing depression was 39.8 times higher for insomniacs than for those without sleep problems.
“Other research suggests that too much sleep; in particular too much rapid eye movement (REM) sleep, can bring on a depressive state.
“Many people who have difficulty sleeping believe they’re not getting enough sleep, evidence is mounting that people with insomnia are in fact achieving at least as much sleep as they require, and possibly more.
“What is known is that insomniacs tend to get into bed early, stay in bed late, sleep during the day, spend more time in bed than non-insomniacs, and that they also underestimate the amount of sleep they actually achieve.
“Most people do not get enough sleep, but not many think of themselves as insomniacs. We can easily be sleep-deprived without having insomnia. And sleep deprivation is like inebriation: the worse it is, the hazier our judgement of how bad it really is.
The most common causes and symptoms of insomnia
- Ineffective stress management
- Pressure Avoidance or Putting things off
- ‘Always on’ Lifestyle e.g. doing too much and never taking time to rest, using technology all the time
- The Disaster Thinking Loop e.g. waking in the night frequently and then worrying that we may have insomnia which makes it difficult to get back to sleep again
- Trying too hard to get to sleep which can have the opposite impact
- Unrealistic expectations on the amount of sleep we should be having
“Many severe cases of insomnia are caused by poor lifestyle habits and patterns of thinking. Even if there is a medical cause for your insomnia something like behavioural conditioning can be your best defence against insomnia and a proven helping hand back to better sleep. For many of my patients, this approach can provide a life-changing validation, a route out of helplessness, and a practical way of getting to sleep.
“No matter what is disturbing your sleep, it’s important to have sleep behaviour that is as good as possible within your circumstances and the good news is that behavioural treatments are highly effective.
“Insomniacs can be helped by practicing good "sleep hygiene”. This includes:
- paying attention to environmental factors such as noise, light, and temperature
- avoiding behaviours that can lead to conditioned insomnia such as reading or watching TV in bed
- avoiding alcohol, nicotine, caffeine, or certain medications before bedtime
- paying attention to the timing of exercise, snacks, and bedtime itself e.g. try not to eat too close to bedtime or carry out strenuous workouts right before bed
- restricting the amount of time we spend in bed not sleeping
“Sleep behaviour is quite variable and adaptable across cultures and situations, and we can learn and unlearn nearly any kind of sleep habit. Together, these non-pharmacological treatments for chronic insomnia are more effective and longer-lasting than medications.
So what can we do?
The cure for ‘Lifestyle Insomnia’ is ultimately simple, and consists of a simple 3-point plan:
- Upgrade your Sleep Environment
- Change your mind set towards sleep with Behavioural Conditioning
- Learn a ‘stress reliever for body and mind’ and commit to re-teaching yourself how to sleep for 4-6 weeks
“One way to think about training yourself to sleep again is to imagine you are training a pet with endless repetition, and positive reinforcement. Only instead of doggy biscuit rewards … your reward is sleep – the best free health and happiness aid you could possess!
“Everything you do, think and feel is linked, and understanding this relationship holds the key to sleep promoting thoughts and beliefs of recovery that in turn help shape your recovery from insomnia into a positive one. Subsequently it will inspire you to commit and adopt the consistent behaviour changes and discipline necessary for sleep.
Change your Mind Set
“Below we look at some examples of self-defeating thoughts that can fuel insomnia and a simple switch you can out into practice to eventually improve your Mind Set around insomnia.
“A number of physical activities, if done regularly, will also help to improve our sleep and combat insomnia.
- Calm your mind & body with breathing exercises - take a few moments to regulate your breathing throughout the day and before you sleep can help to relieve stress and calm your body. I have produced a number of meditations with Hypnos that can be found here: LINK
- Move more before 12pm - many of us engage in too much mental activity and too little physical exercise. Aim to get some energetic physical exercise daily, even if you believe you are too tired to do so. It will ease body tension and you will sleep better as a result
- Limit the Light - be cautious with turning on lights during the night: light is a strong message to your brain, and that message isn’t “go to sleep.” Only turn on dim lights for short periods of time, avoid blue lights (such as those emitted from your phone) and consider having a couple of lights just for night time use e.g. lights with very low wattage / warm bulbs. If you can’t avoid computer screens at night, try installing apps like Lux, which adjust the colour balance of displays at night to make them yellower and mellower.
And finally, the importance of ritual
“Having a good sleep ritual and the same routine every night is vitally important for those experiencing insomnia and especially important for those that have trouble falling asleep in the first place.
“Create a carefully planned and scheduled bedtime ritual of at least half an hour to repeat every single night. This should be done until your insomnia is cured, but it is good practise to use it for the rest of your life if you’re able to.
“The purpose of the ritual is two-fold. Firstly it signals the ‘wind down’ before bed, and secondly it teaches your mind to associate your bedtime with a series of predictable steps.
“Steps such as washing your face, your skincare regime, and brushing your teeth should become a predictable order that is repeated each night in the lead up to bed and signal to your body that it’s time to wind down.
“The more consistent the ritual, the more quickly your brain can learn that face washing followed by teeth brushing equals bedtime, and don’t forget that the timing should start at exactly the same time of night every time.
“I hope this has provided some hope for those that suffer with insomnia, and if you want to see my series of tips and advice with Hypnos on how to sleep well by heading to the Hypnos Sleep page for more."