What ‘a good night’s sleep’ means for one person might be different for another.
Some people might need more than 8 hours of sleep to feel rested while other people might need less.
It is also normal to experience some variation in sleep from night to night and for your sleep patterns to change as you age. However, ongoing sleep difficulties, which leave you feeling constantly tired, can signal a more serious problem – insomnia.
Ongoing sleep problems can affect physical health, mental health, and quality of life, so addressing problems with sleep is essential for wellbeing.1-7
The key symptom of insomnia is difficulty falling asleep, staying asleep, or waking too early, despite having the opportunity to sleep well. 8-10 For insomnia to be diagnosed, sleep difficulties must have been present for more than one month.
Other common symptoms of insomnia include:8-10
- fatigue, tiredness, or lack of energy
- problems with attention, concentration or memory
- difficulties performing social, work, or caregiving responsibilities
- making avoidable errors or having accidents at work or while driving
- low mood or feeling irritable
- tension headaches or digestive problems
- daytime sleepiness, or feeling ‘tired and wired’ during the day but not necessarily sleepy
- worrying about sleep, or about functioning the next day.
Many things can cause insomnia. Insomnia can be triggered by:9,11
- stress and worry
- significant life events
- changes to shift work or to your routine
- changes in home life.
For most people, once a period of stress or change has passed and life has settled down, sleep returns to normal; for others, however, sleep problems can continue.
We know that several health and lifestyle factors can also affect sleep, including:11,12
- caffeine, cigarette smoking, alcohol use, some medications, and some drugs
- environmental factors like noise, light, and a too warm or too cold bedroom
- other health concerns, such as asthma, bronchitis, and chronic pain
- other sleep-related disorders, that might cause the person to feel restless (such as restless leg syndrome) or which might affect the person’s breathing whilst they are asleep (such as sleep apnoea)
- mental health issues, particularly anxiety and depression.
Insomnia often leaves the person feeling frustrated, stressed, and worried about their sleep problems, which can make it even harder for them to sleep, and a sleep-worry cycle may then start.
- Use your bed only for sleep (and sex), and not for other activities such as reading.17
- Make sure your bedroom is quiet and dark during your sleeping hours.18, 19
- Make sure your bedroom is a comfortable temperature – not too cold or too warm.20
- Avoid using electronic media such as the computer, television, smartphone, e-reader or tablet at least one to two hours before going to bed.21
- Avoid coffee, tea and other caffeinated drinks during the afternoon and evening.22,23
- Avoid alcohol.24
- Cut down or stop smoking with help from a medical practitioner. Sudden attempts to stop smoking and nicotine replacement patches can affect sleep.25
- Exercise regularly26, but avoid exercising immediately before bed.27
- Get up at the same time, even if you had trouble sleeping the night before.
- Try not to worry about whether you are going to sleep well, or what will happen if you don’t.28
- Perform important tasks that require you to focus and concentrate during the day rather than in the evening.29
- Practice relaxation or mindfulness techniques when going to bed to help calm the mind and body, and promote rest even when you are not sleeping. Gently focusing on your breath as you breathe in and out can be a simple, helpful technique.30
Cognitive behaviour therapy for insomnia (CBT-I) is the most widely used and effective psychological treatment for insomnia.7,13-16 CBT-I is made up of a number of different techniques, which are described below.
Learning that your bed is for sleep
People with sleep difficulties sometimes use their time awake in bed for activities other than sleep, such as reading, watching TV, and using electronic media (e.g. e-readers and smartphones), which can stimulate the brain and make it harder to fall asleep. Using bedtime for these other activities can also reduce the connection the brain makes between bed and sleep.
In ‘stimulus control therapy’ therefore, clients are encouraged to use their bed for sleep only (sex being the exception), rather than for other activities that stimulate the brain and interfere with sleep.
People with sleep difficulties also often lie awake in bed and then sleep in, preventing them from developing a good sleep routine.
In ‘sleep restriction therapy’, a strict bedtime and wake-time routine is set up to minimise the amount of time spent in bed awake. For example, if a person usually spends 8 hours in bed but only sleeps for six of those hours, they would be set a schedule of going to bed for 6 hours only and waking at a set time, even if they wanted to sleep in. Gradually, as sleep improves, the time spent in bed is also increased.
Practicing helpful ways of thinking
Worrying about sleep and fretting about not sleeping, can make getting to sleep even harder. Cognitive therapy helps the person identify these unhelpful thoughts, and to find more helpful ways of understanding sleep and cope with sleep-related stress.21
Learning relaxation skills
Relaxation skills training involves teaching the person a variety of techniques that help calm the mind and body. Techniques such as progressive muscle relaxation, breathing exercises, and guided imagery (focusing the mind on positive, soothing images), are used to reduce mental activity such as worry that interferes with sleep.22
Practicing sleep hygiene
Sleep hygiene refers to a set of behaviours or habits that can increase the length and quality of sleep.23
Good sleep hygiene practices include making changes to your bedroom to make it a more comfortable space to sleep in, decreasing activities before bedtime that can interfere with sleep (such as using electronic devices), and improving a range of lifestyle factors that support sleep (such as making changes to diet and exercise). Details of good sleep hygiene practices are included in the tips below.
- Daley, M., Morin, C. M., LeBlanc, M., Grégoire, J. P., Savard, J., & Baillargeon, L. (2009). Insomnia and its relationship to health-care utilization, work absenteeism, productivity and accidents. Sleep Medicine, 10(4), 427-438. doi: http://dx.doi.org/10.1016/j.sleep.2008.04.005
- Kucharczyk, E. R., Morgan, K., & Hall, A. P. (2012). The occupational impact of sleep quality and insomnia symptoms. Sleep Medicine Reviews, 16(6), 547-559. doi: http://dx.doi.org/http://dx.doi.org/10.1016/j.smrv.2012.01.005
- Léger, D., Massuel, M.-A., & Metlaine, A. (2006). Professional correlates of insomnia. Sleep: Journal of Sleep and Sleep Disorders Research, 29(2), 171-178.
- Kaufmann, C. N., Canham, S. L., Mojtabai, R., Gum, A. M., Dautovich, N. D., Kohn, R., & Spira, A. P. (2013). Insomnia and health services utilization in middle-aged and older adults: Results from the Health and Retirement Study. The Journals Of Gerontology. Series A, Biological Sciences And Medical Sciences.
- Ishak, W. W., Bagot, K., Thomas, S., Magakian, N., Bedwani, D., Larson, D., . . . Zaky, C. (2012). Quality of life in patients suffering from insomnia. Innovations in Clinical Neuroscience, 9(10), 13-26.
- Johnson, E. O., Roth, T., & Breslau, N. (2006). The association of insomnia with anxiety disorders and depression: Exploration of the direction of risk. Journal of Psychiatric Research, 40(8), 700-708. doi: http://dx.doi.org/10.1016/j.jpsychires.2006.07.008
- Bartlett, D., & Junge, M. (2013). From insomnia to healthy sleep: Cognitive-behavioral applications. In M. L. Caltabiano & L. Ricciardelli (Eds.), Applied Topics in Health Psychology. Chichester, West Sussex: John Wiley & Sons.
- American Academy of Sleep Medicine. (2005). The International Classification of Sleep Disorders (ICSD-2): Diagnostic and Coding Manual (2nd ed.). Westchester, IL: Author.
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington DC: Author.
- World Health Organization. (2008). ICD-10: International statistical classification of diseases and related health problems (10th Rev.). New York, NY: Author.
- Ohayon, M. M. (2002). Epidemiology of insomnia: What we know and what we still need to learn. Sleep Medicine Reviews, 6(2), 97-111. doi: http://dx.doi.org/http://dx.doi.org/10.1053/smrv.2002.0186
- Roth, T. (2007). Insomnia: Definition, prevalence, etiology, and consequences. Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine, 3(5 Suppl), S7.
- Morgenthaler, T., Kramer, M., Alessi, C., Friedman, L., Boehlecke, B., Brown, T., . . . Owens, J. (2006). Practice parameters for the psychological and behavioral treatment of insomnia: an update. An American Academy of Sleep Medicine report. Sleep, 29(11), 1415.
- Mitchell, M. D., Gehrman, P., Perlis, M., & Umscheid, C. A. (2012). Comparative effectiveness of cognitive behavioral therapy for insomnia: A systematic review. [Article]. BMC Family Practice, 13(1), 40-50. doi: http://dx.doi.org/10.1186/1471-2296-13-40
- Morin, C. M., Bootzin, R. R., Buysse, D. J., Edinger, J. D., Espie, C. A., & Lichstein, K. L. (2006). Psychological and behavioral treatment of insomnia: Update of the recent evidence (1998-2004). Sleep: Journal of Sleep and Sleep Disorders Research, 29(11), 1398-1414.
- Buysse, D. J. (2013). Insomnia. Journal of the American Medical Association, 309(7), 706-716. doi: http://dx.doi.org/10.1001/jama.2013.193
- Epstein, D. R., Sidani, S., Bootzin, R. R., & Belyea, M. J. (2012). Dismantling multicomponent behavioral treatment for insomnia in older adults: A randomized controlled trial. Sleep: Journal of Sleep and Sleep Disorders Research, 35(6), 797-805.
- Hume, K. I., Brink, M., & Basner, M. (2012). Effects of environmental noise on sleep. Noise & Health, 14(61), 297-302. doi: http://dx.doi.org/10.4103/1463-1741.104897
- Gooley, J. J., Chamberlain, K., Smith, K. A., Khalsa, S. B., Rajaratnam, S. M., Van Reen, E., . . . Lockley, S. W. (2011). Exposure to room light before bedtime suppresses melatonin onset and shortens melatonin duration in humans. The Journal Of Clinical Endocrinology And Metabolism, 96(3), E463-E472.
- Raymann, R. J. E. M., Swaab, D. F., & Van Someren, E. J. W. (2008). Skin deep: Enhanced sleep depth by cutaneous temperature manipulation. Brain, 131(2), 500-513. doi: http://dx.doi.org/10.1093/brain/awm315
- Suganuma, N., Kikuchi, T., Yanagi, K., Yamamura, S., Morishima, H., Adachi, H., . . . Takeda, M. (2007). Using electronic media before sleep can curtail sleep time and result in self-perceived insufficient sleep. Sleep and Biological Rhythms, 5(3), 204-214. doi: http://dx.doi.org/10.1111/j.1479-8425.2007.00276.x
- Paterson, L. M., Wilson, S. J., Nutt, D. J., Hutson, P. H., & Ivarsson, M. (2009). Characterisation of the effects of caffeine on sleep in the rat: A potential model of sleep disruption. Journal of Psychopharmacology, 23(5), 475-486. doi: http://dx.doi.org/10.1177/0269881109104846
- Drapeau, C., Hamel-Hébert, I., Robillard, R., Selmaoui, B., Filipini, D., & Carrier, J. (2006). Challenging sleep in aging: the effects of 200 mg of caffeine during the evening in young and middle-aged moderate caffeine consumers. Journal Of Sleep Research, 15(2), 133-141.
- Chaput, J.-P., McNeil, J., Després, J.-P., Bouchard, C., & Tremblay, A. (2012). Short sleep duration is associated with greater alcohol consumption in adults. Appetite, 59(3), 650-655. doi: http://dx.doi.org/10.1016/j.appet.2012.07.012
- Jaehne, A., Loessl, B., Barkai, Z., Riemann, D., & Hornyak, M. (2009). Effects of nicotine on sleep during consumption, withdrawal and replacement therapy. Sleep Medicine Reviews, 13(5), 363-377.
- Passos, G. S., Poyares, D., Santana, M. G., D’Aurea, C. V. R., Youngstedt, S. D., Tufik, S., & de Mello, M. T. (2011). Effects of moderate aerobic exercise training on chronic primary insomnia. Sleep Medicine, 12(10), 1018-1027. doi: http://dx.doi.org/10.1016/j.sleep.2011.02.007
- Souissi, M., Chtourou, H., Zrane, A., Cheikh, R. B., Dogui, M., Tabka, Z., & Souissi, N. (2011). Effect of time-of-day of aerobic maximal exercise on the sleep quality of trained subjects. Biological Rhythm Research, 43(3), 323-330. doi: http://dx.doi.org/10.1080/09291016.2011.589159
- Belanger, L., Savard, J., & Morin, C. M. (2006). Clinical management of insomnia using cognitive therapy. Behavioral Sleep Medicine, 4(3), 179-202. doi: http://dx.doi.org/10.1207/s15402010bsm0403_4
- Wuyts, J., De Valck, E., Vandekerckhove, M., Pattyn, N., Bulckaert, A., Berckmans, D., . . . Cluydts, R. (2012). The influence of pre-sleep cognitive arousal on sleep onset processes. International Journal of Psychophysiology, 83(1), 8-15. doi: http://dx.doi.org/http://dx.doi.org/10.1016/j.ijpsycho.2011.09.016
- 3de Niet, G. J., Tiemens, B. G., Kloos, M. W., & Hutschemaekers, G. J. (2009). Review of systematic reviews about the efficacy of non-pharmacological interventions to improve sleep quality in insomnia. International Journal of Evidence-Based Healthcare, 7(4), 233-242. doi: http://dx.doi.org/10.1111/j.1744-1609.2009.00142.x
If you are concerned about the quality of your sleep, if you are feel tired, sleepy or irritable during the day, or if your sleep problems are affecting your day-to-day activities, a medical checkup with a GP is important, to see if a health issue is affecting your sleep.
Some people with insomnia benefit from a combination of medication and psychological interventions. A GP or medical specialist can offer advice and assistance around whether medication might be of benefit.
A referral to a sleep clinic might also be made. The sleep specialist can further assess the person’s sleep, and might arrange for the person’s sleep to be monitored overnight, either at home or in the clinic, to better understand the reasons for the sleep problems and if the natural phases of sleep are disrupted in some way.
You might also consider seeking assistance from a life psychologist.
- Life Psychologists are highly trained and qualified professionals, skilled in providing effective interventions for a range of mental health concerns, including sleep problems.
- A Life Psychologist can help you to identify and address factors that might be contributing to your sleep difficulties and the most effective ways to address insomnia using techniques based on best available research.
- Life Psychologists begin their work by conducting a thorough sleep assessment. You might be asked to keep a sleep diary, which includes a record of bedtimes, wake-times, the quality of sleep, and other issues. With this information, the psychologist can determine the best course of action. Treatment usually involves a combination of the CBT-I techniques described above, tailored to the person.
- Life Psychologists usually see clients individually, but can also include family members to support treatment where appropriate.