Sleep Issues and Insomnia

Chronic sleep disturbances can cause great distress and impair one’s quality of life. It can also lead to mood, memory, alertness, attention, and fatigue problems. These problems can put jobs and relationships at risk.

Symptoms

People with insomnia have problems falling asleep, waking up in the middle of the night, and/or waking up early in the morning. Almost everyone has insomnia at some time due to stressful life events. However, a person should consider seeking help if problems falling asleep or staying asleep last for more than 1 month. A person using sleeping pills for more than 2 to 4 weeks who cannot get a good night’s sleep without using them should seek help.

Common Causes of Insomnia

Insomnia may be caused by many medical or psychological factors or by a person’s life circumstances. Use of sleeping medications for a long time makes insomnia worse. Sleeping medications can be addictive. People can end up relying on them to sleep. Caffeine and nicotine are both stimulants that lead to uneven and lighter sleep. Although alcohol may help tense people to unwind and fall asleep faster, it leads to fitful and nonrefreshing sleep. Psychological problems, such as severe anxiety and depression, are common causes of insomnia. Chronic sleep disturbances may also lead to depression.

Stressful life events, such as divorce, the death of a significant other, pending surgery in the near future, and job changes, can often lead to sleep problems. Most people resume normal sleep after adjusting to these life events. However, some continue having constant sleep problems over time. Chronic stress on the job or long-term conflicts with family members can maintain sleep problems or make them worse.

Behavioral or learned factors help lead to lasting insomnia. During the early point of their sleep difficulties, people who are prone to insomnia may develop conditioned reactions that cannot exist with sleep. For example, after several poor nights of sleep, a person may relate before bedtime routines and bedtime surroundings with worries and fear of being unable to fall asleep. With repeated occurrences, these negative associations lead to increased muscle tension, worries, and difficulty falling or staying asleep. This conditioning process leads to a cycle of insomnia, fear of sleeplessness, more emotional, cognitive, and biological arousal, and more insomnia.  To cope with insomnia, people may also develop harmful sleep habits, such as uneven sleep/wake schedules, daytime napping, and too much time in bed. 

Treatment

Insomnia has usually been treated with sleeping pills. Unfortunately, many sleeping medications are effective only briefly.  Research has shown that cognitive behavioral therapy is effective for treating chronic insomnia. Its benefits also last longer than medication treatments. 

CBT for Insomnia helps clients focus on the following: set a night and wake time, use bed only for sleep and sex, and no naps during the day. Sleep-Restriction techniques are also used. To get enough sleep, people with insomnia often spend a lot of time in bed. While this sometimes works for a time, it often makes the sleep problem worse. Sleep-restriction techniques limit the time spent in bed to the actual amount of time slept. While the initial cutting of time in bed may lead to daytime sleepiness, this method will improve nighttime sleep.  May people with insomnia have certain beliefs about sleep that may interfere with their improvement.  These beliefs are identified and modified appropriately.  For example, beliefs such as “everyone needs 8 hours of sleep” or “insomnia is bad for physical and mental health” only create more anxiety about sleep.  Sleep education about the effects of diet, exercise, and substance use are also discussed.