We all have a poor night’s sleep from time to time: those nights when you lie awake for hours trying desperately to go to sleep but can’t stop worrying about tomorrow. Or when you repeatedly wake up throughout the night, or can’t get back to sleep in the early hours of the morning.
A person with insomnia is unable to fall asleep, stay asleep, and/or wakes up too early at least three times a week for at least three months. This can lead to considerable distress.
Sufferers experience persistent tiredness, low energy and difficulties with concentration, attention and memory. They may feel down, stressed or anxious, not only about getting a good night’s sleep but about their ability to do their daily activities.
Biological factors include changes to the body’s natural 24-hour body clock, or circadian rhythms, which control the timing of when we feel sleepy and awake throughout the day. Circadian rhythms are sensitive to body temperature, light and physical alertness. When there is too much or too little of a combination of these factors, the body doesn’t release enough sleep-inducing hormones such as melatonin to feel sleepy.
Psychological factors, including unhelpful thoughts (“I’m never going to get to sleep tonight”) and behaviours (watching the clock during the night), can reduce the amount and quality of sleep a person gets.
Being unable to fall asleep often leads to bedtime worrying, which makes it even harder to fall asleep. To try to make up for a lack of sleep, you might then start going to bed earlier, sleep in or take daytime naps. Over time, these unhelpful thoughts and behaviours can create a cycle that makes the insomnia worse.
CBT re-trains people to view the bedroom as a place of sleeping instead of a place where they lie awake tossing and turning and worrying about not sleeping. CBT also helps people change their lifestyle and sleeping environment, learn relaxation skills and challenge the unhelpful worries and beliefs that contribute to insomnia.
When people visit their GP for insomnia treatment, they’re often encouraged to use many of the techniques CBT uses. But these skills are difficult to teach in a short consultation, so many patients don’t use them.
If your symptoms persist, your GP may refer you to a specialist doctor or psychologist for CBT.
We’re piloting a seven-week, interactive CBT program to help Australians with insomnia, called Sleep-e. So far, the data looks promising, suggesting it can reduce the severity of insomnia in people waiting for treatment at a public hospital-based insomnia clinic.
To get a good night’s sleep, try to establish a relaxing bedtime routine. Limit the use of computer tablets and mobile devices before bed. If you can’t sleep, get up and do a relaxing activity, such as reading a book, and return to bed only when you feel sleepy again.
Online programs can help you to practise good sleep hygiene habits, change unhelpful sleeping patterns and reduce the worry that can contribute to insomnia, helping you to get a better night’s sleep.
By Imogen Rehm, Swinburne University of Technology; Hailey Meaklim, Swinburne University of Technology, and Jo Abbott, Swinburne University of Technology – Imogen Rehm is PhD Candidate at Swinburne University of Technology; Hailey Meaklim is Provisional Psychologist at Swinburne University of Technology, and Jo Abbott is Research Fellow / Health Psychologist at Swinburne University of Technology