Insomnia

What is Insomnia?

Struggling with insomnia involves experiencing difficulty falling asleep, staying asleep, or waking up too early and not being able to go back to sleep. This condition can lead to feeling tired, irritable, and having difficulty concentrating during the day. Insomnia is common in many mental health conditions, especially depression and anxiety.

Below are five basic rules for managing insomnia, followed by a question-and-answer guide. Lastly, we provide resources for delving deeper into managing insomnia without medical intervention.

Before addressing your insomnia, it’s essential to consult with your GP. Many medical conditions can cause insomnia, so it’s crucial to rule these conditions out because they each require different treatment and management. Insomnia can be a symptom of cardiac, respiratory, and pain-related diseases. It can also be linked to anxiety and depression, which need to be treated separately.

Five Basic Principles:

Making simple adjustments to your routine and environment can significantly improve sleep quality and make it easier to fall asleep and stay asleep, which is especially helpful if you struggle with insomnia.

1. Regularity of Sleep. Going to bed and waking up at the same time every day helps regulate your body’s internal clock, known as the circadian rhythm, which can improve sleep quality and duration. Aim to go to bed at the same time every night and try to wake up at the same time every morning. Even if you have had a bad night and want to sleep in, it is still essential to maintain regular sleep cycles. The total amount of sleep is crucial. Most adults need 7 to 9 hours of sleep per night to ensure sufficient time for both deep sleep and REM sleep, leading to waking up refreshed and restored.
2. Darkness. You will have better sleep quality if you allow darkness to work its magic to promote sleep. Melatonin is a hormone that induces sleepiness and other functions. Darkness triggers melatonin release, signalling it’s time for sleep, while bright light, especially at night, inhibits melatonin, reducing sleep quality. In the evening, dim your home lights to signal your body to wind down. Use low-positioned lights and opt for yellow or deep orange/red bulbs, which are less stimulating. Minimise nighttime screen time, dim your screens and set your devices to a night-time mode that limits blue light. Consider using blue light-blocking glasses 2-3 hours before bedtime (lowbluelights.com). Enhance darkness in your bedroom with blackout curtains or an eye mask. In the morning, get 10-15 minutes of sunlight to suppress melatonin and reset your circadian rhythm, aiding alertness.
3. Temperature 19°. Temperature plays a vital role in regulating sleep. To fall asleep, your core body temperature needs to drop by about 1°C (2-3°F). Keep your bedroom cool, around 19°C (67°F), or consider using a temperature-controlled mattress cover. Expose your hands or feet from under the covers to help cool down. Taking a warm bath or shower before bed is a scientifically supported method to improve sleep quality. Initially, the warm water raises your core body temperature, but the subsequent cooling that occurs afterwards helps you fall asleep more easily and sleep more deeply.
4. Get out of Bed if You can’t Sleep. If you can’t fall asleep within 20-25 minutes, leave your bed and do a relaxing activity elsewhere. Just estimate the 20-25 minute time limit, as clock watching is not beneficial. If you toss and turn in bed without sleeping, your brain quickly learns that the bed is a place to toss and turn. Getting out of bed helps to avoid associating your bed with wakefulness, as it is crucial to associate your bed with sleep. After doing something relaxing and a bit boring, see how you feel. Return to bed only when you feel genuinely sleepy and think there is a good chance you will fall asleep within 10 minutes.
5. No Caffeine or Alcohol. Caffeine is a stimulant and will cause insomnia if taken within 8-10 hours of bedtime. Some people can sleep fine after afternoon caffeine due to tolerance or metabolism differences, but it can still affect sleep structure and cause awakenings through the night. Alcohol is a sedative, not a sleep aid. A ‘nightcap’ may help you fall asleep quickly, but it disrupts natural sleep structure and causes fragmented sleep.

Insomnia Self-Help

Check If You Have Insomnia:

Do you feel tired after waking up?

Do you experience anxiety over not getting enough sleep? 

Have you been struggling to sleep for a while? 

 Do you feel tired and sleepy during the day? 

 Do you go to bed at night fearing that you will not be able to sleep? 

 Do you wake up through the night and have problems falling asleep? 

If you’ve answered yes to any of the above, then continue below…

Test your knowledge

1.	Tiredness during the day is a sure sign I am not getting enough sleep.	TRUE	FALSE
2.	Sleeping tablets or “sleepers” are safe to take for insomnia.	TRUE	FALSE
3.	If I had a bad night and didn’t sleep enough, it is best to sleep-in or take naps to catch up on lost sleep.	TRUE	FALSE
4.	It is difficult to train your brain to sleep naturally without sleeping tablets.	TRUE	FALSE

Answers

1. Tiredness during the day is a sure sign I am not getting enough sleep. TRUE 

Our bodies recover from sleep. Your body repairs muscles that have been strained throughout the previous day while you rest. Your brain organizes the memories of the day as well. A sleep-deprived mind finds it difficult to concentrate and think coherently. After getting adequate sleep, you should wake up feeling refreshed and prepared for the day. Adults need to sleep for seven to nine hours per night, while teenagers need eight to ten. You may nod asleep while watching TV in the early evening or while relaxing in a comfy chair after lunch if you have trouble sleeping. But sleeping through the day after a restless night will only exacerbate insomnia.

2. Sleeping tablets or “sleepers” are safe to take for insomnia.  FALSE 

These drugs, also referred to as “sedative-hypnotics,” function by decreasing brain activity in order to cause sleep. They are no longer recommended as a first line treatment for insomnia as they cause several serious side effects, such as…

• Loss of memory
• Poor concentration 
• Tiredness during the day 
• Falls with the potential for serious fractures 
• Driving accidents 
• Accidents while operating machinery 
• Rebound anxiety the next day and difficulty sleeping the next night
• Addiction with drug seeking behaviour 

3. If I had a bad night and didn’t sleep enough, it is best to sleep-in or take naps to catch up on lost sleep.  FALSE 

Even if you have trouble falling asleep the previous evening, it is still best to maintain a regular sleep routine. Maintaining a routine of staying up until your regular bedtime can assist create pressure for sleep if you have a difficult night. It will be simpler to fall asleep the next night because your brain will feel fatigued. The brain needs sleep to function properly. After experiencing sleep deprivation, you will be able to sleep better.

4. It is difficult to train your brain to sleep naturally without sleeping tablets.  FALSE 

Anyone may learn to sleep naturally, and it is doable. Many people who struggle with insomnia have discovered that good sleep hygiene, or healthy sleeping practices, help them sleep well. Everyone will occasionally experience an insomniac night, but it’s crucial to prevent these episodes from contributing to poor sleeping patterns.

Did you know?

Randy Gardner achieved a world record in 1964 for the longest period of time spent awake. When he broke the record, he was just 17 years old, and he was awake for 11 days! His pals kept an eye on him as medical professionals kept tabs on his condition. He was reported to have experienced hallucinations, paranoia, and difficulties with attention and memory near the end of his effort. Because of concern for the participants’ health, the Guinness World Records for sleep deprivation are no longer maintained.At least we now know how long someone with insomnia can stay awake!

According to sleep experts, sleep is a necessary brain activity, much like breathing. It comes naturally; you don’t have to think about each breath you take. Actually, your breathing becomes uneven if you try to deliberately control it by thinking about it. Similar principles apply to sleep: let your body and brain heal themselves and let sleep find its own natural pattern.

How to convince your brain to sleep

Train your brain to associate your bed with sleep. People tend to toss-and-turn in bed when they are struggling to sleep. This causes your brain to learn that tossing-and-turning is what we do when we are in bed. Stop this by getting out of bed after tossing-and-turning for about 20 minutes. Don’t look at the clock, just estimate 20 minutes and get out of bed if you can’t sleep. Do this with a smile; you are not letting your brain learn bad habits! Go and do something boring in a darkish setting until you feel tired and are sure that you will fall asleep when you return to bed. Go back to your bed and try to sleep. If you toss-and-turn again, get up after about 20 minutes and repeat your boring activity until you feel tired. Your brain will quickly learn that if we don’t sleep when we are in bed then we are going to get up! 

Practice good sleep rhythms and habits. Only go to bed at night if you are tired and ready to sleep. Getting up at the same time every morning will help to ensure that you are tired at the same time every night when you want to sleep. Make sure that your bedroom is comfortable, quiet, and dark throughout the night. Use ear plugs if it is noisy and a mask for your eyes if it is light (especially in the morning during summer). Follow the same routine towards bedtime to train your brain when it is time to sleep.

Below is a list of ideas to help you get your sleep back on track:

• Get up at the same time every morning and go to bed at the same time every evening, even on weekends. This can help you fall asleep faster since your brain will understand the habit you have set.
• Don’t watch TV in your bed. Make your bed a trigger for sleep so when you fall into it at the end of the day, your brain will recognise your fluffy duma and soft pillow as a place for rest.
• After dinner put your devices, such as your computer or mobile phone, on a yellow light or warmer display setting to avoid blue light. Blue light promotes wakefulness, thus try to avoid looking at a blue light screen before you go to bed.  
• Don’t use your mobile phone just before you try to sleep. You may read something upsetting that can keep you awake. Also, avoid playing video games or participating in an engaging activity right before bedtime. These will cause your brain to be active when it should be winding down.
• Exercise during the day or early evening. This will tire your body out, leaving you more prone to sleep.
• Avoid caffeine after 2pm. Caffeine is a stimulant and will keep you awake. Alcohol too should be avoided as it may lead to rebound brain activity, causing you to wake in the middle of the night. 
• Ensure that your bedroom is comfortable. Eliminate noise and light to create a cozy, sleeping environment.
• If you wake up during the night, avoid using your mobile phone. If you must look at it then search the internet for “sleep hygiene”. Read up on it and try to follow the advice.
• Don’t sleep-in or nap during the day if you had a bad night. Some people call this daytime sleep a “nanna nap”. Cut out daytime napping altogether until your sleep pattern is healthy. Once your sleep patterns are back to normal then you can carefully add a short daytime nap if you want (less than 30 minutes and also known as a “power nap”). 
• Your thoughts are crucial when trying to fall asleep. Try not to worry, rather write your worries down for the next day. Try picturing something calming to encourage sleep. Some people think of black velvet or blackness to promote sleep. Others imagine something pleasant like walking on a tropical beach on a beautiful day. Some people replay in their mind good memories from the past. It is good practice to have the same thoughts or memories in your mind that enable you to feel calm, so that you may fall asleep easier. It is also good to have the same sleep promoting thoughts or images every night when you go to bed.

The Story of Mr Black

“I am 45 years old and have been struggling with insomnia for years. I have been nervous before going to bed; I was scared I would not be able to sleep again. I have felt tired and grumpy during the day. My relationships have suffered, and I have struggled with life at home and at work. I even thought of leaving my work because I could not cope. My depression and anxiety were just going downhill. 

I spoke to my nurse and realised that I was making things worse out of habit. Because I was so tired, I would often nap during the day, especially after dinner while watching TV. I would also watch TV in bed and scroll through Facebook posts. It often upset me and I would struggle to fall asleep. I would wake up through the night. I even took some sleeping tablets, but it made me feel like a zombie the next day, so I stopped it. 

My nurse helped me to chart my sleep habits and I started to learn a lot about sleep hygiene. I started getting up at the same time every morning, even after a bad night. I forced myself to stay awake during the day and became so tired towards the evening that I fell asleep without difficulty. I removed the TV from the bedroom and it helped me to associate the bed with sleep. 

I did not wake up as often through the night and when I did, I was ready for it. I got up after about 20 minutes of tossing-and-turning. I would then have half a glass of warm milk and sit in the lounge reading old magazines. I would go back to bed when I felt tired and would usually fall asleep without any problems. If I had a bad night then I would tell myself, “I will get through the day without napping to sleep better the following night”. 

I also learned that I could fall asleep easier by thinking about my favourite rugby game. I thought about the two tries that my team scored, replayed them in my mind, and sleep would follow. 

I feel so much better and intend to stick with healthy sleeping habits.”

How to track your sleep and why you should

Sleep monitoring helps you better understand your sleep patterns, which can help you determine the cause or solution to your problem. Monitor your sleep with a device such as a Withings Sleep Tracking Mat (click here). Smartwatches and fitness trackers (Fitbit – click here) can also help measure your sleep. Monitoring your sleep daily is the same as monitoring your weight daily. Daily monitoring lets you learn what is causing changes in your sleep quality and then make adjustments.

Sleep Diary

Use this diary to monitor your sleep. Complete it in the morning. Do not worry about exact answers, just guess if you are unsure. You can show this diary to your nurse or doctor, it will equip them with more information so that they can better help you.

Enter start date:_______	Day 1	Day 2	Day 3	Day 4	Day 5	Day 6	Day 7
At what time did you go to bed last night?
How long did it take you to fall asleep?
How many times did you wake up through the night?
In total, for how long were you awake during the night?
At what time did you get up to start your day?
In total, how many hours were you able to sleep last night?
Rate your sleep quality from last night from 0-10: 0 is extremely poor, and 10 is excellent.

Sleep Coaching

CBT-i Coach: An app for people struggling with insomnia. This app will guide you through ways to improve your sleep habits by developing positive routines and tracking your sleep. Click here to find out more.

ThisWayUpClinic.org. This evidence-based program is designed to help you break free from the shackles of sleepless nights and reclaim your well-deserved rest. Developed by expert psychologists and sleep specialists, the course offers a step-by-step approach to understanding and overcoming insomnia through cognitive-behavioural techniques. You’ll learn practical strategies to calm your racing mind, establish healthy sleep habits, and create an optimal sleep environment. With its user-friendly online format, you can access the course materials anytime, anywhere, allowing you to progress at your own pace. Click here for more info.

Books for Insomnia

Say Good Night to Insomnia by G. Jacobs (click here): This book teaches powerful relaxation techniques to take control of your mind and body. Helpful exercises and tips are provided along the way to help you better manage your sleep.

End the Insomnia Struggle by C. Ehrnstrom (click here): Provides an easy, all-inclusive program to help treat insomnia. You are taught how insomnia goes from a few nights of poor sleep to a chronic problem, how sleep actually works and tactics to overcome sleeplessness.

Depression and Bipolar Workbook by C. Aiken (click here): Shares “30 ways to lift your mood and strengthen your brain.” This book is designed to help you cope with depression, hypomania and anxiety.

Podcasts on Insomnia

CBT-Insomnia, A Patient Guide: This short, 20 minute podcast explains how Cognitive Behavioural Therapy (CBT) can treat insomnia and improve depression. Click here for more.

Websites

Dark therapy (click here) is a helpful way to calm down agitated moods, such as mania and mixed states. It’s as simple as spending time in a completely dark room or wearing blue light-blocking glasses from 6 PM to 8 AM each night. Not only can it help improve your sleep, but it can also be beneficial even if you’re not able to drift off. Give it a try; it might just make a positive difference!