Introduction

The term insomnia refers to a number of sleep complaints including inadequate duration and quality of sleep. These sleep problems may involve difficulties falling asleep, difficulties staying asleep, poor sleep quality, and daytime tiredness. Poor sleep and sleep problems are extremely common. It is estimated that approximately 35% of the population suffers from insomnia during the course of a year. The proportion of people who simply do not get enough sleep on a regular basis is much higher.

Sleep problems have important consequences. Falling asleep while driving is a major cause of serious motor vehicle accidents. Poor sleep the night before has been linked to impaired cognitive performance the following day. Having inadequate sleep (4 hours or less) is associated with a mortality risk 1.5 to 2 times higher than those who sleep 7-8 hours a night. Sleep problems are also associated with emotional disturbances. Finally, adequate, restorative, sleep is an important determinant of quality of life.

Overcoming Sleep Problems

How can sleep problems be overcome? Many sleep problems respond well to simple behavioral interventions. In cases of common daytime tiredness resulting from inadequate sleep, ensuring a reasonable amount of time for sleep (e.g., retiring by 11pm if one must rise by 6 or 7am) is a logical first step. "Sleep hygiene" is also important. The sleeping environment should be comfortable (good mattress, temperature, noise level) and should not be used for activities such as work, study or eating. Work, TV watching or internet surfing, highly stimulating activities, should be avoided before bedtime. Remember, taking the time for adequate sleep may improve your performance the following day. Activities such as quiet leisure reading, a hot bath, massage or sex may promote sleepiness.

Triggers

Acute or chronic stress and anxiety can trigger acute or chronic insomnia. Practicing relaxation techniques, such as paced diaphragmatic breathing or progressive muscle relaxation can help reduce tension and improve sleep quality. Regular aerobic exercise is also a good way to reduce anxiety and improve sleep quality. However, vigorous exercise right before bed should be avoided as it promotes wakefulness.

What you eat and drink can also have a big impact on your sleep. Many sleep- deprived people are heavy consumers of caffeine rich beverages such as coffee, tea and colas. Caffeine is a powerful stimulant. To improve sleep, you may want to try eliminating or cutting back on your caffeine intake. If that is not possible, try to at least avoid consuming any caffeine in the evening. In addition, eating heavy meals right before bed should be avoided, especially if gastric reflux is a problem. Drinking a little warm milk helps some people fall asleep. Alcohol may improve sleep onset latency but can disrupt sleep. To improve sleep quality, try and keep alcohol intake moderate.

Many medications are used to treat insomnia. A number are associated with serious side effects and risks (especially if combined with alcohol) and can be habit forming. Insomnia medications should be discussed carefully with your physician and you should have a clear understanding of how to use any prescribed medication appropriately. Those with medical problems, especially those experiencing chronic pain, may have insomnia secondary to their medical condition and should discuss their condition and any sleep problems with your physician. Whether or not medication is taken, the sleep tips presented here are still quite relevant.

Improving Sleep Habits

Once sleep problems have started, they may be maintained by anxiety associated with trying to fall asleep or clockwatching. For people dealing with occasional insomnia, bedtime may become somewhat anxiety provoking, as they start to worry about not being able to fall asleep. This type of anxiety promotes wakefulness, as the more they "try" to fall asleep, the more restless they become. If you are not able to fall asleep within 30 minutes, you should get up out of bed and do something (such as quiet reading) until you feel sleepy again. Staying in bed any longer, tossing and turning, associates the sleeping environment with wakefulness and anxiety. Realizing that you will eventually feel sleepy, not getting too worried by it, and doing something else allows sleepiness to return. If it helps, think of sleepiness as cyclical. If you miss it once, be assured that it will return again and enjoy the extra time you have for yourself to do something else.

In some cases, simply not trying to fall asleep or paradoxical intention can also help reduce insomnia. Since the more you try to force yourself to sleep, the more difficult falling asleep becomes, not trying, or doing the opposite - trying to stay awake - may remove the anxiety and promote sleep in some cases. Taking the focus off trying to sleep by engaging in an activity like leisure reading or a relaxation exercise can also be helpful.

To summarize, sleep problems and sleep deprivation are very common and can have serious consequences. Good sleep hygiene and behavioral treatments can often significantly improve the quality of sleep.

Dr. David Aboussafy, Ph.D.
UCounsel Corporation
Vancouver Hospital and Health Sciences Center
University of British Columbia

Further Information and Support
For more information, contact David Aboussafy, Ph.D. at [email protected] or [email protected] or see the Insomnia Course at UCounsel.com

References
Bootzin, R.R. (1985). Insomnia. In M. Hersen & C. Last (Eds.). Behavior Therapy Casebook. (pp. 132-145). New York: Springer.