Clinical Psychologist Amreen Sekhon explains Insomnia

Insomnia is defined as difficulty initiating or maintaining sleep, or both, despite adequate opportunity and time to sleep, leading to impaired daytime functioning. Insomnia may be a cause of or result of poor quality or quantity of sleep.

However, insomnia is very common as 90% of the general population has experienced acute insomnia at least once. Approximately 10% of the population may suffer from chronic insomnia.

Risk factors

Although, insomnia affects people of all age groups; people in the following groups have a higher chance of acquiring insomnia:

  • History of mental health disorder including depression etc
  • Emotional stress
  • Individuals older than 60 years
  • Working late night shifts
  • Travelling through different time zones

Signs and Symptoms of Insomnia

  • Daytime fatigue
  • Mood changes
  • Daytime sleepiness
  • Anxiety
  • Headaches
  • Lack of energy
  • Poor concentration and attention
  • Poor social function
  • Increased errors and mistakes

Types of Insomnia

1.Transient Insomnia

Transient insomnia lasts for less than a week. It can be caused by another disorder, by changes in the sleep environment, by the timing of sleep, severe depression or by stress. It leads to sleepiness and impaired psychomotor performance.

2. Acute Insomnia:

Acute insomnia is the inability to consistently sleep well for a period of less than a month. Insomnia is present when there is difficulty initiating or maintaining sleep or when the sleep that is obtained is non-refreshing or of poor quality. These problems occur despite adequate opportunity and circumstances for sleep and they must result in problems with daytime function. Acute insomnia is also known as short-term or stress-related insomnia.

3. Chronic Insomnia:

Chronic insomnia lasts for more than a month. It can be caused by another disorder, or it can be a primary disorder. People with high levels of stress hormones or shifts in the levels of cytokines are more likely than others to have chronic insomnia. Its effects can vary according to its causes. They might include muscular weariness, hallucinations, and/or mental fatigue. Chronic insomnia can cause double vision.


Cognitive Behavioral Therapy

Cognitive behavioural therapy (CBT) as a treatment modality uses a combination of behavioural and cognitive techniques to overcome dysfunctional sleep behaviours, misperceptions and distorted, disruptive thoughts about sleep.

Universal Sleep Hygiene

A common finding is that a patient’s lifestyle leads to sleep disturbance. This is usually phrased as inadequate sleep hygiene, referring to a problem in following generally accepted practices to aid sleep. These include, for instance, keeping regular hours of bedtime and arousal, avoiding excessive caffeine, not eating heavy meals before bedtime, and getting adequate exercise.

Stimulus Control Therapy

Stimulus control therapy aims to break the cycle of problems commonly associated with difficulty initiating sleep. By attempting to undo conditioning that undermines sleep, stimulus control therapy helps reduce both primary and reactive factors involved in insomnia. The rules attempt to enhance stimulus cues for sleeping and diminish associations with sleeplessness. The first rule is, go to bed only when sleepy to maximize success. Second, use the bed only for sleeping and not for reading, watching tv etc. Third, do not lie in bed and become frustrated if unable to sleep. After a few minutes get up, go to another room and do something non-arousing until sleepiness returns. The fourth and final instruction attempts to enhance the mechanisms underlying the circadian and sleep-wake cycles-that is awaken at the same time every morning and totally avoid napping.

Sleep Restriction Therapy

Sleep restriction therapy is a strategy designed to increase sleep efficiency by decreasing the amount of time spent awake while lying in bed. This therapy specifically targets those patients who lie awake in bed unable to sleep. Restricting time in bed can help to consolidate sleep. If the patient reports sleeping only 5 hours of a scheduled 8 hour sleep time in bed, reduce the time in bed.

Remedies to improve sleep

Create a sleep schedule: Try to go to sleep and wake up at the same time every day.

Avoid taking naps: Naps could make it hard for you to fall asleep at bedtime.

Keep your bedroom quiet and dark: Turn on white noise such as a fan to help you relax. Do not use your bed for any activity that will keep you awake. Do not read, eat or watch tv in your bed.

Limit caffeine, alcohol and food to earlier in the day: Only drink caffeine in the morning. Do not drink alcohol within 6 hours of bedtime. Also, do not eat a heavy meal right before going to bed.

Exercise regularly: Daily exercise may help you sleep better. Do not exercise within 4 hours of bedtime.

Amreen Sekhon