Blink… blink…. 4:27 AM Oh no…not again! It’s too early! Your mind starts firing up. No, no, no…. you toss, you turn. Try to find a cozy position. 4:43 AM Argh…Sigh. It’s no use… Going back to sleep seems hopeless. There goes another day ruined…. So you lie there frustrated, begging your body to sleep, but your mind won’t turn off. Does this sound familiar?
By Jennifer Kwong
Maybe it’s the falling asleep part that is difficult. Does it take a long time to settle, up to an hour or more, before sleep begins? Or, do you wake up multiple times during the night, never really falling back into a deep sleep? In any case, by the morning, you just don’t feel refreshed.
Sleep: one of the most important functions of the human body that affects so many areas of life including our psychological functioning. When we sleep poorly, our body and mind suffer the consequences!
Insomnia is the common term used for sleep disturbance. While everyone experiences sleep disturbance from time to time, when difficulties persist, other problems arise that can negatively impact daily functioning. There may come a point when you need help, typically starting with some medical advice. If you seek medical help, your doctor may help distinguish between stress-related sleep difficulties (e.g. due to situational stressors) and possible medical conditions, such as sleep apnea, or what is called a primary “insomnia disorder” diagnosis.
The criteria for insomnia disorder includes persistent disturbed sleep for more than one month (e.g. problems falling asleep or staying asleep), feeling tired in the morning, and daytime symptoms associated with poor sleep, such as fatigue, irritability, anxious and/or depressed mood, problems with concentration, and interference with work, home, or school tasks.
It is important to know that there are other situations that may contribute to insomnia-like symptoms, such as a medical or mental health condition that interferes with sleep. For example, fibromyalgia can cause pain that interrupts sleep. Similarly, high anxiety can also be significant enough to disturb sleep. A sleep disorder such as sleep apnea, where a person temporarily stops breathing during sleep, also leads to many of the same symptoms as insomnia. So in addition to a general assessment, your doctor may recommend a sleep study in order to find out more about your particular sleep issues.
Let’s say you have a physical check-up and a sleep study done. Results are all “normal” – except that you are still having trouble with sleep. You may have primary insomnia without a medical condition or other sleep disorder. What can be done?
Learning more about sleep can be helpful and there are a number of resources available. From sleep aids to relaxation CDs, there is a whole industry geared towards helping people sleep better. Before you spend a lot of money, here are a few steps you can try first:
1. Keep a sleep log
Sleep is a function that is necessary for the body and normally occurs with some regularity (a.k.a. circadian rhythms. You usually get tired and need to sleep at some time, and will wake naturally when undisturbed). With insomnia, the pattern of sleep has been disrupted over a period of time. Track your sleep over a week or two, noting when you go to bed, approximate the number of times you wake at night, and note when you wake up the next day. For each night, rate the overall quality of sleep from 1 to 10 (ten being the best night’s sleep). Over a week or two, you may discover if there is a pattern, such as which nights were better than others and what was different on those days.
2. Back to routine
Again, as certain body functions operate on a schedule, creating a bedtime routine can help to re-train your sleep cycle. Determine when you need to wake up in the morning, work backwards adding the number of hours you need to generally feel refreshed, and then add an extra hour or so for time to start getting ready for bed. Having a regular turn-down time and routine helps the body and mind relax and prepare for sleep – repetition builds familiarity, comfort, and expectations for sleep; just ask any parent with a toddler! For adults, aim to also have a regular wake up time even on weekends and holidays. The habit of sleeping in can have the effect of derailing your sleep cycle.
3. Sleep at night, be active during the day
Look at your daily schedule over a week. How much time is spent sitting down? How much movement does your body go through? It has been well researched that the human body needs regular physical exercise to maintain healthy body weight and function. If you are not physically active enough during the day, your body may not be tired enough at bedtime – despite mental fatigue. Similarly, naps are problematic because those “mini-sleeps” lead to your body not being tired enough by bedtime. If you are currently so fatigued that you need to nap in the afternoon, aim to nap one hour or less (use an alarm) and gradually reduce the time. Incrementally replace with a short quiet time to just rest your eyes and body, instead of a full sleep.
4. Examine environmental factors
Consider all possible factors that may affect your sleep from a physical perspective. Is the room dark enough? Quiet? Too warm or too cold? Mattress and pillow support? Bed partners? Food, caffeine and alcohol consumption? Electronic devices? While it may be comforting to have Fido with you on your old mattress, with music or the TV on to lull you to sleep, these may in fact be contributing to your disturbed sleep. Other possible factors could be caffeinated beverages too late in the day (caution with those iced coffee drinks in the summer!), internet surfing before bedtime, or even proximity to an electronic device that alerts every Tweet or message. These factors tend to excite the mind rather than help it to relax. Experiment with changing or removing one element at a time for a few nights and see what difference that makes.
5. Examine internal factors
Consider all possible internal factors that may be affecting your sleep. This includes honestly evaluating mental stressors such as family or relationship problems, work or school issues, worries about finances, unresolved anger, grief, disappointment, or sadness. Even happy situations can create sleep disturbance, such as going on holiday or starting a new job. While strong emotions to particular situations can temporarily disrupt sleep, persistent sleep problems lasting a month or more may indicate it’s time to consult with a professional.
6. Dealing with negative thoughts and self-talk
Did any of the thoughts in the introduction of this article sound familiar? It’s common when we are frustrated and under stress to have negative thoughts. When we are not able to see past the current stressors for options or solutions, our thoughts can inadvertently create a vicious cycle of increasing stress. Thoughts such as “another day ruined” or even a phrase like “oh no, not again!” can heighten distress and anxiety. Negative predictions such as “I just can’t sleep” or continually focusing on how difficult it is not sleeping can also perpetuate tension and be counter-productive.
Learning about negative automatic thoughts and how to shift our self-talk can be a powerful way to alleviating the stress that comes from not sleeping well. That mental shift may help with achieving a more relaxed state of mind. If this negative self-talk rings true for you, there are a number of self-help workbooks and audio resources that may be beneficial. Alternately, it could be worth exploring working with a therapist. You may only need a few consultations or short-term therapy to assess your situation and create an action plan. Using a variety of different strategies, a therapist may be able to assist you with identifying and handling the negative thoughts that are keeping you up at night!
Insomnia, especially chronic insomnia (lasting six months or more), has often been described as torture. Surely, the body and mind feel as though they have been through the wringer when sleep is elusive! Without taking care of your sleep issues, you could be exposing yourself to increased risk of physical illness and a decline in psychological functioning. If you think you might have insomnia, talk with a trusted health care professional for options. Get more information and perhaps try some of these six tips. The reward for your time and energy spent will eventually be, hopefully, a better night’s sleep.
Jennifer Kwong, MA is a psychotherapist with Dr. Heather McLean and Associates Psychology Centre in Markham. She works with individuals for various life issues, including anxiety, mood disorders, and insomnia. She also knows first hand that while insomnia is unpleasant, it can also be managed with positive life choices and changes.
Canadian Research Study: Insomnia and Depression Study at the Sleep and Depression Lab, Ryerson University, Toronto. (416) 979-5000 ex 2185.
Self-help workbook recommendation: • Quiet your mind & get to sleep. Carney, C.E. and Manber, R. (2009). • Overcoming Insomnia: A Cognitive-Behavioral Therapy Approach Workbook. Edinger, J.D. and Carney, C.E. (2008).