Insomnia

by University of Cambridge Counselling Service

Sleep is as essential to us as food, air and water. Sometime in your life you may have difficulty sleeping – many people do. Anyone can suffer from insomnia, although sleeping problems are more common among women (especially menopausal), the ill, the elderly, smokers, and alcoholics. Sleep problems are, however, surprisingly common among young people. While it is not an illness and is in no way life-threatening, insomnia can be very distressing, frustrating, exhausting, depressing and at worst it can make you feel like you’re going crazy.

Types of Insomnia

There are two broad categories:

  • Chronic insomnia – lasting for several weeks, months or even years
  • Transient insomnia – lasting for a few nights or weeks only, usually connected to a stressful event e.g. an exam, a bereavement.

Within these broad categories insomnia usually takes one or more of the following forms:

  • Difficulty falling asleep – more common among young people
  • Sleeping lightly and restlessly, waking often, lying awake in the middle of the night – more common in people over 40. In younger people it may be associated with depression.
  • Waking early and being unable to get back to sleep – this is more common in older people and anyone worrying about something in particular.

Common Symptoms

If you …

  • are tired during the day
  • have frequent headaches, are irritable or lack concentration
  • are tired and not refreshed on waking
  • sleep better away from home
  • take longer than 30-40 minutes to fall asleep
  • wake repeatedly during the night
  • wake far too early and are unable to get back to sleep
  • only get to sleep with the aid of sleeping pills or alcohol

… then you are probably suffering from insomnia.

Main Causes

Insomnia is a condition that is caused by something else! Sometimes it won’t be immediately obvious what the causes are in your own case, but the following list might give clues:

  • states of mind – anxiety, depression, worry, anger, grief, anticipating a difficult event
  • change – moving house/city, starting university
  • environment – noise, discomfort, time zone change
  • pain – one of the commonest causes
  • medical conditions – heart, breathing, stomach, digestive, high blood pressure, arthritis, anorexia.
  • recreational drugs – including nicotine, caffeine, heroin, cocaine, amphetamines, LSD, cannabis
  • sleeping pills and tranquillisers – can actually cause sleep disturbance
  • other prescription drugs – including some contraceptives, diuretics, slimming pills, beta-blockers, stimulants.

Some causes of insomnia can’t be easily dealt with but most can.

What can you do about insomnia?

A great deal. The good news about insomnia is that you can cure yourself – in your own way, in your own time and at your own pace. You may wish to enlist the support or help of your doctor, a college nurse or a counsellor, but you won’t necessarily need to. However you must be prepared to make some changes in your lifestyle in order to sleep better.

Things you can do to help yourself

Change Your Environment

You need a comfortable bed and a room that’s quiet, warm and dark enough. Unfortunately this is not always be possible. You might have noisy neighbours, a cold north-facing room, a partner who snores, furniture you have to make do with. But there are some things you can do which will help.

  • Your bed – put a board under the mattress if it sags, or try putting your bed in a different position. Make sure your bedding is clean and that you are warm enough, but not too hot.
  • Light – if light troubles you use thicker curtains or putting a scarf or a sleep mask over your eyes. If you feel more comfortable with a little light, leave the curtains open a little or use a night light.
  • Noise – a common cause of sleeplessness! Use earplugs if it’s noise you can’t do anything about – or change your attitude towards it. People can sleep through high levels of noise – it’s not so much the level of noise but how you feel about it that keeps you awake. Use relaxation exercises to calm yourself and take your mind off it. Take some ‘diplomatic action’ – e.g. talking to noisy neighbours. Keep a radio/tape player by your bed and use it to mask other noise. And if noise from neighbours continues to be a serious problem – speak to college authorities or the local Environmental Health Officer.

Change Your Lifestyle

If you are having difficulty sleeping and are serious about solving the problem you will have to change some aspects of your lifestyle. For a start you will need to cut out or cut down on all stimulants. These include: coffee and tea, alcohol, nicotine, cola drinks, food additives, ‘junk food’, slimming pills or appetite suppressants.

Here are a number of other suggestions

  • exercise regularly
  • stay up until a reasonable bedtime even if you feel sleepy earlier
  • go to bed only when you are feeling really tired and sleepy
  • if you can’t sleep, get up and only go back to bed when you’re really sleepy again
  • establish a routine that gives you 7-8 hours sleep (though individual needs do vary)
  • get up at the same time each day
  • if you’re a late sleeper, force yourself to get up earlier
  • relax mentally and physically for an hour before bedtime
  • have a warm bath, do some yoga or take a light walk before turning in
  • make a list of the things on your mind then forget about them
  • do a security check – but only once!
  • replace negative thoughts with positive ones e.g. “I can sleep/get back to sleep”

Some things to avoid:

  • taking stimulants to keep you awake, or sedatives or alcohol to help you sleep
  • sleeping during the day no matter how tired you are
  • going to bed when you’re stressed, wound up or not ready
  • having arguments at bedtime or in bed
  • using your bed for working, watching TV, eating, telephoning – i.e. waking activities
  • lying in bed awake for more than 30 minutes
  • eating, drinking or smoking when you get up during the night
  • falling asleep in front of the TV
  • drinking too much towards the end of the evening
  • worrying yourself into not sleeping
  • getting angry with yourself or the world if you can’t sleep – it only makes it worse!

You won’t need to do all of these. Decide which would be most helpful and start with those. If that doesn’t help, try others until you are sleeping better. Your aim is to break the cycle of insomnia. You achieve this by establishing a good bedtime/sleep routine and by reinforcing the connection between bed and sleep.

Relaxation

Research suggests that people with sleeping difficulties tend to be more worried, depressed, unhappy and anxious than others, although apparently cheerful, calm and confident people can also suffer from insomnia. If you are stressed or anxious here are a few suggestions:

  • change or resolve the things causing you stress when possible
  • accept situations you can’t change
  • keep your mind and body as relaxed as much as possible throughout the day
  • give yourself enough time to do the things you need to do -including eating
  • don’t take on too much and avoid unrealistic demands
  • live in the present, rather than worrying about the past or fearing the future
  • talk to your partner if there are problems in your relationship
  • have some relaxing, non-competitive activities – something you do just for pleasure, for fun
  • give yourself some ‘quiet time’ each day
  • practise a relaxation technique or breathing exercises regularly

There is a lot of help available. There are numerous books on relaxation. You may find that your college runs a relaxation group. At the University Counselling Service we regularly run anxiety management groups for students. In addition see the UCS leaflets on Simple Relaxation and Anxiety.

Self Confidence

Research also suggests that people who suffer from insomnia tend to be less confident and have lower self esteem than others. Therefore anything that you can do to increase your confidence or improve your self esteem is likely to help you sleep better. Once again there are very many self-help books available, or you may prefer to consult a counsellor.

Depression

If you have been suffering from insomnia for some time you may be depressed. Signs to look out for are:

  • waking in the middle of the night or early morning and unable to get back to sleep
  • loss of interest, energy and appetite
  • aggression and anti-social behaviour
  • aches and pains that have no physical explanation

If you are depressed it makes sense to seek some help. Speak to a college nurse, see your doctor or make an appointment to see a counsellor. Refer to the UCS leaflet on Depression.

Food and drink

There are some foods and drink which interfere with sleep, particularly if taken just before bed e.g. very rich foods and alcohol. It’s therefore wise to avoid or cut down on these before sleeping. On the other hand, there are some foods that are thought to aid sleep. Here are some suggestions:

  • if getting to sleep is the problem, eat a carbohydrate-high meal 2 hours before bed
  • if staying asleep is the problem, have some bread and honey or a bowl of cereal at bedtime
  • have a warm milky drink at bedtime
  • some people find herbal teas soothing and helpful, especially camomile
  • hot water, lemon and honey or hot red grape juice are good alternative hot drinks

Sleeping Pills

If you are wondering about taking medication to help you sleep, speak to your doctor. It is also advisable to consult your doctor if you are already taking medication and are concerned about the side-effects or are thinking of stopping.

Alcohol and sleep

Alcohol is more disruptive to sleep than caffeine! Your body will produce adrenaline to compensate for the alcohol in your system. Alcohol also makes you thirsty. Both cause you to sleep fitfully or to wake. You don’t have to give up alcohol altogether but in the interests of solving the problem of sleeplessness and establishing a healthy sleeping pattern, why not think about cutting down – perhaps by not drinking late at night or by deciding to have a number of alcohol-free days a week.

If you are concerned about the amount you are drinking or think you might have an alcohol problem, speak to your doctor, a college nurse or a counsellor.

Anger and Sleep

‘Bottled up’ anger could be the underlying cause of your sleeplessness. If this is true for you:

  • figure out why you feel quite so angry
  • address or remove the cause of your anger
  • where there is nothing you can do about it, accept and understand your feelings
  • do some physical exercise; this might help you get pent-up anger and frustration out of your system
  • if you are depressed or grieving (anger can be a feature of both) make sure you get the support that will enable you to deal with your feelings.

Much of the above applies to other feelings, although anger can be particularly troublesome.

Mental games to help you sleep

There seem to be two schools of thought on this subject – those who believe that mental games can send you to sleep and those who believe that they stimulate your mind and keep you awake!

If you think they might help you, here are a few examples:

Word games

  • spell long words and sentences backwards
  • think of a poem or song then count how many a’s or b’s there are in it
  • work your way through the alphabet thinking of a four-letter word beginning with each letter
  • repeat long pieces of poetry or prose

Imagination games

  • recall in great detail a favourite painting, piece of music, or place
  • imagine a storm raging outside while you are safe and warm in bed
  • visualise yourself sinking into your bed until you can’t tell where your body ends and the bed begins
  • make your mind a complete blank then imagine a pleasant colour and prevent it from taking any form.

And yes, if all else fails, you can always count sheep!

http://www.counselling.cam.ac.uk/selfhelp/leaflets/insomnia
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