Sleep Problems? Learn To Manage Insomnia With Psychological Therapy

Sleep is an important part of daily life. We spend about one-third of our time in sleep. To put into perspective, a 60-year-old individual will have spent 20 years in sleep.

Quality sleep is very important as one gets to rest and restore the body’s energy levels. But at any stage in life, one can experience sleep difficulties due to several reasons. Prolonged sleep difficulties can develop insomnia symptoms. The prevalence of insomnia is 30-40% among the adult general population.

Insomnia refers to an individual’s inability to fall or stay asleep at night. This sleep disorder can be categorised into chronic insomnia and transient insomnia. Transient insomnia is short-term and can be due to shift work or stressful life events, for example, the loss of a family member.

On the other hand, individuals with chronic insomnia find it difficult to fall and stay asleep for a minimum of 3 nights a week for at least 3 months. They don’t get the much-needed restorative sleep and thus, feel exhausted during the day. People with chronic intermittent insomnia experience a few nights of good restful sleep followed by numerous sleepless nights.

Insomnia symptoms (Diagnostic Statistical Manual of Mental Disorder V)

According to the DSM-V, people who have insomnia present with the following symptoms:

• Problems falling asleep
• Staying asleep, and/or
• Early morning awakenings
• Impairment in daytime functioning

As such, you may have insomnia if:

• You find it very hard to fall asleep
• You lie awake for long periods of time even after bedtime
• You keep waking up at night
• You wake up early mornings and can’t go back to sleep
• You do not feel at all rested when you wake up
• You are unable to nap in the daytime even though you’re tired
• You feel tired, irritable and have problems concentrating during the day.

The sleep problems may cause distress and/or some problems at work, at home, or with others. Also, the sleep problems occur at least 3 nights per week and has been going on for at least 3 months

Causes of insomnia

It’s not always clear what causes insomnia, but this sleep disorder is often associated with the following risk factors:

• Gender - more women experience sleep problems compared to men
• Age factor - older aged individuals may experience fragmented sleep, and lack deep sleep
• Physiological factors - long term pain, heart conditions, other sleep disorders
• Psychological factors - depression, anxiety, stress, worry, schizophrenia
• Stressful life events
• Unhealthy lifestyle
• Poor sleep environment - noisy bedroom, too hot/too cold, uncomfortable bed
• Certain medication - antidepressants, steroid medication, epilepsy medication

Psychological therapy for insomnia

Insomnia is under-reported, under-diagnosed and under-treated, as most individuals may either never discuss sleep problems with their physician, or think that there is no treatment available, or may be sceptical about treatments for insomnia.

Sleep problems can be managed with psychological therapy, depending on the severity. For those who experience clinically severe insomnia, they may need to seek medical treatment, which can be combined with therapy. Studies reported that medical treatment combined with therapy can be effective for the long term. Mild to moderate Insomnia can be managed with psychological therapy. The particular therapy that is available is Cognitive Behaviour Therapy for Insomnia (CBT-I). CBT-I is scientifically and empirically proven to be effective. However, in general, many are not aware of this therapy.

Dr. Yasmin is a psychotherapist who is equipped in helping individuals to manage sleep problems through CBT-I therapy. Dr. Yasmin is a Lecturer and a Psychotherapist who is a Certified Cognitive Behaviour Therapist and has done vast research on insomnia and psychological intervention to treat Insomnia and has conducted numerous workshops on managing Insomnia.

Cognitive Behaviour Therapy For Insomnia (CBT-I)

A complete therapeutic intervention will be provided by a therapist.

In brief, the therapy includes:

1. Behaviour Component
Once you learn the behavioural therapy, you will get a clearer idea on how to practice healthy sleep patterns.
Behavioural Therapy
Sleep Hygiene – The Do’s and Don’ts for Proper Sleep. Sleep Hygiene is about healthy sleep practices such as healthy lifestyles, healthy sleep environments, proper sleep habits - such as proper time to go to bed and to wake up.
Stimulus Control Therapy
Learn to associate bed with sleep rather than sleeplessness. Not to spend too long being sleepless on bed. The bed must not be associated with wakeful activities such as work, study, and others. .
Sleep Restriction Therapy
To establish regular sleep patterns, practice proper time to go to bed and wake up. .
Relaxation Breathing Technique
You will learn how to gain relaxation through breathing exercise. This breathing exercise helps one to feel relaxed and calm and be able to fall asleep easier.

2. Cognitive Component
Once you learn cognitive technique, you will have a clearer mind and increased confidence to sleep better.
Cognitive Technique
This technique is for patients who have developed negative thoughts about being unable to sleep. Negative thoughts about sleep will only worsen the sleep problems by triggering worry or anxiety.

Patients will be guided on how to change the negative thoughts to positive thoughts of sleep.

Why is sleep important?

Many people do not realise that the lack of sleep can bring numerous long-term health consequences, including heart disease and high blood pressure. Here are some reasons why you should take the necessary steps to protect your sleep quality:

• Sleep boosts learning and memory consolidation
• Sleep is needed for growth and cell regeneration
• Researchers at the Warwick Medical School found that prolonged sleep deprivation resulted in an increased risk of dying from conditions such as stroke, heart attacks and cardiovascular diseases
• A European study discovered that individuals who had three insomnia symptoms were three times more likely to develop heart failure Insomnia and lack of sleep are linked to hypertension
• Insufficient sleep that causes sleep debt can harm endocrine function and carbohydrate metabolism
• Sleep and our circadian rhythm are needed to help regulate immune functions, and thus, help keep our bodies healthy
• Insomnia is an associated risk factor for anxiety disorders

How much sleep do you need?

Adults should get seven to nine hours of sleep each night. From this period, 20 to 25% is typically REM sleep while 10 to 25% is deep, restorative sleep. As such, you should aim to get at least 1 to 2 hours of deep sleep if you average 8 hours of sleep a night.

References

Besedovsky, L., Lange, T., Born, J., (10 Nov 2011) Sleep and Immune Function, Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3256323/ [Accessed 5 April 2022]

Breslau, N., Roth, T., Rosenthal, L., Andreski, P., (15 March 1996) Sleep disturbance and psychiatric disorders: A longitudinal epidemiological study of young adults, Available at https://www.sciencedirect.com/science/article/abs/pii/0006322395001883 [Accessed 5 April 2022]

Calhoun, D.A., Harding, S.M., (August 2010) Sleep and Hypertension, Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2913764/ [Accessed 5 April 2022]

Laugsand L.E., Strand L.B., Platou C., Vatten L.J., Jansky I. (5 March 2013) Insomnia and the risk of incident heart failure: A population study, Available at https://academic.oup.com/eurheartj/article/35/21/1382/582739 [Accessed 5 April 2022]

Spiegel, K., Leproult, R., Van Cauter, E. (23 Oct 1999) Impact of sleep debt on metabolic and endocrine function, Available at https://pubmed.ncbi.nlm.nih.gov/10543671/ [Accessed 5 April 2022]