person in bed awake

What is insomnia?

Insomnia is as condition described by many as stressful, anxiety provoking, and debilitating.  Insomnia is defined as the difficulty falling asleep and/or staying asleep.  Insomnia impacts an individual by impairing their ability to function during the day and is often associated with daytime fatigue.  Insomnia is categorized as either a chronic or a short-term disorder.  If insomnia lasts a minimum of three nights per week over a three-month period, it is considered a chronic condition. 

There are 68 sleep disorders that have been identified; chronic insomnia is the most common of them all.  Did you know that 10-15% of the population experience chronic insomnia?  It is highly prevalent and very challenging for people to deal with.  This disorder is far more common than other disorders such as sleep apnea (5% of the population) or restless leg syndrome (5-10%).

People with chronic insomnia often complain about how hard it is to work, study or engage in activities of daily living.  They often report feelings of dysphoria: a profound state of unease or dissatisfaction.  They also say they tend to feel unhappy, have low energy, withdraw socially, have less interest in their normal activities, experience inattentiveness or difficulty focusing, feel lethargic and slowed down.  People with chronic term insomnia can also experience motor impairment and be prone to accidents or be labeled as clumsy.  Being in social situations can lead to feeling intimidating, especially if feeling incapable of finding the energy required of them to engage socially.  People with this sleep disorder tend to have more visits to their doctor, have more lab tests done, take more sick days from work, experience a lower productivity at work or more work accidents, and have an increased risk of developing Type Two Diabetes and Cardiovascular Disease.

Many people believe that insomnia is a symptom of mental illness, but often the insomnia comes first!  Chronic insomnia is associated with an increased risk of developing depression, anxiety, and substance use disorders.  Even more reason to find help and treat the insomnia separately from any other mental illness. 

We should not delay providing people with Insomnia a treatment to support them in reducing their symptoms.  Cognitive Behaviour Therapy for Insomnia is the gold standard treatment that has been shown to make significant differences in the sleep of individuals with Chronic Insomnia.

What Can I do? Healthy Sleep Habits

  • Avoid caffeine in the afternoon
  • Reduce evening alcohol use
  • Avoid eating a big meal before bed
  • Avoid all screens one hour before sleep
  • Do not use the bed for anything other than sleep

It can be frustrating for someone with Chronic Insomnia to be told this information.  Most of the time, they have already been trying this and it is not working.  CBT-I has been demonstrated to work with different age groups and it is the first line of treatment for adults of any age.  If CBT-I is not enough, doctors recommend pharmaceutical options.

Treatments Available: What is CBT-I?

The goal of CBT-I is to use cognitive and behavioural changes to help natural sleep processes work at their best capacity.  Often there are interferences with our natural homeostatic and circadian sleep processes.  Behaviour patterns, stress, anxiety, and environmental concerns (think about pets, or loud environments) can impact the quality of our sleep.  CBT-I uses strategies to reduce these interferences so that our body’s natural ability to sleep can return to normal.

4 Components of CBT-I

Sleep restriction therapy:  Therapists create a plan that allows the client to restrict time in bed in order to build up the sleep drive.  This helps to stabilize the circadian sleep wake rhythm.

Stimulus control therapy: By using cognitive strategies, therapists help clients make a strong association between the bed and good sleep.

Cognitive restructuring: “I need a solid 8 hours of sleep, or I will be a mess tomorrow!”  These types of thoughts can be detrimental to good sleep.  Cognitive Restructuring helps a client’s mind enter a state that is more conducive to allow sleep to arrive.  We focus on examining and changing dysfunctional beliefs about sleep.

Relaxation training:  Therapists use this to focus on de-arousal: calm a racing mind and reduce tension in the body to improve chances of a solid sleep.

If you are interested in learning more, book with a CBT-I counsellor at Island Clinical Counselling. 

Written by Kathryn Atkinson