Insomnia

Insomnia is a very common sleep disorder that can be quite distressing for sufferers when it is chronic and untreated. Insomnia is a sleep disorder associated with difficulty falling asleep at the start of the night; waking up frequently overnight; waking up overnight and being unable to fall asleep again; or early morning awakening. It is usually associated with daytime tiredness and distress. Chronic insomnia occurs when the symptoms are present for more than 1 month for at least 3 nights per week (DSM V).

There are many possible causes or contributors to insomnia, including medications, sleep rhythm disturbances, breathing disturbances overnight, restless legs symptoms, mental health conditions (such as anxiety and depression), and “habitual alertness” in bed.

The first step in managing your insomnia is to have a thorough sleep assessment by a Sleep Physician. This will include a detailed history of your condition to determine the nature of your insomnia (e.g. sleep initiation versus sleep maintenance insomnia) and possible causes. At times a sleep diary or a sleep study may be required for further assessment.

Treatment of chronic insomnia is directed at the underlying contributors, and this may include:

• medication changes
• treatment of physical sleep disturbances, such as sleep apnoea or restless legs symptoms
• additional management of mental health or pain conditions
• simple changes to your evening and bedtime habits
• more involved day to day sleep scheduling and behavioural changes
• focused relaxation and cognitive techniques for more chronic and severe cases.

The later treatments are often provided by sleep psychologists and are the core of “cognitive behavioural therapy”, which has been shown conclusively in studies to provide good short and long term improvements in insomnia.

Medications can also be prescribed to treat insomnia but generally these should only be used in the short term and do not address the underlying causes. The better and longer term approach is to use the non-medication approaches.