“Sleep is the best meditation.” (Dalai Lama)
Have you ever had a bad night sleep? I have. And sleep as a subject is very close to my heart.
The importance of sleep to our health and wellbeing is being more recognised and understood.
When you go to bed do you fall asleep easily? How long does it take you to fall asleep? Have you been taking sleeping pills? When you finally fall asleep, do you sleep well or do you keep waking? Do you wake very early and you stay awake or fall asleep again? These are some questions I ask people who are worried about their sleep.
Some additional questions I also ask are the following: Have you been feeling tired all the time for no reason, nervous, anxious or frightened? Do you find difficult to relax? Have you been worrying about little things in your life? Do you worry that something terrible were about to happen? Do you tend to being fearful in special situations, such as: Going out alone, staying at home alone, being in crowds, travelling (especially by public transport)? Does waiting on lights make you nervous, angry, agitated? How has your appetite been? Is it different now from your usual pattern? Have you lost interest in food or you eat more than usual? Have you lost (or increased) your weight since the trouble started? How much? Do you have any aches and pains? Have you had less sexual drive than usual? What would you say the nature of your trouble is? Are there any difference with the patterns during your working days and on weekends? Do you take afternoon naps? If you do, how long?
It is estimated that about 30-35% of population have acute insomnia, and 10-15% have chronic insomnia.
No one can disagree that sleep plays important role in our life, as sleep is vital for all living species, and it comprises approximately one-third of our life. That means, those who live, on average, 75 years, are supposed to spend 25 years sleeping. That by itself shows that sleep is very important for our health. Sleep affects our physical health, our concentration, our activity levels, emotions and relationships. We sleep so that we can stay active, be focused and feel good during the day.
If we do not sleep, we are going to be tired throughout the day. The problem becomes bigger if it becomes chronic. According to some researchers, about one third of the population have or may have some acute problem with sleep. That is usually associated with increased stress in life, and it can keep people worrying and out of sleep for some time. But in such cases, when the problem or stress goes away, sleep problem goes away too.
Some people do not take it seriously and make fun and say funny jokes about sleep. But it still does not diminish our need for sleep. However, the need for sleep varies from person to person. Children and teenagers sleep more, while adult people sleep an average of 7 to 8 hours of shut-eye each night.
Sleep needs to be regular and habitual. A good night sleep is what we need for both our physical and mental health. In recent years, scientists have discovered that people who sleep at least 6 hours have better memory than those who sleep less. Beside problems with memory, those people can have problems with concentration, learning, logical reasoning and/or mathematical calculation.
Probably all of us had a night or two that could not fall asleep, but for some people spending nights without sleep are a way of life. Almost two third of people I see complain that they do not sleep well. Most of them have already been diagnosed with some mental disorders.
The first group of sufferers are those whom take a long time to fall asleep, the second complains of waking up during night and having a problem to get back to sleep. The third group of suffers from early wakeup. And the fourth one has a combination of symptoms already mentioned.
A number of medical conditions can also interfere with sleeping patterns, but it does not mean that we cannot improve our sleep. There is evidence of a connection between sleep problems and mental health difficulties across all ages.
Chronic insomnia – a problem or condition?
Insomnia involves the inability to fall asleep or initiate sleep, the difficulty maintaining sleep (waking up during the night), and waking up too early with difficulty getting back to sleep. You may have insomnia if you need more than 30 minutes to fall asleep or having difficulty maintaining sleep, or waking up too early for more than 30 minutes, and the difficulty occurs despite adequate opportunity for sleep. Insomnia can lead to serious medical problems. Insomnia as a disorder is a 24-hour disorder, not just about the night time.
To be diagnosed with insomnia it should be taken in account what is happening during the day and there should be some day time consequences – at least one of the following: fatigue, daytime sleepiness, attention, concentration, and/or memory impairment, poor social, work, or school performance, lack of energy, irritability and/or mood disturbance, lack of motivation, tension, headaches, feelings of “being run down”, making mistakes and/or accidents at work or while driving vehicles, and having concerns or worries about sleep.
Psychosocial correlations of insomnia are: it affects the quality of daily function, it makes impact on the quality of one’s life, it affects personal safety, it decreases job or school performance, as well as it increases work or school absenteeism.
And not just that, clinical correlations of insomnia is associated with increased medical co-morbidity (increased medical problems). Insomnia is associated with Diabetes, heart disease/condition, cardio-vascular disease, and obesity (weight gain).
In my clinical experience, the majority of clients with depression and anxiety (about 8 out of 10) also experience lack of sleep or some form of insomnia. Some of them increase their sleep, most often as a way of avoiding stressful situations.
Getting 8 hours of sleep is the number 1 bedroom fantasy of many people. Learning to relax is an important life skill and can help improve our sleep. Learning to breathe in a calm way is an easy to learn relaxation strategy that everyone can learn and use it before going to bed, or if wake up during the night and find it difficult to fall asleep again. Resetting your nervous system is crucial to getting a good night sleep.
If working in shift work environment, your amount of sleep can vary, and it can cause poor sleep and insomnia as a consequence. Not sleeping well can cause more stress and mental health problems, resulting with more serious psychological (depression, anxiety, etc) and physical problems.
Insomnia causes slowness and drowsiness over the next day, poor achievement, with becoming prone to physical and mental illness. Some studies also point out that there is a correlation between longevity and good sleep.
Insomnia has a variety of causes, such as stress or anxiety, but also taking too much of caffeine or alcohol can cause sleepless nights.
For insomnia, doctors often (at least during last 10-20 years) prescribe some medication. Sleep specific medications are: Z-drugs, benzodiazepines (temazepam, triazolam), orexin antagonists, but includes the common side effects such as: next day drowsiness, complex sleep behaviours, memory impairment, etc. It is recommended only for a short-term use.
As insomnia is a symptom, not a condition, when medications are discontinued, insomnia symptoms often return again. Dysregulated nervous system makes sleep very difficult, so resetting your nervous system is crucial to getting a good night’s sleep. The stress shaped by insomnia can have effects on people’s emotional lives, making them more labile and with a sense of loss of control of their emotional state.
Studies on sleep deprivation repeatedly show a negative impact on mood, cognitive performance, and motor function due to an increasing sleep tendency and disruption of the wake state.
After a bad night’s sleep, we might feel more stressed, with trouble focusing on work related tasks, be too emotional, and potentially have trouble falling asleep the very next night. Prolonged lack of sleep can make us more vulnerable to experiencing stress and less resilient at managing daily stressors.
Sleep disruptions are often triggered by life stress or change and will resolve on its own with good sleep habits and coping strategies. Chronic insomnia can develop as a result of sleep disruptions.
Cognitive behavioural insomnia interventions are recommended as the first line treatment for chronic insomnia rather than sleep medication due to relative risk profiles and long-term effectiveness. If sleep medications are prescribed, they should be generally only for a limited period of time.
Treatment of insomnia
Ruling out other sleep disorders (disrupted sleep, obstructive sleep apnea, etc.).
Cognitive Behavioural Therapy for Insomnia (CBT-I)
- Keeping a regular wake time.
- Bed is for sleep only.
- Interventions to increase sleepiness at bed time.
- Practicing relaxation strategies.
- Interventions to address beliefs about sleep.
- Developing healthy sleep habits – eg. keep a regular wake up time, avoid substances.
Treating comorbid conditions.
Prescribed short-term medication combined with behavioural interventions.
Barriers to good sleep
There is no guarantee that everyone will sleep well and be without a sleep problem. However, everyone can do something to keep away some products that can make your sleep more difficult.
If you avoid the following substances, you have more chance to sleep well:
Caffeine. It is a strong stimulating substance and should be avoided as much as you can.
Smoking cigarettes/Nicotine. Smokers take more time to fall a sleep than non-smokers. Also, they wake up more frequently.
Alcohol/Alcoholic drinks. Even though alcohol induces sleepiness, and it may look like it helps to sleep, the presence of alcohol in the blood changes the sleep rhythms and causes early waking.
Illegal drugs and prescribed medication. Antidepressants and steroids are known that they produce insomnia.
Heavy meals. While a light meal may induce sleepiness, especially if it contains carbohydrates, such as bread, pasta, and rice, the heavy meals taken close to bed time attracts organic energy to the process of digestion, interrupting sleep and causing gastric discomfort.
Sleep is important for our physical and mental health; sleep is essential for attention, memory, and overall mental function. Sleep is essential for maintaining our health and mood. A good night sleep gives us a great boost to our immune system and help us deal with stress. Setting routine around bedtime can help us feel refreshed the following day. It is important to try to get between 7-9 hours of sleep at night, as well as to avoid using technology at least 1 hour before going to bed.
Long-term result of sleep problems can include getting overweight, but also: obesity, diabetes, heart disease, and high blood pressure. Stress/Stressors also affect our sleep along with physical and social environments. If someone walks around the house, or snores this can also bring discomfort.
Some of good general health principles to be considered:
- Eat fresh, unprocessed, nutritious and toxin-free foods.
- Move your body often, and breathe – especially fresh air.
- Get enough quality and quantity sleep – 7-8 hours for sleep is considered ideal.
- Get daily sun exposure – especially in the morning.
- Be active, challenge you mind and body – but avoid vigorous exercise right before sleep.
- Learn to manage your stress, and keep it under control.
- Get perspective on life – it is the way people see life.
- Have healthy relationships – with honesty, trust, respect and open communication between partners.
- Spend more time in nature.
- Detox your life from toxic people.
- Minimise or no Caffeine intake at all.
- No Tobacco/Nicotine – it makes dreams more vivid and makes harder to fall asleep.
- No Alcohol – alcohol does not help sleep but likely to get disrupted and wake up worse.
Start your day with:
- Wake up around the same time every day – it helps creating routine around sleep.
- Get out of bed immediately when wake up – it also helps creating routine around sleep.
- Catch the morning sun – waking with sunlight will help restart body clock and brain switch on.
- Get out in the fresh air and do some physical exercise – it will help wake up and improve sleep.
- Do not take nap unless you are tired – even that time keep it short – no longer than 30 minutes.
Additional brief help for a good night sleep:
- Ensure your bedroom is not too hot or too cold – create routine to program your body clock.
- No meals (especially heavy) late at night – heavy meals are barriers to quality sleep.
- Have a warm drink – Camomile tea can help you with sleep – use honey as sweetener.
- Do relaxing activity – such as reading or listening to music softly, or take a warm bath / shower.
- Turn off electronic devices – TV, computer, the internet – at least 1 hour before going to sleep.
There is no health without mental health, and there is no mental health without good quality sleep. There is no good quality sleep without good mood and good general health. People who sleep are not lazy. They are smart. Sleep won’t cure the coronavirus, but can help our bodies fight it. Ideally, management of sleep disorders should include a combination of medications and behavioral treatment. If you still struggle with sleep problems, check with your doctor, get referral and see a qualified therapist or sleep specialist.
- Durmer, J.S, Dinges, D.F. Neurocognitive consequences of sleep deprivation. Semin Neurol. 2005:25(1):117-29. http://dx.doi.org/doi:10.1055/s-2005-867080 (Links to an external site.)
- Glovinsky, P. & Spielman, A. (2006) The Insomnia Answer, A Perigee Book.
- Pavlova, M.K. & Latreille, V. (2019) Sleep Disorders, The American Journal of Medicine, https://www.amjmed.com/article/S0002-9343(18)30944-6/fulltext [Accessed: December 4, 2022]
- Orygen Institute, https://www.orygen.org.au [Accessed: December 4, 2022]
Author: Nenad Bakaj, MHumServ (RehabCouns), BSocWk, DipAppSci (Comm&HumServ), AMHSW, MAAC, MAASW, JP (Qld)
Nenad Bakaj is a Brisbane based Clinical Counsellor, Accredited Mental Health Social Worker, Life Coach and Bigger Bite Out Of Life Trainer with a keen interest in positive psychology, mental health and wellbeing, and is continually developing his professional skills and knowledge. Nenad enjoys working with adolescents and young adults, as well as older clients, and feels it is a privilege to be able to support them. In the counselling room, Nenad aims to build rapport with his clients to assist them to reach their health, relationship, personal and life goals, and a happy and fruitful life.
To make an appointment try Online Booking. Alternatively, you can call M1 Psychology Loganholme on (07) 3067 9129 or Vision Psychology Wishart on (07) 3088 5422.