Sleep is something that we have all experienced. But, what do scientists mean when they talk about sleep? Sleep refers to a temporary state of reduced awareness marked by specific physiological patterns and behaviours (Hendricks et al., 2000). While we don’t have a complete understanding of the mechanisms through which sleep impacts our lives (Assefa et al., 2015), we do know that sleep is important for optimal cognitive (e.g., memory/attention), mental, and physical wellbeing (Zielinski, McKenna, & McCarley, 2016). As a result, more and more scientists and policymakers are publicly underscoring the importance of sleep for health and wellbeing.
Naturally, the ongoing public focus on sleep may spark questions such as: Is a sleepless night considered insomnia? When should I consider getting support? Fortunately, we have answers to these questions, and there is a lot we can do to help people get a better night’s sleep. In this blog post, we’ll explore topics like what exactly insomnia is, when it’s a good idea to seek professional support, the effectiveness of psychological support in addressing insomnia, and whether good sleep habits are overrated for insomnia.
What is insomnia?
Many people associate insomnia with difficulties falling asleep, such as tossing and turning in bed in endless frustration. However, insomnia is more than that. Insomnia comprises a wide category of sleep-related difficulties with specific clinical features and can be split into three domains. “Early” insomnia refers to difficulties falling asleep when a person actively attempts to go to sleep (sleep onset problems). “Middle” insomnia refers to difficulties in staying asleep, such as waking up consistently during the night and having trouble falling back to sleep. “Late” insomnia (or sometimes called early morning awakenings) refers to difficulties going back to sleep after waking up much earlier than planned. A person may experience difficulties on a single domain, or several domains simultaneously.
Why should we care about insomnia?
Occasional sleep difficulties are common, and generally not a cause for concern. Insomnia tends to resolve on its own, but sometimes it can persist. When insomnia becomes chronic (lasts at least 3 months, for most days of the week), people may begin to experience significant feelings of tiredness during the day, cognitive concerns (e.g., “foggy” memory and concentration), and other mental and physical difficulties (Fernandez-Mendoza & Vgontzas, 2013; Riemann et al., 2022). In particular, chronic insomnia can exacerbate existing psychological concerns and contribute to the development of new ones (Riemann et al., 2022). For example, depression, anxiety, post-traumatic stress disorder (PTSD), and manic symptoms in individuals with bipolar spectrum conditions are often precipitated by insomnia and sleep loss (Harvey, Talbot, & Gershon, 2009; Nappi, Drummond, & Hall, 2012; Koffel, Khawaja, & Germain, 2016). Addressing chronic sleep disturbances is therefore important for mental health.
Do I have insomnia, and if so do I need support?
Recognizing the signs of insomnia is the first step in addressing the problem. When thinking about whether to seek support for insomnia, consider whether you tick the below criteria (American Academy of Sleep Medicine, 2014). If you answered “Yes” to all three criteria, you may benefit from consulting a qualified professional about your sleep.
Criterion 1) Can tick at least one of the below, for at least 3 days a week:
Despite having a sufficient opportunity to fall asleep (i.e., you have allocated enough time for sleep), and an environment that helps increases the chances that you will fall asleep (e.g., dark, temperature slightly cool, low noise levels):
- Do you struggle to fall asleep for at least 30 minutes after going to bed with the intention to sleep?
- Do you frequently wake up during the night, and have significant trouble getting back to sleep?
- Do you wake up too early and are unable to return to sleep?
AND
Criterion 2) Have you been experiencing any of the above for at least three months?
AND
Criterion 3): Can tick at least one of the below AND believe it is due to your sleep-related difficulties:
- Feel tired, fatigued, and/or sleepy during the day?
- Find it difficult to concentrate and/or pay attention to something for a long period of time, and/or have difficulty remembering things?
- Hear people tell you that you are moody, irritable, aggressive, or impulsive?
- Find your motivation and energy has dropped?
- Find that you are making more errors at work?
- Are overall concerned/dissatisfied about your sleep patterns?
How can health-professionals be of service for insomnia difficulties?
Cognitive Behavioral Therapy for Insomnia (CBTi) is an effective evidence-based approach for treating insomnia (Perlis, Jungquist, Smith, & Posner, 2005; Morin & Espie, 2007; Freeman et al., 2017; Riemann et al., 2022). This therapy focuses on improving sleep by tackling factors that keep insomnia going, such as habits that contribute to sleep problems. A healthcare professional trained in CBTi will help you:
- Identify and address negative thoughts about sleep, and actions that promote restful sleep;
- Implement strategies to reduce symptoms of insomnia, and risk of future re-emergence; such as ways to reduce anxiety / stress, and feelings of hyperarousal prior to falling asleep;
- Help you improve your sleep quality and amount, and feelings of restfulness during the day.
A healthcare professional experienced in the assessment of sleep-related concerns can also help explore whether your sleep problems are best attributable to insomnia, or/and a comorbid sleep-related condition such as sleep apnoea and delayed sleep wake phase disorder; which warrant a different therapeutic approach.
Can I stop sleepless nights simply by improving my sleep habits?
Contrary to popular belief, good sleep recommendations (sleep hygiene) are not sufficient to address chronic insomnia (Irish et al., 2015). A more tailored approach, such as CBTi, is required for people experiencing chronic insomnia. However, sleep hygiene can be useful in the early phases of acute insomnia, and within a comprehensive relapse prevention plan to reduce risk of insomnia re-emergence in the future. Some common examples of good sleep hygiene are given below:
- Go to bed and wake up at the same time every day, even on weekends;
- Engage in calming activities before bed, such as reading or taking a warm bath;
- Keep your bedroom cool, dark, and quiet. Invest in a comfortable mattress and pillows;
- Avoid screens (phones, tablets, TVs) at least an hour before bedtime;
- Avoid caffeine, alcohol, nicotine, and large meals close to bedtime.
How can we help?
If you’re struggling with sleep problems, and you feel that they are affecting your mental health, don’t hesitate to seek help. You can contact the Centre for Clinical Psychology in Melbourne at 03 9077 0122 or visit our website https://ccp.net.au/booking/ to book an appointment. Our experienced professionals can provide the support and guidance you need to achieve better sleep and mental health.
References:
American Academy of Sleep Medicine. (2014). International Classification Of Sleep Disorders (3rd ed.). American Academy of Sleep Medicine.
Fernandez-Mendoza, J., & Vgontzas, A. N. (2013). Insomnia and its impact on physical and mental health. Current Psychiatry Reports, 15, 1-8. https://doi.org/10.1007/s11920-013-0418-8
Freeman, D., Sheaves, B., Goodwin, G. M., Yu, L. M., Nickless, A., Harrison, P. J., … & Espie, C. A. (2017). The effects of improving sleep on mental health (OASIS): a randomised controlled trial with mediation analysis. The Lancet Psychiatry, 4(10), 749-758. https://doi.org/10.1016/S2215-0366(17)30328-0
Harvey, A. G., Talbot, L. S., & Gershon, A. (2009). Sleep disturbance in bipolar disorder across the lifespan. Clinical Psychology: Science and Practice, 16(2), 256–277. https://doi.org/10.1111/j.1468-2850.2009.01164.x
Irish, L. A., Kline, C. E., Gunn, H. E., Buysse, D. J., & Hall, M. H. (2015). The role of sleep hygiene in promoting public health: A review of empirical evidence. Sleep Medicine Reviews, 22, 23-36. https://doi.org/10.1016/j.smrv.2014.10.001
Koffel, E., Khawaja, I. S., & Germain, A. (2016). Sleep Disturbances in Posttraumatic Stress Disorder: Updated Review and Implications for Treatment. Psychiatric Annals, 46(3), 173–176. https://doi.org/10.3928/00485713-20160125-01
Morin, C. M., & Espie, C. A. (2007). Insomnia: A clinical guide to assessment and treatment. Springer Science & Business Media.
Nappi, C. M., Drummond, S. P., & Hall, J. M. (2012). Treating nightmares and insomnia in posttraumatic stress disorder: a review of current evidence. Neuropharmacology, 62(2), 576–585. https://doi.org/10.1016/j.neuropharm.2011.02.029
Perlis, M. L., Jungquist, C., Smith, M. T., & Posner, D. (2005). Cognitive behavioral treatment of insomnia: A session-by-session guide. Springer Science & Business Media.
Riemann, D., Benz, F., Dressle, R. J., Espie, C. A., Johann, A. F., Blanken, T. F., … & Van Someren, E. J. (2022). Insomnia disorder: State of the science and challenges for the future. Journal of Sleep Research, 31(4), e13604. https://doi.org/10.1111/jsr.13604
Zielinski, M. R., McKenna, J. T., & McCarley, R. W. (2016). Functions and Mechanisms of Sleep. AIMS Neuroscience, 3(1), 67–104. https://doi.org/10.3934/Neuroscience.2016.1.67
