Insomnia

On this page you will learn more about insomnia.

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What is insomnia?

Insomnia can be defined as difficulty falling or staying asleep, as well as waking up too early with an accompanying feeling of fatigue and an inability to go back to sleep. It affects not only the quality of sleep but the general quality of life and causes daytime problems.

Insomnia is categorised as either primary or secondary. The former refers to insomnia as the root cause and its own diagnosis; there is no other explanation of an individual’s experience of sleeplessness. Latter, in turn, describes a situation where insomnia is only a symptom of a bigger, underlying issue such as a mental health issue or a physical condition.

The sufficient amount of hours of sleep varies from one person to another, usually oscillating around 7- 8 hours of sleep among adults. Nevertheless, what defines the nature of insomnia is the duration of the problem. If the symptoms are present up to 7 days, then the insomnia is categorised as transient. Acute or short-term insomnia refers to the disturbances in sleep persisting up to three weeks. One experiences chronic insomnia when sleepless nights last for more than three weeks.

Symptoms of Insomnia

Symptoms of insomnia fall into two general categories: sleep disturbances and daytime issues.

The disordered sleep can mean experiencing difficulties with falling and staying asleep as well as frequently waking up in the night or waking up too early without the possibility of falling asleep again and not feeling rested in the morning. As a result of continuous sleepless nights, insomnia interferes with the quality of functioning throughout the day. The most common symptoms include the overwhelming feeling of tiredness throughout the day, impaired cognitive functioning such as poor focus, difficulty with memory as well as impaired social functioning and decreased motor coordination which can be especially seen in the proneness to making errors or having car accidents. Emotionally, insomnia can trigger constant worries about sleep, heightened irritability, impulsiveness, aggression, anxiety or depression.

Why insomnia occurs?

Generally, the causes of insomnia can be divided into different categories:

Lifestyle

The factor that most commonly triggers insomnia (both short-term and chronic) is experiencing stress in life. When faced with a challenging situation, we tend to
get stuck in our worries that keep us wide awake at night. Experiencing a
distressing life event like a job loss, death of a loved one or a divorce will most
probably worsen the ability to rest and the overall quality of sleep.
Another frequent cause of insomnia is a change to the biological clock by either
travelling between time zones or having different shifts at work. The internal
circadian rhythms regulate the sleep-wake cycle, stable temperature or
metabolism. Being jet-lagged or having an irregular work schedule can
contribute to sleeplessness.

Insomnia can also occur due to unhealthy habits and activities revolving around
sleep, for example, taking long naps during the day or having an irregular
sleeping routine. Eating big meals late at night or looking at a screen moments
before going to sleep will most probably disrupt your sleep cycle. The
environment in which one sleeps is a crucial factor here. If there’s a lot of light
or noise or your bed is uncomfortable, getting a good night’s sleep is hardly
possible. The way we use our beds plays an essential role in being able to
sleep at night as well. People who use beds not only to sleep or have sex but also
to work, eat or watch TV are more likely to experience insomnia.

Lastly, the amount of caffeine, nicotine and alcohol consumed undoubtedly
affect our sleep cycle. Caffeine is widely used for its stimulating properties,
which keeps us awake. Nicotine, as another stimulant, does the same. Alcohol,
on the other hand, is believed to help with falling asleep, which might be true for
many people. This substance, however, worsens the quality of sleep since it
prevents the transition into deeper stages of sleep, which, in turn, leads us to
wake up frequently throughout the night.

Physical condition

There’s a variety of health conditions that can cause insomnia. Among them are:
frequent urination, chronic pain, asthma, diabetes, acid reflux, overactive
thyroid, cancer and Parkinson’s or Alzheimer’s disease. Sleep-related disorders
such as sleep apnea, which interrupts the duration of sleep and restless leg
syndrome, which makes falling asleep extremely hard, can also trigger
sleeplessness.

Mental health issues

Insomnia is connected to many mental health disorders. For example, there’s a
significant link between anxiety, PTSD and sleeplessness. Stress-inducing
thoughts characteristic of anxiety and PTSD can powerfully interfere with sleep.
Another connection was observed between insomnia and depression since a
fairly frequent sign of this mental disorder is waking up too early.
With that being said, there are many prescription medications for both physical
and mental health conditions (e.g. antidepressants, medicines for asthma, blood
pressure, allergies) which can be partly responsible for insomnia.

Can insomnia go away?

Insomnia is a condition that varies from one individual to another in its duration,
causes and severity of symptoms. Generally speaking, insomnia can and does go
away, but it depends on many different factors.
Short-term insomnia, either transient or acute, tends to be triggered by an
individual’s lifestyle and sleeping conditions. It is when we become mindful of
those causes, remove unhealthy habits, and apply correct sleep hygiene, that the
issues subdue and eventually go away completely.

Most commonly, it is a presence of stressful periods in our lives that result in
sleepless nights. Once the problematic situation is resolved, the stress levels go
down, and our ability to sleep soundly is restored.
However, suppose the sources of distress, such as marital issues or a hostile
working environment, are continuous and not adequately addressed by an
individual. In that case, there’s a slight chance of spontaneous recovery.
What most commonly causes long-term chronic insomnia is the underlying, complex
mental or physical issue such as chronic pain syndrome, sleep apnea, depression
or anxiety.

The good news is – there are many treatments for insomnia, specifically tailored
to each person’s needs.

Insomnia and Anxiety

Sleep plays a crucial role in the state of our mental health. It replenishes our
resources and restores our energy. Thanks to systematically getting a good
night’s sleep, we are more resilient, emotionally and mentally. However, if we
suffer from insomnia or we neglect the importance of resting, we are more likely
to perceive the world negatively, be emotionally unstable, and produce
unhealthy patterns of thinking.

Insomnia is known to be a symptom of many mental disorders, especially
anxiety. The two conditions are connected and influence one another. The
likelihood of developing insomnia among those with an anxiety disorder is
substantially higher than the rest of the population. In turn, sleep-deprived
individuals are at a higher risk of either developing or intensifying the symptoms
of an already existing anxiety disorder. Harvard Publishing claims that more than
50% of adults with a Generalised Anxiety Disorder struggle with sleep
deprivation and insomnia.
This link between the two conditions works both ways, though. Treating anxiety
helps lessen the severity of insomnia. In the same fashion, addressing the issue
of sleeplessness heightens the ability to cope with the mental disorder.

Treatments for Insomnia

Fortunately, there are many treatments specifically tailored to each person’s
individual needs, depending on their cause of insomnia. Whether the
sleeplessness results from a physical illness, a stressful situation or a symptom of
a mental health issue, it is always a good idea to see a doctor. Once the cause is
established, the sleep-deprived individuals can take the proper steps towards
recovery.

Some sleep specialists might need your polysomnogram (PSG) results. This
unique sleep study examines and monitors several physical activities that take
place overnight. The information obtained in a PSG provides essential feedback
applied in the treatment.

There’s a large body of scientific data supporting the claim that insomnia is best
treated when medical and non-medical aspects are combined. Many
over-the-counter antihistamine sleep aids help in the short-term with falling
asleep and enhancing the overall quality of rest. Unfortunately, using these
medications continuously has many undesired side effects such as tiredness
during the day, addictive potential, morning drowsiness, and the growth of
tolerance to these sleep aids.

Prescribing strong sleeping medication is treated by physicians as an ultimate
means to alleviate symptoms of insomnia when no other trigger for
sleeplessness can be detected. Either way, it is in your best interest to consult
the use of any medication with your doctor, especially if you already take
other medicines. For example, some antidepressants, drugs for asthma, allergies
or weight-loss supplements can augment the severity of insomnia.

CBT-I

One of the widely used treatments for insomnia is Cognitive Behavioural
Therapy (CBT-I). The therapy mainly focuses on the client’s thoughts, habits and
activities that might hinder the ability to get a good night’s sleep. Those who
struggle with insomnia tend to create negative conditioning around sleep, which
works like a downward spiral – the more frequent the distress, the greater
difficulty with falling asleep. CBT-I addresses these specific issues and provides
the clients with helpful tools to use when facing insomnia, such as relaxation
techniques or sleep schedule management skills.

Sleep Restriction Therapy

If you are looking to increase the time you spend on efficient, restorative sleep
instead of tossing and turning in bed, this treatment might be for you. At the
core of this method lies the idea that a fixed timeframe for sleep can counteract
insomnia. When applying the theory of sleep restriction therapy in practice, the
patients are supposed to have a specific time for waking up and going to bed.
Therefore, even if they do not manage to get a good night’s sleep, even if they
are tired and not well-rested, they still have to get up at the appointed time in
the morning. In that way, falling asleep the following night can get more
accessible because of how sleep-deprived they were in the first place.

Relaxation Training

Insomnia often is a by-product of experiencing high levels of distress and
anxiety in life. Simply laying in bed in order to calm down does not work. In
these cases, individuals need to learn special relaxation techniques such as
meditation, yoga or guided imagery, which can successfully inhibit undesired
arousal or intrusive thoughts around bedtime.
Progressive muscle relaxation (PMR) is a technique used to alleviate insomnia
worth mentioning because of its effectiveness in releasing bodily tension,
eliminating anxious thoughts, and even reducing chronic pain symptoms in
some cases. The method, described by Edmund Jacobson in the 1930s, takes just
around 15 minutes daily.

This straightforward, rather simple practice focuses on clenching, tensing and
loosening a muscle group, one after another. The nature of this exercise is
centred around directing one’s attention in a mindful manner on a specific area
of their body and spreading the profound feeling of relaxation.
Those who report a chronic struggle with sleeplessness often claim that PMR
creates a sense of mental clarity or calmness and serves them as a very efficient
aid to drift off to sleep at night.

Prevention

Lifestyle changes should always accompany the treatment for insomnia.
Inappropriate sleep habits cause most cases of transient and acute insomnia (up
to 3 months). Often, the ability to fall or stay asleep throughout the night is
hindered by various stimuli. Learning to control them can effectively end sleep
deprivation.

Here are some ideas to consider:

  • Wake up and go to sleep regularly around the same time every day.
  • Try your best to avoid taking naps or at least limit their duration to 30 minutes.
  • Be mindful about different sources of light and noise when going to sleep; restrict them as much as possible.
  • Double-check if your bed is comfortable and use it exclusively for sexual activity and sleep, nothing more.
  • Refrain from watching TV, using any screens and eating large portions of food late at night.
  • Give up the evening consumption of coffee, tea, alcohol, cigarettes or any other stimulants.
  • Establish a workout routine – avoid exercising in the evenings since that could prevent you from falling asleep.
  • Unwind in the evening with a relaxing ritual such as guided meditation or bubble bath.

Developing good sleep hygiene is crucial in supporting recovery from insomnia and maintaining a high level of functioning during the daytime. Do not hesitate to take action towards treating insomnia and reach out to a doctor or therapist to get help.

Last updated on: 2022.02.10

Author: Maria Kwiatkowska

Reviewed by: Antigone Lanitis