goodtoknow says: Insomnia is a harmless but miserable condition. It can leave you feeling exhausted, irritated, low and desperate for sleep. Some insomniacs have difficulties simply getting to sleep, others find they wake very early in the morning or frequently through the night. Insomnia is usually temporary however and often related to stress. It doesn't affect your performance the next day as much as you may think. Help yourself by winding down properly and avoid too much caffeine and alcohol. Relaxation techniques help as can many herbal remedies.
For a full medical explanation of the causes, symptoms and treatments of insomnia from patient.co.uk, read on.
About one in five people have some difficulty with sleeping. However, there are many things you can do to help yourself. This leaflet aims to show you some of them. For example, simple things like winding down before bedtime, avoiding certain foods and drinks, and a bedtime routine can help. Further ways to promote sleep in more difficult cases include relaxation techniques, regular exercise, and sleep restriction. Sleeping tablets are not the best way to help with sleep problems because you can get addicted to them, and they often stop working if you take them regularly.
- Find out more: Understanding normal sleep
- Foods to help you sleep
- An expert's view on how to beat insomnia
- How hypnosis helped cure Jane's sleeping problems
A normal nights sleep has three main parts.
Each night, about 4-5 periods of quiet sleep alternate with 4-5 periods of REM sleep. In addition, several short periods of waking for 1-2 minutes occur about every two hours or so, but occur more frequently towards the end of the nights sleep. The graph below shows a typical normal pattern of sleep in a young adult.
Normally, you do not remember the times that you wake if they last less than two minutes. If you are distracted during the wakeful times (for example, a partner snoring, traffic noise, fear of being awake, etc), then the wakeful times tend to last longer, and you are more likely to remember them.
Insomnia means poor sleep. About 1 in 5 adults do not get as much sleep as they would like. Poor sleep can mean:
If you have poor sleep, you may be tired in the daytime, have reduced concentration, become irritable, or just not function well.
Different people need different amounts of sleep. Some people function well and are not tired during the day with just 3-4 hours sleep a night. Most people need more than this. To need 6-8 hours per night is average. Most people establish a pattern that is normal for them in their early adult life. However, as you become older it is normal to sleep less. Many people in their 70s sleep less than six hours per night.
So, everyone is different. What is important is that the amount of sleep that you get is sufficient for you, and that you usually feel refreshed and not sleepy during the daytime. Therefore, the strict medical definition of insomnia is "a persistent difficulty falling or staying asleep, leading to impairment of daytime functioning".
Poor sleep may develop for no apparent reason. However, there are a number of possible causes.
You may remember the normal times of being awake in the night. You may feel that to wake in the night is not normal, and worry about getting back off to sleep. You may 'clock watch', and check the time each time you wake up. This may make you irritated or anxious, and you are more likely to remember the times of wakefulness. You may then have an impression of having a bad night's sleep, even if the total amount of time asleep was normal.
Poor sleep is often temporary. This may be because of stress, a work or family problem, jet-lag, a change of routine, a strange bed, etc. Poor sleep in these situations usually improves in time.
You may find it difficult to switch off your anxieties about work, home or personal problems. Also, poor sleep is sometimes due to depression. Other symptoms of depression include: a low mood, lethargy, poor concentration, tearfulness, and persistent negative thoughts. Depression is common. Treatment of depression or anxiety often cures the poor sleep too.
This sometimes occurs in obese people who snore, more commonly in obese men. In this condition the large airways narrow or collapse as you fall asleep. This not only causes snoring, but also reduces the amount of oxygen that gets to the lungs. This causes you to wake up to breathe properly. You may wake up many times each night which may result in daytime tiredness. (Note: most people who snore do not have sleep apnoea, and sleep well.)
Various illnesses keep some people awake. For example, illness causing pain, breathlessness, leg cramps, indigestion, cough, itch, hot flushes, dementia, mental health problems, etc.
These can interfere with sleep. There are three common culprits.
For example, ecstasy, cocaine, cannabis and amphetamines can affect sleep.
Some drugs sometimes interfere with sleep. For example, diuretics ('water tablets'), some antidepressants, steroids, beta-blockers, some slimming tablets, painkillers containing caffeine, and some cold remedies containing pseudoephedrine. Also, if you suddenly stop taking regular sleeping tablets or other sedative drugs, this can cause 'rebound' poor sleep.
Some people just need less sleep than others. If your sleep pattern has not changed, and you do not feel sleepy during the day, then you are probably getting enough sleep. Older people and people who do little exercise tend to need less sleep. Some people think they should be able to nap during the day - and sleep eight hours at night!
Whatever the initial cause, worry about poor sleep, and worry about feeling tired the next day, are common reasons for the problem to become worse.
This section will discuss three topics which often help to promote better sleep - understanding some facts, sleep hygiene, and further methods to combat insomnia. In effect, these can be used in a step-wise fashion. You need only go on to the next 'step' if the previous step is not very helpful, but each step requires a greater degree of effort.
It is often helpful to understand that short periods of waking each night are normal. Some people are reassured about this and so do not become anxious when they find themselves awake in the night. Also, remember that worry about poor sleep can itself make things worse. Also, it is common to have a few bad nights if you have a period of stress, anxiety or worry. This is often just for a short time and a normal sleep pattern often resumes after a few days.
Three further ways that may help to promote sleep are: relaxation techniques, exercise and sleep restriction.
Relaxation techniques These aim to reduce your mental and physical arousal before going to bed. Relaxation techniques may help even if you are not anxious, but find it hard to get off to sleep. There are a number of techniques. For example, progressive muscular relaxation has been shown to help promote sleep. This technique consists of tensing and relaxing various muscle groups in sequence.
Your GP or a counsellor may be able to recommend a tape or CD that takes you through deep breathing exercises, and other methods to help you relax.
Daytime exercise Regular daytime exercise can help you to feel more relaxed and tired at bed time. (However, you should not do exercise near to bed time if you have insomnia.) If possible, do some exercise on most days. Even a walk in the afternoon or early evening is better than nothing. However, ideally, you should aim for at least 30 minutes of moderate exercise on five or more days a week.
Moderate exercise means that you get warm and slightly out of breath. You do not nead to go to a gym! Brisk walking, jogging, cycling, climbing stairs, heavy DIY, heavy gardening, dancing, and heavy housework are all moderate-intensity physical exercises.
Sleep restriction This is a treatment strategy that may be advised by your doctor. It is best done only under the supervision of a doctor or sleep specialist. Very briefly, the principle of this treatment is that you limit the time that you spend in bed at night. As things improve, the time in bed is then lengthened. An example of the way that this may be done in practice is as follows.
If you have severe persistent poor sleep, your doctor may refer you to a psychologist or other health professional. The main treatment used to help people with poor sleep is called cognitive behaviour therapy (CBT). Briefly, CBT is based on the idea that certain ways of thinking can trigger or 'fuel' certain health problems such as poor sleep. The therapist helps you to understand your thought patterns. In particular, to identify any harmful or unhelpful ideas or thoughts which you have that can contribute to you not sleeping well. The aim is then to change your ways of thinking and/or behaviour to avoid these ideas. Also, to help your thoughts to be more realistic and helpful.
CBT for insomnia is almost always used in combination with the techniques described above. That is, 'sleep hygiene', as well as other techniques such as relaxation techniques, exercise, and sleep restriction.
In the past, sleeping tablets were commonly prescribed. However, they have been shown to have problems, and are now not commonly prescribed. Possible problems with sleeping tablets include:
If a sleeping tablet is prescribed, it is usually just a short course (a week or so) to get over a particularly bad patch. Sometimes a doctor will advise sleeping tablets to be taken on only 2 or 3 nights per week, rather than on every night. This prevents tolerance or dependence to the tablet from developing. There are various types of sleeping tablets. Your doctor will advise.
See a doctor if you feel that illness or medication is causing poor sleep. Treating any underlying condition that is causing the problem, if possible, can help to promote sleep. In particular, depression and anxiety are common causes of poor sleep and can often be treated.
Sleep Council Tel: 01756 791089 Web: www.sleepcouncil.org.uk A non-profit making organisation that aims to raise awareness of the importance of a good night's sleep to health and wellbeing. It provides helpful advice and tips on how to improve sleep quality and on how to choose the right bed for optimum sleeping comfort. It is funded by the National Bed Federation, the trade association for British bed manufacturers, but works independently and does not recommend or endorse specific companies or products. It produces a number of free leaflets.
© EMIS and PIP 2006 Updated: June 2006 PRODIGY Validated