What is insomnia? We all have trouble sleeping from time to time, but medics classify a true bout of insomnia as regularly having trouble falling asleep, or repeatedly not being able to stay asleep long enough to feel refreshed and recharged come the morning.
Officially, chronic insomnia is defined as difficulty falling asleep, with dropping off taking more than 20 minutes
So you might drop off well enough but find yourself waking several times during the night, or find yourself counting sheep ’til the early hours with no sign of drifting off.
After several weeks of this kind of sleep disruption, it’s likely that you’ll feel tired, irritable and have trouble concentrating or staying focused on a task. Lack of sleep is tough to deal with and the more stressed you become about not being able to sleep, the more it can take hold.
So what can be done? We asked Dr Paul Reading, a consultant neurologist, sleep expert and until very recently, the president of the British Sleep Society, exactly that question.
Here’s what he had to say about the root causes of insomnia and how to tackle them to guarantee some decent shuteye.
What causes insomnia?
Those with severe chronic insomnia most likely have brains that are ‘wired up’ or predisposed to have the problem, which usually lies dormant until there is a trigger, some form of life stress for example, which causes acute insomnia. When the trigger disappears, insomniacs are left with chronic problems of sleep onset and/or maintenance which are often fuelled by bad habits or maladaptive behaviours such as languishing in bed.
How do you define insomnia, as opposed to just occasional trouble sleeping?
Officially, chronic insomnia is defined as difficulty falling asleep, with dropping off taking more than 20 minutes for example, or trouble staying asleep through the night for more than three nights a week, for over three months. There must have been adequate opportunity and desire to sleep (if you’re lacking shuteye simply because of a series of late nights, that’s not insomnia) and the sleep problem must also be having a significant adverse impact on your daily functioning for it to be considered a medical problem. Some chronic sufferers coming to see me at the clinic have often experienced symptoms for decades.
What’s the best way to ‘cure’ insomnia?
For that, there is no easy answer! Once sleep hygiene issues have been addressed, avoiding coffee for example and assessing whether you have a good sleeping environment, the best proven treatment is behavioural, particularly cognitive behaviour therapy designed for insomnia (CBT-I), which is hard to get on the NHS. Short-term courses of hypnotic drugs may help some people, but they are not a useful long-term strategy.
What should you not do when trying to tackle insomnia?
If you have insomnia, the worst thing to do is to actively ‘try to sleep’, as the effort will counteract the natural sleep-onset process. People should be encouraged not to spend hours in bed trying to sleep. It’s also important that people with insomnia are not dismissed, and GP’s are in a difficult position here as they have very little training in sleep and are unlikely to prescribe sleeping tablets for more than a week or two. There is usually no clear referral pathway for chronic insomnia sufferers either. The way forward is education.
Home remedies for insomnia
If you think you might be suffering from insomnia, it’s important to see your GP to discuss your symptoms and treatment options. In the meantime however, the NHS suggests trying these simple changes to your lifestyle and bedtime habits in the hope of helping you get a better night’s sleep.
Avoid caffeine, nicotine and alcohol late at night
It’s a good idea to avoid drinking coffee, strong tea or any other stimulants in the hours leading up to bedtime. Try decaf hot drinks or herbal teas instead.
Only go to bed when you're feeling tired
As Dr Paul Reading says, lying in bed simply willing yourself to sleep won’t help. If necessary, go to bed later than usual if it means you might be able to fall asleep more quickly. If you find yourself lying in bed feeling anxious about not being able to sleep, get up, go to another room for around 20 minutes and do something else, such as reading or listening to soft music, before trying again.
Try to create a relaxing bedtime routine
Taking a warm (but not overly hot) bath, listening to calming music and drinking a warm, milky drink are all activities that may help you ease your body into sleep mode. A little lavender oil on your pillow could also help.
Make sure you have a good sleeping environment
Use thick blinds or curtains or wear an eye mask if the early morning sunlight or bright street lamps affect your sleep, and make sure your bedroom is at a comfortable temperature for sleeping. If noise is a problem try wearing ear plugs, and ensure you have a comfortable mattress, pillow and bedding.
Don't ‘plug in’ to your devices before bed
Try to avoid using back-lit electronic devices such as smartphones, tablets and computers right before going to bed, as it can leave your brain feeling ‘wired up’.
Avoid regularly using over-the-counter sleeping tablets
It’s better to consult your GP to discuss how you can tackle the underlying problems which are causing your sleep problem. It is not clear how effective some sleeping tablets really are, and they may also have potential side effects.
Other tips include:
- Avoid napping during the day
- Try to get at least 30 minutes of exercise per day
- Avoid eating a heavy meal late at night
- Don’t watch the clock while you’re falling asleep
- Try getting up at the same time every day