Why can’t I Sleep?

Insomnia is very common. It affects between 15% and 30% of the population. Chronic sleep disturbance can result in excessive fatigue, exhaustion, irritability, tension, memory and concentration problems, depression, impaired performance on tasks requiring fine motor skills and attention to detail, and a general sense of unwellness.

Although not directly related to insomnia, individuals with chronic sleep problems report more frequent health problems than do good sleepers. Physical complaints often involve headache, stomach problems, aches and pains, and allergies. Chronic insomnia is associated with more frequent hospitalizations.

Clinical Characteristics

From time to time we all have trouble sleeping. Poor sleep becomes a problem when it occurs three or more nights per week over at least a month. The most common kinds of insomnia involve problems with either sleep onset or maintenance. Sleep onset insomnia occurs when it takes the individual more than 30 minutes to fall asleep. With maintenance insomnia there are frequent or extended awakenings totalling more than 30 minutes or premature awakening in the morning with less than 6 ½ hours of sleep. Of course there are variations of the above and some people get by well on only a few hours of sleep.

Causes

Insomnia may be caused by a number of medical, psychological, or environmental factors. Almost any condition producing physical discomfort or pain is likely to cause insomnia. Acute and chronic pain, respiratory impairment, restless leg syndrome, muscle twitching, heart burn can affect sleep as can less obvious problems such as endocrine, GI, renal, and central nervous system disorders.

Certain medications for high blood pressure or asthma can disturb sleep as can stimulants, such as coffee, tea, colas, and nicotine. Some antidepressant are associated with insomnia. Alcohol may help you to relax and fall asleep but it affects mid cycle sleep.

Stressful life events such as a loved one’s death, divorce, job loss, financial difficulty, tests, jet lag, shift work, conflict with others, and uncertainty about one’s future can affect sleep. While most people resume normal sleep patterns once the stress has been removed, the pattern for poor sleep may be maintained among some individuals.

Once sleep is disturbed psychological factors begin to play a bigger role. You may become angry and frustrated with yourself for not sleeping. You may find yourself “watching the clock” and seeing the time go by. You may be worried that you will never get a good night’s sleep. This negative self talk only worsens the situation. Sleeping in and napping may worsen the problem.

Treatment

Medication can be a very good short term fix but it is not a long term solution. As we develop tolerance to the medication a higher dose may be required and stopping the medication only makes the insomnia worse. Some of the medications are hard to stop so be careful in following this treatment.

Psychological treatment for insomnia involves obtaining a detailed history of the sleep problem. Teaching the individual appropriate strategies for restoring normal sleep patterns and altering the negative thoughts can be beneficial. Altering unrealistic expectations, examining diet, exercise, and other environmental factors that may affect sleep are also important.

Tips For A Good Night’s Sleep

1) Don’t use the bedroom for eating, reading, watching television, or  listening to the radio. Use the bed for sleep. There is one exception!

2) Go to bed only when sleepy. If not asleep within 15 to 20 minutes get out of bed and go to another room. Return to bed when sleepy and try again to fall asleep. Repeat this process until you fall asleep. You are teaching your body and mind that bed is for sleep.

3) Get out of bed the same time every morning at least until you have re-established a good sleep pattern. Do not sleep in to make up for lost sleep or nap during the day.

4) Before you go to bed establish a “before sleep” ritual such as locking the door, setting the alarm, brushing your teeth, taking a sip of water, putting your pyjamas on, etc. Follow this pattern every night. This gets your mind and body primed for sleep. Remember that we have a routine for putting our children to bed and it works!

5) Don’t drink caffeinated drinks, such as coffee, tea, or cola after 7:00 in the evening and until you get your sleep pattern back to normal it is better to stop drinking these completely.

6) Minimize your use of alcohol. Avoid a “nightcap” before bed. This may help you fall asleep but may disrupt your sleep later in the night.

7) Don’t allow you mind to race or let yourself worry in bed. If you start to worry, get up and go to another room and return to bed when you have finished worrying or slowed down your mind. You may find it helpful to write out what is bothering you rather than stewing over it.

8) If you nap during the day do so for less than one hour and no later than 3:00 in the afternoon.

9) Exercise regularly but avoid strenuous physical exertion after 6:00 p.m.

10) Make the sleep environment comfortable, i.e., an appropriate level of warmth and darkness, free from noise and other distractions.

11) Avoid having  snacks if you wake up. This may trick your body into waking up every night to eat. Better to eat well at supper.

Adapted from Insomnia: Psychological Assessment and Management (1993) by Charles M. Morin

Here are a few good resources for MP3 relaxation exercises.

http://www.fammed.wisc.edu/our-department/media/mindfulness

http://marc.ucla.edu/body.cfm?id=22

Or try this iTunes app: Sleep Easily


Image courtesy of Photostock at FreeDigitalPhotos.net

© Robert Schnurr 2012