Insomnia essentially refers to when sleep goes wrong, whether that be difficulty getting to sleep, sleep maintenance, or early waking.
Symptoms can include:
Around one third of people are estimated to have sleep difficulties. Research indicates around 10 per cent of people have persistent, severe insomnia – that is, difficulty sleeping for at least three nights per week for at least three months, resulting in negative consequences the following day. Insomnia is especially common among women and older people.
Everyone is different, and the amount of sleep you need can be influenced by your age, lifestyle, diet and environment. As a general rule, teenagers need around 9 hours’ sleep; young adults, 7.5 to 8.5 hours’ sleep; adults, 7—8 hours. Sleep is less consolidated at night in later life, with older people typically sleeping for 6 to 6.5 hours. Older people do, however, tend to use daytime naps to ‘top up’.
Insomnia is often referred to as a 24-hour disorder because it results in negative daytime as well as night-time effects.
Quite simply, poor sleep reduces quality of life.
Insomnia can be driven by many factors, including stressful events, physical and mental health problems, drug misuse, certain medicines, a poor sleeping environment, and lifestyle factors. Genes can play a part – it can be inherited. Hormones may also play a role, as insomnia is more common in women, with pregnant women especially likely to report disturbed sleep patterns.
Perpetuating factors can keep the problem going once it has started. A vicious cycle often develops; people with insomniac tendencies will often worry about not sleeping properly. This frustration and anxiety then further compounds their sleeping problems.
The potential for side-effects and dependence means sleeping pills are generally viewed by doctors as a last resort, something that should be used for only a few days or weeks at a time. They don’t treat the cause of your insomnia – rebound insomnia occurs following discontinuation and this is characterised by a worsening of the original symptoms – and can become less effective over time.
Hundreds of scientific studies have shown cognitive behavioural therapy for insomnia (CBT-I) to be a very effective long-term treatment. Studies show as many as three-quarters of people with persistent insomnia obtain lasting benefits.
CBT-I is a modified form of CBT that has been tailored to deal with the problem of insomnia by helping people change their sleep-related behaviours and thoughts. Sleep-related anxiety is common in people with anxiety. There tends to be an excess focus on sleep itself: the thought ‘I won’t be able to sleep’ is an all-too-common one that triggers feelings of anxiety. This results in mental and physiological arousal, compounding your inability to sleep. CBT-I helps to break this vicious circle.
Cognitive skills help you tackle the mental factors associated with insomnia – the racing mind, stress, sleep-related anxiety – while we will also discuss how to develop good sleep habits and avoid certain behaviours. Sleep scheduling, stimulus control techniques, daytime and bedtime relaxation techniques, and lifestyle habits that aid sleep are all a part of therapy. The aim is to establish a ‘pro-sleep’ routine that cements a strong connection between bed and successful sleep.
The rich evidence base surrounding the effectiveness of these cognitive and behavioural techniques mean that international advisory bodies have recommended CBT-I as the first-line treatment for insomnia.