Anxiety in Adults

Insomnia

What is Insomnia?

Insomnia is just one of many diagnoseable sleep disorders. Insomnia is characterized by difficulties falling asleep, difficulties staying asleep (waking often) or early morning wakening. Insomnia is associated with a number of other symptoms such as low energy, fatigue, difficulty concentrating, mood difficulties and difficulties with productivity such as at work or school.

We can differentiate insomnia into two categories, based on how long it has been an issue:

  • Acute insomnia – can last anywhere from a few days up to three months. Acute insomnia is brief and is often associated with life circumstances such as relationship, family or work stressors, anxiety, physical illness, pain, grief or travelling. Acute insomnia is experienced by many people and tends to resolve without treatment.
  • Chronic insomnia – sleep disturbances for at least three nights per week for more than three months. There are several different causes for chronic insomnia, though the initial cause of the insomnia is often different to the factors which maintain insomnia. Common causes of chronic insomnia include environmental changes, unhealthy sleep habits, shift work, particular medications or other mental health difficulties.

There are various psychological factors which turn acute insomnia into chronic insomnia. These factors include anxiety about lack of sleep, adjusted evening or daily routines based on amount of sleep, excessive focus on sleep, increased stress or worry and ruminative thinking patterns about sleep. Individuals often develop negative thought patterns about sleep, their ability to sleep or the impact of their sleep difficulties. These thought patterns, in combination with negative sleep associations develop into a cycle of insomnia.

Symptom Checklist

  • Do you have difficulty falling asleep or staying asleep?
  • Does your reduced sleep have a negative impact on your relationships, work or school performance?
  • Do you feel anxious about sleep, or your lack of sleep?
  • Do you spend an excessive amount of time thinking about sleep?

How Common is Insomnia

Acute insomnia is very common, though research also indicates that chronic insomnia occurs in around half of adults at some stage of their life. Chronic insomnia often occurs alongside other mental or physical health conditions. In some instances, insomnia is a consequence of an untreated underlying anxiety disorder (see Generalized Anxiety Disorder section) or mood disorder such as depression or bipolar. In addition, if chronic insomnia is left untreated it is not uncommon for individuals to develop other difficulties as a result, particularly alcohol or substance (drug) related difficulties.

What Treatments are Recommended for Insomnia?

Treatments recommended for insomnia include both medications and psychological treatments. Common medication options include melatonin and also benzodiazepines. Medication options are best discussed with your General Practitioner or Psychiatrist, and typically provide short term relief. Cognitive Behavioural Therapy (CBT) has a growing research basis and has been shown to provide better long-term results than medication alone. CBT for insomnia (CBT-I) and (please delete this and)typically consists of around five-six appointments. As with all mental health difficulties, the exact number of appointments required will depend on a number of factors including the severity and chronicity of insomnia and whether there are other mental health difficulties co-occurring.

CBT-I involves developing an individualized formulation of the various factors maintaining the insomnia cycle and reducing/eliminating these factors. The components of CBT-I involve developing healthy sleep hygiene, identifying and reframing unhelpful sleep related thoughts, relaxation strategies, eliminating negative sleep associations through stimulus control, and relapse prevention.

Sources & Useful Links

https://sleepfoundation.org/insomnia/home

http://www.cci.health.wa.gov.au/resources/infopax_doc.cfm?Mini_ID=50