Insomnia

Approximately, 40% of Canadians will experience a sleep disorder during their lifetime, which can lead to serious health risks over time (Morin et al., 2011).  In this blog post, I will be focusing on insomnia. I have come across many clients, friends, family and even myself who have suffered with insomnia at one point in our lives.

What is insomnia?

Insomnia refers to a sleep disorder where a person experiences an inability to sleep (American Psychiatric Association, 2013).  People with insomnia will either have trouble falling asleep, staying asleep, or both.  Insomnia can be acute (short-term) or chronic (ongoing). Acute insomnia is common and often is brought on by situations such as stress at work, family pressures, or a traumatic event. Acute insomnia lasts for days or weeks. Chronic insomnia lasts for a month or longer. In contrast, primary insomnia isn’t due to medical problems, medicines, or other substances. It is its own distinct disorder, and its cause isn’t well understood. Many life changes can trigger primary insomnia, including long-lasting stress and emotional upset.

Insomnia can cause daytime sleepiness and a lack of energy. It also can make you feel anxious, depressed, or irritable. You may have trouble focusing on tasks, paying attention, learning, and remembering. These problems can prevent you from doing your best at work or school. Insomnia also can cause other serious problems. For example, you may feel drowsy while driving, which could lead to an accident.

Causes of Insomnia

Long working days, social and family responsibilities, irregular shift work and illness can lead to self-imposed sleep restriction, while an untreated or undiagnosed physiological condition may cause a chronic disorder that disrupts the quantity or quality of sleep, said Dr. Ryan, a consultant at the Sleep Disorders Program atUBC Hospital (CBC News, 2015).

Lack of sleep increases one’s risk for serious health conditions. The problem is over time, you incur a sleep debt which you can never fully repay. This is probably going to have long-term health consequences. That’s the risk.

In a study examining the prevalence of insomnia among Canadians, they found 40.2% presented at least 1 symptom of insomnia (that is, trouble falling or staying asleep, or early morning awakening) for a minimum of 3 nights per week in the previous month, 19.8% were dissatisfied with their sleep, and 13.4% met all criteria for insomnia (that is, presence of 1 insomnia symptom 3 nights or more per week for at least 1 month, accompanied by distress or daytime impairment). Insomnia was associated with female sex, older age, and poorer self-rated physical and mental health (Morin et al., 2011).   Individuals with a history of depression and other factors like stress and anxiety will increase the likelihood someone may experience insomnia (Psychology Today, 2015).   Insomnia is a prevalent condition, although few people seek professional consultation for this condition (Morin et al., 2011).

Some behaviors that aggravate insomnia, and they can also be responsible for causing the sleeping problem in the first place:

  • Worrying about the upcoming difficulty sleeping
  • Ingesting excessive amounts of caffeine
  • Drinking alcohol before bedtime
  • Smoking cigarettes before bedtime
  • Excessive napping in the afternoon or evening
  • Irregular or continually disrupted sleep/wake schedules

Treatment

  1. Reconditioning: One method is to recondition yourself to associate the bed and bedtime with sleep. For example, not using your bed for any activities other than sleep and sex. So, no laying in bed while you study or watch TV. As part of the reconditioning process, the person is usually advised to go to bed only when sleepy. If unable to fall asleep, the person is told to get up, stay up until sleepy and then return to bed. Throughout this process, the person should avoid naps and wake up and go to bed at the same time each day. Eventually the person’s body will be conditioned to associate the bed and bedtime with sleep.
  2. Sleep Hygiene: I often advise people about this one a lot.  Practicing sleep hygiene is important for all of us. Sleep hygiene refers to habits and practices that are condusive to sleep (Psychology Today, 2015). First, you should practicwe going to sleep at the same time of night and getting up at the same time each morning. Make your bedroom sleep-friendly. Avoid bright lighting while winding down. Try to limit possible distractions, such as a TV, computer, or pet. Make sure the temperature of your bedroom is cool and comfortable. Your bedroom also should be dark and quiet. Exercise regularly, but not in the last two hours before going to bed. Sex can be a natural sleep inducer and helps some people.  Avoid caffeine in the afternoon and evening.  Also, try to avoid alcohol.   Also, set up a routine before bed and practice this each night so that your body will condition itself to know it’s time to relax and go to bed.
  3. Relaxation Techniques: such as breathing, meditation, yoga, or Progressive Muscle Relaxation. These techniques will help you relax and relieve some body tension so you can fall asleep.
  4. Counselling: seeing a counsellor can help you target the anxiety you experience when dealing with insomnia.  Here is a table, I found on www.helpguide.org to illustrate this.
    InsomniaRobinson, L., Smith, M. & Segal, R. (September, 2015).  Can’t Sleep? Causes, Cures and Treatmens for Insomnia. Retrieved from http://www.helpguide.org/articles/sleep/cant-sleep-insomnia-treatment.htm
  5. See a doctor:  If you have trouble falling asleep night after night, or if you always feel tired the next day, then you may have a sleep disorder and should see a physician. Your primary care physician may be able to help you; if not, you can probably find a sleep specialist at a major hospital near you. Most sleep disorders can be treated effectively.
  6. Medication: may provide temporary relief, but it will not address the underlying cause of your sleep disorder.  There are many over the counter sleep aids, but it is in your best interest you talk to a doctor first.  Prescription medication for sleep can be highly addictive and it can be tempting to rely on it for sleep. It’s best to use medication only as a last resort, and then, only on a very limited, as-needed basis. Evidence shows that lifestyle and behavioral changes make the largest and most lasting difference when it comes to insomnia.

What worked for me?

I suffered with really bad insomnia while I was doing my Master’s degree. It would flare up whenever I was really stressed or anxious and I had it for about two years.  I would have nights where I would not sleep a wink and then have to go to school or work.  Everyone would ask “Can’t you miss school or work?” The answer was always “No.” I felt like people didn’t understand and some people really didn’t understand.  I felt so alone and distraught.  I was so angry at myself, “why can’t I be normal?”  My doctor prescribed me an antidepressant that worked as an anxiety medication.  It wasn’t a sleeping pill.  It would just make me feel relaxed enough to feel sleepy.  It really helped while I tried to address my anxiety in order to target the underlying issue.  I also don’t work as a server where I would be getting off work late at night feeling wired, and unable to fall asleep right away.  Another factor that really helped was reconditioning and practicing sleep hygiene. I have developed a routine that I do every night before bed so that my body knows it’s time to go to bed.  I have my fan running so my room is the perfect temperature, I have my diffuser going so that I can relax and I make sure my room is extra dark.  I only drink caffeine in the morning and I try not to think about work or anything stressful in the evenings.  I also go to bed at the same time every night and wake up every morning around the same time so I don’t sleep in.  It’s taken a long while, but I finally have gotten my insomnia under control.  I haven’t had a sleepless night in months.  The last one I had was after something very stressful and traumatic.  So I know it will flare up from time to time, but now I know what to expect.  It is still a work in progress, but I atleast have the coping skills I need.

VGH/UBC Hospital Foundation (Sleep Disorders Program) 
Sleep Disorders Program referrals can only be initiated by your physician. If you are a patient who wants to be seen at the Sleep Disorders Clinic, you need to talk with your doctor first who can then refer you.
Location: UBC Hospital
Rm. G-285 – 2211 Wesbrook Mall
Vancouver, BC Canada
V6T 2B5
604.822.7606

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. Washington, D.C: American Psychiatric Association.

Morin, C., LeBlanc, M., Belanger, L., Ivers, H., Merette, C. & Svard, J. (2011). Prevalence of insomnia and its treatment in Canada. Canadian Psychiatry, 56(9): 540-548.

Psychology Today (2015). Insomnia. Retrieved from https://www.psychologytoday.com/conditions/insomnia

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