Insomnia is difficulty getting to sleep or staying asleep for long enough to feel refreshed the next morning. In the vicious circle of insomnia, arousal is often the starting point of a poor night’s sleep. Arousal means we are ‘wide-awake’. Many things can create a state of arousal at bedtime, but the main sources are our feelings (like feeling sad, unhappy or anxious), our thoughts (for example, repetitive thoughts and concerns going round and round in your mind), and our health (particularly conditions which cause pain, discomfort, muscular tensions, digestive problems, etc).
All of these factors can cause arousal, which prevent you from falling asleep. People who experience sleep problems can also become anxious about the consequences of not sleeping (for example, being concerned about feeling sleepy, or irritable, or ‘below par’ the next day). All of this encourages the person with insomnia to try harder to fall asleep. This is the point where, for many people, insomnia becomes chronic, because trying to fall asleep helps to keep you awake. That’s because trying to fall asleep creates a special type of arousal that occurs only when we attempt to control something that should be automatic.
- Find it difficult to fall asleep
- Lie awake for long periods at night
- Wake up several times during the night
- Wake up early in the morning and not be able to get back to sleep
- Not feel refreshed when you get up
- Find it hard to nap during the day, despite feeling tired
- Feel tired and irritable during the day and have difficulty concentrating
It’s not always clear what triggers insomnia, but it’s often associated with:
- Stress and anxiety
- A poor sleeping environment – such as an uncomfortable bed, or a bedroom that’s too light, noisy, hot or cold
- Lifestyle factors – such as jet lag, shift work, or drinking alcohol or caffeine before going to bed
- Mental health conditions – such as depression and schizophrenia
- Physical health conditions – such as heart problems, other sleep disorders and long-term pain
- Certain medicines – such as some antidepressants, epilepsy medicines and steroid medication
The self-management approach: take control of your sleep
People who develop sleep problems often say things like “There is nothing that can be done for my sleep problems” or “I have tried everything and nothing has helped”. This self management program will help you to break the vicious circle by teaching you skills and methods which control insomnia. The emphasis of the approach is not on ‘curing’ insomnia. Rather, the self-management approach will help you to decrease your sleep problems, increasing your satisfaction with sleep, and deal effectively with sleep difficulties when they occur.
The key principles of the self-management approach to insomnia
Motivation and effort
Even if the procedures seem simple, following all the advice is the key to success. Completing the program will take approximately 6 weeks, depending on the severity of your sleep problem, your health, and your level of motivation. Do not expect improvements in the first few weeks. Your sleep difficulties have probably been present for some time, so it’s well worth the effort and patience to follow the advice offered and wait for change to happen gradually.
The changes in lifestyle and sleep habits suggested in this self-management program will not only affect you, but may also affect other members of your family. It is important, therefore, to let them know what you plan to do, and to encourage them to support you. If you share your house or your bedroom with another person, your sleep problem can become their sleep problem, so getting their support to improve your sleep makes good sense.
We have already emphasized that the aim of this self-management program is to improve the quality of your sleep by reducing the frequency and severity of your sleep difficulties. Change will happen gradually, but it is important that you notice these changes as they happen. Over the course of this self-management program you should find that your sleep efficiency improves.
If you have insomnia, speak to your doctor. If warranted, he or she can refer you to a specialist sleep doctor or psychologist. They can assess how your insomnia and any associated mental health difficulties interact and tailor your treatment accordingly.