The occasional restless night can be frustrating. But imagine what life would be like to have difficulty falling or staying asleep for months or years at a time. It’s the kind of torture that is often inflicted on prisoners of war to break them down. And in fact, studies have shown that chronic insomnia not only disrupts our sleep, but also contributes to how we feel physically, emotionally, and psychologically. It affects our moods, thoughts and behaviours. It influences our energy and desire to face the day, go to work, pay attention in class, drive our cars and live our lives. It impacts our ability to stave off illness, recover from injuries, and has been found to contribute to the development and increase of symptoms of depression, anxiety, pain, substance abuse and more.
According to a 2017 Statistics Canada study, 55% of women and 43% of men between the ages of 18-64 have trouble going to or staying asleep and 22% of us are suffering from chronic insomnia.
If you are amongst that group, and if you have tired (pardon the pun) of experimenting with various sleep hygiene techniques with little success, you might be interested to learn some information and techniques that just might help you rediscover that blissful state of uninterrupted sleep that you once enjoyed.
Dr. Colleen Carney and Dr. Rachel Manber are world-renowned experts in treating insomnia using a cognitive-behavioural approach and have collaborated on three books on the topic. In their wonderful self-help workbook, Quiet Your Mind and Get to Sleep: Solutions to Insomnia for Those with Depression, Anxiety or Chronic Pain, Drs. Carney and Manber help us understand the why’s and how’s of chronic insomnia while addressing other problems that often accompany it. They explain how treatments associated with sleep hygiene are generally not effective for chronic insomnia. They challenge the notion that treating medical or psychological issues automatically improves insomnia. Instead, they say that insomnia needs to be treated as a separate issue at the same time. And they suggest that worrying about our lack of sleep is a big contributor to maintaining it.
In addition, they introduce us to three main factors that contribute to chronic insomnia:
1) Circadian Disruption: While some of us are early birds and others are night owls, we all rely on an internal clock that determines the best times for us to sleep. Most of us are familiar with how our circadian clock becomes confused when we fly overseas and enter into a new time zone. And the same logic applies when we delay going to bed until 3:00 a.m. or sleep in until noon the next day. It’s as if we have crossed several time zones, not only disrupting our circadian rhythm, but also compromising our ability to sleep. The authors recommend that we establish regular routines that we maintain seven days a week. This includes regular wake-up, eating and sleep times and regular light exposure.
2) Homeostatic Disruption: Another aspect that influences our sleep is our ‘sleep drive.’ During the course of the day, we have opportunities to fill our sleep drive to its maximum capacity, so that by the time it is bedtime, we have enough in store to maintain our sleep throughout the night. We can expand our sleep drive by the level of activity that we perform during the day, and we can reduce it, for example, by, taking a nap in the middle of it. If we are chained to a desk all day and glued to a couch all evening, there is little hope of gathering enough sleep drive to sustain us through the night. Being physically and socially active is key.
3) Arousal System: Our arousal system is comprised of physiological arousal (i.e. too wired to be tired because of too much caffeine); cognitive arousal (i.e. ruminating about the previous day or worried about the following) and conditioned arousal (we associate being in bed with nightmares, pain, hot flashes or tossing and turning all night). If our arousal system is overactive, we may override our sleep drive. Staying in bed when you can’t sleep is another sleep-incompatible behaviour. The authors recommend getting up and out of bed if you wake and can’t return to sleep within thirty minutes. They suggest doing something relaxing until you feel sleepy again, rather than reinforcing the negative associations that you already have about lying in bed awake.
With assessments, worksheets and wonderful explanations and diagrams, this comprehensive workbook makes it easy to understand the reasons for our insomnia and provides practical techniques and solutions as to what we can do about it. With a cognitive-behavioural approach, it shines a light on how our thoughts, moods and behaviours maintain the negative patterns that we have developed and the steps that we can take to change them. Whatever your question or concern, the authors seem to have addressed it.
If you are suffering from chronic insomnia, and in particular, if your insomnia has affected your mood or level of pain, I recommend that you read this book so that you can once again enjoy uninterrupted sleep. And if you need some additional help, please let me know. I’d be happy to help.