Sleep Problems & Insomnia: Key Facts & Helpful Strategies
In this article, I give you the essential facts about insomnia and what you can do about it. We cover the following topics:
What Is Insomnia?
Waking up in the middle of the night. Not a problem if you get back to deep sleep quickly. But nighttime awakenings are a nightmare when staring at the ceiling for hours.
Sleep problems are many and varied. Some issues are diagnosable conditions. Insomnia is perhaps the most well-known difficulty.
Insomnia is defined as a problem where people experience daytime consequences of difficulties getting to sleep, staying asleep, or having satisfying sleep despite sufficient opportunities to get 40 winks (1).
Causes of insomnia
There are many potential causes of insomnia. Increased alertness or ‘arousal’ levels are an important psychological element. High arousal is represented by:
An unhelpful focus on sleep problems
Compensating for poor sleep during the day
Sleep-related anxiety
Trying hard to sleep
There’s nothing wrong with your brain specifically with insomnia. You would be a goner if the bits of your brain responsible for sleep didn’t work!
Other causes of insomnia include:
Stress
Bad sleep habits
A change (or an unhelpful) to your normal sleep/wake routine
Alcohol, drugs, and some medications
Medical conditions
Physical pain
We even write songs about insomnia…
Types of insomnia
Insomnia is divided into two main categories based on how long the problem has existed (2).
Short-term insomnia often comes as the result of a stressful life event (e.g., losing a job, death of a loved one). We typically regard short-term as a period of fewer than three months.
Chronic insomnia is the long-term version of this problem. Stressful life events that trigger insomnia can persist (e.g., medical conditions). Psychological factors maintaining insomnia also tend to become more influential over time, thereby maintaining poor sleep.
Primary insomnia
This form of insomnia is described above. ‘Primary’ means sleep disturbance despite no obvious psychological or medical explanation.
Secondary sleep problems are caused by an identified health issue. Examples include sleep apnea, restless leg syndrome, and long COVID. The ‘secondary’ classification is now outdated in favour of ‘co-ocurring’ problems where we give equal attention to treating sleep problems and the accompanying medical/mental health issue(s).
Insomnia ICD 10
The ICD-10 is a disease classification system created and maintained by the World Health Organisation (WHO). Specific criteria are specified in the ICD-10 in order to maintain diagnostic consistency.
The other main classification system for insomnia is the DSM-5. Originally a classification system for psychiatric disorders, the DSM has grown with each edition to include conditions of potential relevance to mental health issues.
Do I have insomnia?
Seek diagnosis from a qualified health professional, rather than self-diagnosing. Talking to a professional is important because he/she can also explore potential causes and co-occurring problems. Bearing this in mind, insomnia may be present if you:
Have problems getting to sleep
Wake frequently during the night
Can’t get back to sleep once awake
Feel tired after waking
Experience problems such as mood issues and poor concentration
Insomnia test
Insomnia is just one of many sleep problems people encounter.
There’s a diverse range of other sleep-related issues ranging from narcolepsy to night terrors. Steer clear of internet quizzes or tests. Most are not validated scientifically and cannot adequately assess for other forms of sleep, medical and mental health problems.
I’m tired by I can’t sleep
Approximately 10-20% of adults experience persistent sleep disturbance, with 1-2% of people suffering from 'primary insomnia' (1,3). This form of insomnia has no underlying medical or mental health cause (e.g., breathing disorders, depression); conditions that can often disrupt sleep.
Many people I work with experience sleep disturbance. Problems getting to sleep and being awake for long periods in the night (often with a racing mind) are especially aggravating.
A beautiful good night. Is it possible?
Sleep disturbance can be treated. But, this is a vast topic. We can't cover all you need to know in a short article. How to fall asleep is not a simple topic in the presence of insomnia. However, here are a few tips to consider if you are experiencing this problem:
See your GP for a medical check-up to try and rule out any obvious medical explanations for sleep difficulties.
Next, consider an assessment with an appropriately qualified mental health professional if you are experiencing psychological issues in addition to sleep problems. In particular, be on the lookout for low mood and increased anxiety. Again, you want to consider if poor sleep is the consequence of a treatable underlying health condition.
Anxiety and insomnia
Sleep problems are commonplace in many psychological issues. Anxiety is no exception.
It is common to see people wake the middle of the night with various worries. You lie there, 20 minutes turns to an hour with thoughts going around your head in an endless circle. Treating the underlying anxiety often relieves sleep disturbance.
Some other tips
Other strategies for insomnia
If you get the all-clear from a physical and psychological perspective, you could try these tips:
Avoid caffeine, other stimulants and alcohol from early afternoon.
Exercise regularly, but not within a few hours of going to bed.
Don't use your bedroom for anything other than sleep and sex.
Think about your sleep environment and bedroom. Where possible, eliminate the following: excessive noise, extreme temperatures, uncomfortable mattress and pillows, bright lights.
Think about your pre-bed routine: Have a winding-down period that starts at least one hour before bed. Do something relaxing and repeat this routine nightly.
Only go to bed when 'sleepy tired'.
Avoid daytime napping.
Do not try to compensate for a poor night's sleep the following day (e.g., cancelling activities, reducing your workload, etc).
If you have been lying awake in bed for 15 mins, get up, do something relaxing (e.g., try the body scan meditation below), and don't return to bed until you feel sleepy tired. Rinse and repeat if needed.
Why do I wake up at 3am?
Sleep disturbance often occurs as a regular pattern. For instance, people wake at the same time night after night. We do have ways to address these recurring cycles.
The above suggestions are just a tiny sample of how we can address sleep disturbance from a psychological perspective. Thankfully, we do have alternatives to sleeping pills. Some of these strategies come from cognitive behavior therapy (CBT) for insomnia.
One big area not mentioned so far is the role of thinking. This is a key treatment area in CBT for insomnia. People who have insomnia often:
Catastrophise (e.g., 'My day is ruined if I can't sleep')
Start to impose unrealistic expectations (e.g., 'I must sleep 10 hours without waking', ‘light sleep is not allowed’), or
Engage in other unhelpful thinking patterns (e.g., focus on trying hard to sleep).
Have faulty beliefs about sleep (e.g., everyone must get 8 hours sleep every night)
You can effectively tackle these thoughts. For example:
Unrealistic expectations can be evaluated through education about sleep cycles and the circadian rhythm.
You can employ other behavioural tactics (e.g., keeping a sleep diary and adjusting sleep/wake times according to the information collected).
Sleep can improve
Lying awake night after night seriously knocks your quality of life. Thankfully, insomnia can be treated. Reach out to a sleep expert if this issue is affecting you.
Insomnia meme
Hopefully you can make some progress with sleep problems. In the meantime, humour can be a helpful coping mechanism. Here are some insomnia memes for a quick laugh.
Insomnia Quotes
O sleep, O gentle sleep, Nature's soft nurse, how have I frightened thee. That thou no more will weigh my eyelids down, And steep my senses in forgetfulness? William Shakespeare, Henry IV, part 2.
When the world is itself draped in the mantle of night, the mirror of the mind is like the sky in which thoughts twinkle like stars Khushwant Singh
A ruffled mind makes a restless pillow Charlotte Bronte
Nothing cures insomnia like the realization that it’s time to get up Unknown
His insomnia was so bad; he couldn’t sleep during office hours Arthur Baer
We are Coaching & Clinical Psychologists with extensive experience helping people conquer a range of wellbeing and performance issues at home and in the workplace. We can also help with sleep problems. Read more about our work, watch practical skills videos or browse other articles. Get in touch anytime.
References
(1) Edinger et al., (2008). Overcoming insomnia: A cognitive-behavioural therapy approach. Oxford: Oxford University Press.
(2) https://www.sleepfoundation.org/insomnia/types-of-insomnia
(3) Espie, C. (2006). Overcoming insomnia and sleep problems. London: Robinson.
