Monday, 6 March 2023

Excessive Daytime Sleepiness: Should I Be Concerned?

From healthnews.com

Excessive daytime sleepiness (EDS) is a debilitating symptom that significantly decreases the quality of life. A number of sleep disorders can cause EDS. These include conditions like obstructive sleep apnoea (OSA), narcolepsy, insomnia, circadian rhythm disorders, parasomnias, and more. If you suspect you may have EDS, a sleep study can help uncover a potential underlying cause. 

Key takeaways:

  • Excessive daytime sleepiness can cause feelings of fatigue, tiredness, and an overwhelming urge to sleep. At worst, it can cause unintentional lapses into sleep at unwelcome times.
  • There are numerous sleep disorders that can contribute to EDS.
  • As EDS is a symptom and not a diagnosis, it is important to investigate this symptom with the help of a healthcare provider to uncover the root cause so that correct treatment can be provided.

Torso under a pillow

What is excessive daytime sleepiness?

Excessive daytime sleepiness is defined as an overwhelming feeling of exhaustion, tiredness, and fatigue. It is estimated that about 18% of individuals are affected by EDS. People who are excessively sleepy can find themselves falling asleep unintentionally in inappropriate situations. This can be very distressing, especially since EDS can impair a person’s ability to perform well at work, in school, or even while driving.


Symptoms of excessive daytime sleepiness

In addition to the symptoms of exhaustion and sleepiness, EDS can also cause other related symptoms, including:

  • Difficulty concentrating
  • Poor mood
  • Irritability
  • Cognitive dysfunction

Causes of excessive daytime sleepiness

Because EDS is a symptom and not a stand-alone diagnosis, it is important to understand that there are numerous health problems that can cause excessive daytime sleepiness. In the setting of sleep, EDS can be caused by several different types of sleep disorders that reduce sleep quality.

It is always best to consult a healthcare provider if you are struggling with EDS. It is likely you may be referred for a sleep study, which is a test that analyses your sleep physiology and can look for many sleep disorders that may be contributing to your EDS. It is important to determine the underlying cause of EDS in order to make sure you receive the right treatment.


Obstructive sleep apnoea

If you snore, wake up gasping at night, or find yourself feeling tired even after getting at least seven to eight hours of sleep at night, you may have obstructive sleep apnea. This is a sleep disorder characterised by repetitive obstruction of the airway at night, which causes a brief cessation in breathing. In response, the body experiences an “arousal” to help kick-start the body’s breathing back up. This constant disruption to sleep is what makes OSA a possible cause of EDS.


Insomnia

For some people, insomnia can understandably be the cause of EDS. People with insomnia have difficulty with initiating sleep, maintaining sleep, and returning to sleep after waking up at night. Because of this poor, fragmented sleep, EDS can often occur.


Narcolepsy

Narcolepsy is another possible cause of excessive daytime sleepiness. It is a very rare disorder, only affecting about one in every 2,000 people. People with narcolepsy have a deficiency in a neurotransmitter in the brain called orexin, also sometimes referred to as hypocretin. This insufficiency causes problems with the brain’s ability to regulate the sleep-wake cycle and causes severe EDS.


Circadian rhythm problems

Some people may suffer from circadian rhythm disorders, which occur as a result of the body’s natural clock being out of sync with the environment. Shift work is a common cause of circadian rhythm problems. People who work overnight, for example, are susceptible to EDS because being awake all night can cause confusion internally as to what time of day it really is. The irregular sleep pattern and confusion of the body clock is what cause EDS in these people.


Parasomnias

Parasomnias are any unwelcome behaviours or experiences that occur during sleep and happen as a result of incomplete arousal from a deep sleep. It is an umbrella term that includes several sleep problems including sleepwalking, nightmares, rapid eye movement behaviour disorder, and more. Because of the disruptive nature of these behaviours on getting restful sleep, parasomnias can be a cause of EDS.


Restless legs syndrome, limb movements

Restless legs syndrome (RLS) is a sleep disorder that is characterized by an overwhelming urge to move the legs that is often worse at night-time and is relieved by getting up and moving. It can be extremely disruptive to sleep given its occurrence in the night-time hours and can make it hard to fall asleep and stay asleep. Once asleep, people with restless legs can sometimes experience periodic limb movements (PLM) as well, which can cause sleep disruption and subsequent EDS.


Treating excessive daytime sleepiness

The treatment for EDS is guided by the underlying cause. People with sleep apnoea may be recommended a breathing machine known as a continuous positive airway pressure (CPAP) device to help correct their breathing. Behavioural therapies, medications, and certain supplements can be used to treat insomnia, narcolepsy, circadian rhythm disorders, parasomnias, and RLS/PLMs.

Excessive daytime sleepiness can be a debilitating symptom and is a feature of many sleep disorders. If you are struggling with EDS, it is important to consult with your healthcare provider to start looking for an underlying cause. While a sleep study may be recommended, you should follow the recommendations given to you as guided by your healthcare provider. While EDS can be distressing, there is a multitude of treatment options that can be employed to address this problem once a diagnosis is found.


https://healthnews.com/sleep/sleep-disorders/excessive-daytime-sleepiness-should-i-be-concerned/

Sunday, 5 March 2023

7 Ways to Manage Daytime Fatigue

From psychologytoday.com 

Practical tools to use when you feel like you are sleepwalking through your day


KEY POINTS

  • Using light and caffeine strategically can target the two underlying sleep systems regulating human sleep and wakefulness.
  • Movement and novelty can stimulate dopaminergic and other physiological responses, promoting wakefulness.
  • Working with, rather than against, fatigue symptoms can increase your cognitive bandwidth to manage them.


Insomnia–or difficulties initiating or maintaining sleep interfering with wakefulness–can sometimes make you feel like your productivity has gone out to lunch. Associated features of insomnia– acute or chronic–vary from person to person but usually include irritability, anxietydepressed mood, anergia, inattention, reduced concentration and processing speed, and amotivation. Not having restful deep sleep can negatively impact all areas of our lives, including keeping us from performing our best at work.

So, after a rough night (or several), how can you get through your day without sleepwalking?

Consider these evidence-based environmental, behavioural, and cognitive strategies.

Environmental Strategies

Environmental factors play a large role in entraining our circadian rhythm and course-correcting our day after a rough night.

1. Go toward the light.

Light is one such factor. A zeitgeber–German for “time giver”–light works to synchronize our circadian rhythm, or our internal clock, via a drowsiness-promoting hormone called melatonin. Blue or otherwise, light sends signals to retina photoreceptors, prompting the suprachiasmatic nucleus to stop producing melatonin. In other words, light interrupts its production; darkness promotes it. For this reason, humans sleep in darkness and remain active in daylight.

To shake off the heavy residue of a sleepless night, try to bathe your retinas in 15-30 minutes of sunlight upon waking and, ideally, as often as possible throughout your workday. If you work from home, consider working outside. Or at least try working near a window and keeping your office light and bright. And if you don't have a window, quit your job. (joking, kind of).

Consider setting alarms every 30-60 minutes or so to remind yourself to step outside for a dose of sunlight, even just 5 minutes of it.

2. Frontload your caffeine intake.

Adenosine circulates throughout our central nervous system (CNS) to regulate the homeostatic sleep drive, one of the two systems that regulate human sleep and wakefulness. This system governs the increased propensity to sleep with more time spent awake. Increased wakefulness means more accumulated “pressure” to fall asleep. Adenosine builds this sleep pressure and resets after sleeping.

Caffeine acts as an adenosine receptor antagonist. It binds to adenosine receptor sites that accumulate sleep pressure and block build-up. In most healthy adults, caffeine has a half-life between five to six hours, meaning 50 percent of the dose remains in your CNS after five to six hours.

And after a night or two of insomnia, you might feel tempted to overconsume caffeine to get through your day–but don’t. This cycle can quickly get vicious, keeping you stuck using caffeine to mitigate fatigue during the day but impairing your ability to initiate and maintain sleep at night.

Keep your caffeine handy in the morning but aim to eliminate it after 12 PM, especially if you experience insomnia.

Behavioural Strategies

What we do (or don’t) during the day can perpetuate daytime fatigue and maintain our insomnia symptoms at night.

3 and 4. Break up with prolonged sitting and move on.

Accumulating evidence links prolonged, uninterrupted sitting to metabolic parameters, including blood pressure, obesity, insulin resistance, and blood glucose dysregulation. Aside from the metabolic consequences, a whole working day sitting also impacts fatigue and cognition–potentially amplifying the effects of a bad night.

Some research, for example, has found employees report reduced fatigue across the day using sit-to-stand desks relative to seated work. Other studies comparing uninterrupted sitting with three-minute bouts of light-intensity walking every 30 minutes reveal decreases in employees’ self-reported levels of drowsiness and sluggishness.

A host of reasons may explain why including increased: 1) cerebral blood flow, 2) expression of brain-derived neurotrophic factor, which stimulates neuronal activation, and 3) enhanced availability of performance-enhancing neurotransmitters, including epinephrine and norepinephrine.

When you arrive at the office, consider standing at your desk–at least for a few minutes to start–and gradually adding time as your stamina, tolerance, and self-efficacy increase. And if you don’t have a convertible standing desk, adding a platform or a few thick books beneath your computer will do the trick.

On rough days, also make brief bouts of movement part of your work protocol–it’ll improve your fatigue now and benefit your sleep later.

Remember: sleep pressure, or the body’s “hunger” for sleep, accumulates with increased time spent awake. Mild, moderate, or vigorous daytime energy expenditure in any form–walking, swimming, taking the stairs–can stimulate sleep-promoting adenosine. More activity during the day means more sleep pressure and, usually, quicker, deeper, and more consolidated sleep at night.

5. Do something new and slightly challenging.

Have you ever noticed yourself on the verge of dozing off when you’re doing something repetitive and boring at work? That’s your brain’s way of saying, “thanks, but nothing to see here.”

Adaptation to a dynamic world promotes survival, and our brains have evolved to remember salient events diverging from business as usual.

Novel and slightly challenging experiences induce dopamine release in the hippocampus, promoting attention and memory. The nucleus accumbens–which receives direct projections from the hippocampus–also plays a significant role in motivation, reward, pleasure, and even slow-wave (or deep) sleep. When these brain regions go un or under-stimulated, we may feel drowsy.

In other words, novel (vs. repetitive, unchallenging, familiar) stimuli/tasks not only activate regions of the brain associated with reward and pleasure, but they also keep us present and captivated. This trifecta of pleasure, presence, and captivation usually feels energizing.

This doesn’t mean shirking your work responsibilities after a sleepless night. But during those moments of intense dragging, consider briefly pivoting to a new project rather than opting for something routine or repetitive. Once your energy levels perk up, you can revisit the stale, boring stuff.

Cognitive Strategies

Our thoughts and appraisals about a bad night of sleep and its consequences for productivity can also influence how we participate in vs. sleepwalk through our workday.

6. Reframe

Cognitive behavioural therapy (CBT) makes a few assumptions –chiefly that our thoughts, feelings, and behaviours have synergistic and reciprocal relationships. Our thoughts and feelings influence our behaviours, and our behaviours influence our physical health.

We can’t directly control how we feel but we can control what we do and think in response to those feelings. Similarly, while we can’t directly control our sleep on any given night, we can influence how we respond to a rough night to reduce its hold on us during the workday.

It’s easy to catastrophize, and if you find yourself doing this most nights of the week and experience associated issues falling or staying asleep, seek treatment.

In the meantime, consider this reframe: the body always attempts to achieve homeostasis. A bad night of sleep last night significantly increases the odds of having a better sleep tonight.

See each night as a new night–it doesn’t matter what happened last night. Sleep naturally unfolds when we let go of conscious activities, including deliberate efforts to make sleep happen.

7. Practice radical acceptance.

But sometimes, examining and challenging our thoughts can feel fatiguing, especially if you already feel fatigued. Radical acceptance describes seeing reality as it is, without judgment. It doesn’t mean we like, invite, or want our pain (in whatever form it takes)–it just means we stop fighting with it. Counterintuitively, radically accepting and greeting our daytime fatigue with compassion can give us the cognitive and emotional bandwidth to start changing our reality. But changing reality requires first accepting reality, not rejecting it.

Conclusion

Rough nights happen to everyone–but using a few basic behavioural, environmental, and cognitive tools on the backend can keep you from sleepwalking through the day.

Using caffeine strategically and implementing light, movement, and novelty into your daytime routine can help. You may even consider asking for a convertible standing desk. But don’t underestimate the contribution of your thoughts to your energy levels. Reframing your thoughts and sticking to the facts, not grappling with them, can give you the emotional and cognitive bandwidth you need to get through the day.

https://www.psychologytoday.com/us/blog/engaging/202302/7-ways-to-manage-daytime-fatigue

Saturday, 4 March 2023

Odd Cures For Insomnia You Never Thought Of

From thelist.com

Counting sheep, drinking warm milk, eating ... lettuce? For as long as humans have been around, they've been sharing incredibly unusual cures for insomnia. There's nothing more frustrating than spending a night tossing and turning, and chronic insomnia is linked to a whole host of negative health issues that can have a cumulative effect. If you've tried traditional methods to encourage slipping into sweet, restorative slumber and haven't had any luck, you may just want to try some of the weirder tricks out there. Some solutions that are off the beaten path could just be worth a shot.

Of course, if a persistent lack of sleep is having a significant effect on your day-to-day, it's best to consult with your doctor to determine potential underlying causes and treatments. If your insomnia is fairly infrequent, though, we have some odd sleep hacks for you to try, as well as some just to entertain you. Hopefully, you'll be paying a much-needed visit to dreamland soon.

Eating raw onion before bed

Onions are loaded with an amino acid called L-tryptophan — the same compound found in turkey that many credit with post-Thanksgiving-dinner sleepiness. This amino acid is thought to be a natural sedative that contributes to the body's creation of serotonin and melatonin (two neurotransmitters most insomniacs are likely familiar with). L-tryptophan has been shown to enhance sleepiness and lessen the amount of time it takes to fall asleep, which are both coveted traits for anyone who's experienced a restless night.

Before you go chomping down on an onion apple-style, though, try other methods of getting the veggie down that are a little less aggro. Some swear by placing onion slices in a jar and opening up that bad boy up before bed to breathe in the vapours. Strange, yes, but arguably more pleasant than eating a raw onion. You can also brew onion tea, which entails boiling an onion (skin on is fine) in some water — skin on is fine — for about an hour. When it's ready, mix in some honey to improve the flavour. Alternatively, onion extract may help you catch some quality ZZZs, as a 2020 study published in Food Science and Biotechnology found.

If you tend toward heartburn or acid reflux, it's best to avoid ingesting onions, as it can contribute to flare-ups. Also, if you share your bed with a sensitive partner and are a considerate person, well, they may be happier if you explore other sleep hacks. 

Sleeping with your head to the east

Another natural cure for insomnia may be as simple as changing the direction you sleep. According to the Indian architectural and design philosophy called vasu shastra, sleeping with your head facing north is a no-no. This is because, according to this school of thought, the head is akin to the North Pole of the body. Just like what happens when you put the same pole of two magnets together, there is a repellent property — this is believed to cause tension, which in turn makes it more challenging to fall asleep.

Facing your head east is instead the preferred sleeping direction. The principles of vasu shastra say this allows you to align with the energy of the sun, and is ideal for cultivating peaceful slumber and waking up refreshed. Alternatively, you can try placing your pillow toward the south. This is thought to encourage a harmonious exchange of energy that results in solid, restful sleep, as well as promoting prosperity, happiness, and health. And who wouldn't want that?

Light therapy

If you're seeking a cure for insomnia without supplements or medications, light therapy may fit the bill. It works to alter your circadian rhythm (your body's 24-hour internal clock), according to WebMD. This method can be particularly helpful if you have trouble falling asleep at the time you want — for instance, your schedule requires you to wake up early, but you find you're not able to conk out until late at night, even if you tuck yourself in on time.

Giving yourself 20-minute sessions to fall asleep

This method for encouraging sleep taps into stimulus control, a form of cognitive behavioural therapy — a practice that aims to retrain your brain out of unhelpful patterns of thought or behaviours to provide relief. 

According to this method, if you've been trying to fall asleep for 20 minutes and it's not working, you should get out of bed and do a relaxing activity you enjoy. This can be reading, listening to a podcast, knitting — really anything that tends to quiet your mind. When you get to the point of feeling sleepy again, head back to bed. Again, give yourself 20 minutes to drift off. If you're still restless, get up and head back to a relaxing activity (the same one as before or a different one).

The goal is that, rather than spending time in bed struggling to sleep, you'll stop this negative bedtime cycle in its tracks. Incorporating this habit into your sleepytime routine is thought to encourage more solid snoozing, and it gives you greater control over the whole endeavour, which feels better than languishing in that restless state in bed.

Consuming lettuce in various forms

You may have seen the viral TikTok trend praising the benefits of lettuce water to encourage sleep. Well, the practice of incorporating this veg to bring on ZZZs goes back to the ancient Egyptians and Romans. These cultures tended to finish off their meals with lettuce to encourage calmness and sleepiness — and it was also used as an aphrodisiac (pick a lane, guys!). Further, according to Calm, eating fried lettuce was a folk remedy employed by the French as, yes, a way to cure insomnia.

There is some science behind this method. A sleep-enhancing compound called lactucarium is found in lettuce — it's a milky secretion primarily produced at the stem base of the vegetable. It's also known as lettuce opium, and it can have a sedative and even hypnotic effect. Before you go chomping down on iceberg leaves, it should be noted this compound is stronger in other varieties, especially red romaine.

Today's adaptation of using lettuce to fall asleep is to boil the vegetable into a tea, but be forewarned — sipping this before bed may cause you to have to get up at night to pee, which is a definite sleep-disturber. It's possible the sleep-enhancing effects you see on TikTok may be more the result of the placebo effect, but even so, it won't hurt to try this unusual "cure." If it works for you, kudos.

Tricking your brain to take the pressure off sleeping

This cognitive behavioural therapy method works by getting the better of your active brain. Instead of trying to will yourself to sleep, which can often backfire, you essentially trick your brain by telling yourself you're trying to stay awake. 

As sleep scientist Katharina Lederle told Glamour UK, "If we fear something, we do everything we can to try and avoid it." A build-up of anxiety around trying to get to sleep often results in sleep slipping further out of reach. This paradoxical intention practice is all about stopping that merry-go-round.

To try it: From bed, tell yourself you'd like to stay awake a little longer. Although you shouldn't get into lively activities or force yourself into wakefulness, this little brain hack can sometimes do just the trick. It works because, according to Dr. Lederle, "By giving up on the aim to fall asleep, you stop putting in the 'effort' to fall asleep, and that means the pressure to 'perform' (i.e. fall asleep) disappears. Physiologically, this means the body and brain can finally calm down and relax."

Using hypnosis to change your focus

More than a swinging pocket watch in your face getting you to act in bizarre ways, hypnosis can be an effective method to achieve behavioural changes. It's often utilized to help with breaking habits like smoking or even managing pain control. Though professionals suggest it works best under the guidance of a trained hypnotherapist, you can also potentially achieve benefits with self-hypnosis by using video or audio sources, like an app, according to the Sleep Foundation.

This process promotes relaxation and reorients negative thoughts and feelings, and it can reduce the noise caused by anxiety and depression, which are often enemies of a good night's sleep. Hypnosis uses visualization to direct focus to calming thoughts or images, then deepening that level of relaxed focus. Next, the listener receives therapeutic suggestions geared toward falling asleep.

Hypnosis is more effective on certain people, but it can be a solid option for those who have racing thoughts at night or tend to stress out over bedtime, as it can calmly direct your mind to slumber.


Getting real weird with animal-based 'cures'

When it comes to the most bizarre of insomnia treatments, history provides a number of options that are mighty weird — and downright gross. The restfulness authorities over at Calm compiled a bunch of the world's wildest cures for sleeplessness, and though their effectiveness is subject to your own discretion, stomach, and ability to get your hands on this wacky stuff, they are definitely odd.

After surveying people on different cures, Calm found that participants most often rated smearing dog earwax on the teeth as the weirdest — and we'd agree. Credited to Italian Renaissance mathematician and physician Gerolamo Cardano back in the 16th century, the reasoning behind this method isn't entirely clear. One thing is obvious, though — he must have been one sleepless dude to experiment with Fido's floppy ears.

Another unusual cure is eating sea slug entrails, a folk remedy out of Japan. These are a delicacy in Japan, though, and perhaps a worthy fit for someone with an adventurous spirit. The Romans threw their own unusual suggestion into the mix — rubbing the fat of a field mouse on the soles of their feet. And, not to be outdone, medieval Europeans advised sipping a concoction made with castrated boar bile. Yum.

We'd argue that there are far better (and more palatable) ways to fall asleep so, you know, maybe skip these cures.

Limiting the time you spend in bed

Back to another cognitive approach to better snoozing, this method — sleep restriction — sounds counterintuitive but has been shown to produce results in just a week, according to Stanford Medicine. Sleep restriction requires you to stay in bed only for as long as you tend to sleep — i.e., if you only sleep six hours a night but toss and turn (or lounge around) awake in bed before or after sleeping, don't. Only allow yourself those six hours in bed.

Initially, you may feel sleepier during the day, but this method is said to improve the (time-restricted) sleep you do have. After a week or so — as long as you're sleeping through the night with minimal interruption — yo'llu gradually extend your time in bed by 15 to 30 minutes. Allow your body to acclimate to each added chunk of time for at least another week, and continue increasing as you adjust. If you return to experiencing unwanted wakefulness, go back to restricting time in bed to the average number of hours you're actually asleep. The goal is to discover the optimal amount of time to devote to bed and then stick with that magic number.

Oh, and regardless of how little you sleep, don't restrict yourself to any less than 5.5 hours.

Getting your sleep in smaller chunks

For some people, consistent naps just work better than aiming to sleep through the night. This is especially true for those who work off-hour schedules. Called polyphasic sleep, this method entails getting your sleep in two or more chunks per 24-hour period. Comparable to how infants (or even cats and other animals) get their sleep, this can look like a couple of longish naps during the day and a relatively short time sleeping overnight. Polyphasic sleep could also consist of multiple 20-minute naps, or even sleeping in three stages — before dawn, at some point in the afternoon, and after sunset.

However, you will likely fall short of the recommended seven to nine hours of sleep per night if you follow this method. Although polyphasic sleep may be effective initially for some, it often isn't sustainable. Nevertheless, some people just tend toward this style of sleep. Provided you feel alert during your waking hours — and enjoy likely having more of them — polyphasic sleep may be a dream cure for insomniacs.

https://www.thelist.com/1217200/odd-cures-for-insomnia-you-never-thought-of/ 

Friday, 3 March 2023

How to Overcome Insomnia With Cognitive Behavioral Therapy

From healthnews.com

Insomnia is a sleep disorder that affects millions of people globally. Insomnia can significantly impact a person's daily life, causing fatigue, mood swings, difficulty concentrating, and even depression. This article will explore a treatment for insomnia called cognitive behavioural therapy for insomnia (CBT-I)

Key takeaways:

  • CBT-I is a multicomponent treatment that combines cognitive, behavioural, and psychoeducational approaches to address the root cause of insomnia.

  • Cognitive restructuring helps challenge negative sleep-related thoughts, leading to healthier sleep habits and long-term improvements in well-being.

  • Establishing healthy sleep hygiene habits, such as maintaining a consistent sleep schedule and creating a peaceful bedtime environment, can help to promote restful and healthy sleep patterns.

  • Insomnia can be cured with the help of a trained professional using CBT-I, which leads to substantial improvements in duration and quality of sleep.

People with insomnia have trouble getting and feeling rested. This affects various aspects of their daily lives negatively. Cognitive behavioural therapy for insomnia (CBT-I) aims to modify sleep patterns and provide people with simple strategies to fall and stay asleep. Proper sleep improves productivity and well-being, and helps people to focus.


Woman having a hard time falling asleep



What is insomnia?


Insomnia is a chronic sleep condition characterized by difficulties getting asleep, remaining asleep, and waking up too early. It can affect people of all ages and lead to daytime fatigue, irritability, and difficulty concentrating. Several factors can contribute to insomnia, such as stress, anxiety, depression, medical conditions, and certain medications. While medication can treat insomnia, cognitive behavioural therapy for insomnia (CBT-I) is a non-invasive and effective treatment that can help individuals overcome their insomnia.


Insomnia is often linked to other physical and psychological conditions. For example, chronic insomnia has been associated with a range of health problems, including high blood pressure, heart disease, diabetes, chronic pain, and mood disorders like depression and anxiety.


How does CBT-I work for insomnia:


Cognitive behavioural therapy for insomnia explores the relationship between thoughts, behaviours and sleep. A skilled CBT-I therapist will identify thoughts, feelings, or behaviours that may be contributing to the symptoms of insomnia. During treatment, thoughts, and feelings about sleep are analysed and tested for accuracy, while behaviours are assessed for their impact on sleep. Any misconceptions or obstacles to restful sleep are then addressed by the therapist through clarifications and reframing to promote healthy sleep behaviours.


Analysing thoughts, feelings, and actions


The interplay between thoughts, feelings, and actions can contribute to insomnia in different ways. For example:


  • Thoughts. Negative, racing, or intrusive thoughts can make sleeping difficult. For example, worrying about things that can go wrong, dwelling on bad things that happened in the past, or heightened anxiety about not being able to sleep can keep you awake at night.
  • Feelings. Emotions such as anxiety, frustration, anger, or loneliness can make it difficult to fall or stay asleep.
  • Actions. Poor sleep habits or a lack of sleep hygiene can have a detrimental effect on sleep. Counterproductive habits include using a cell phone or laptop before bedtime, drinking caffeine or alcohol, or having an irregular sleep schedule.

Learning about sleep hygiene


Sleep hygiene refers to a set of healthy sleep behaviours that can improve the quality and quantity of sleep. These habits include:


  • Maintaining a consistent sleep and wake-up routine, even on weekends and holidays.
  • Creating a comfortable, quiet, cool, and dark sleeping environment.
  • Relaxation techniques such as deep breathing, meditation, or progressive muscle relaxation can be useful for reducing stress and promoting relaxation.
  • Avoiding or reducing stimulants like caffeine, nicotine, and alcohol, particularly close to bedtime.
  • Engaging in regular physical activity can promote healthy sleep, but try to avoid intense exercise close to bedtime.
  • Minimise exposure to electronic devices before bedtime because the blue light they emit can inhibit the production of melatonin, a hormone that plays an important role in regulating sleep.
  • Developing a relaxing bedtime routine to signal to your body that it's time to sleep, such as taking a warm bath, reading a book, or listening to relaxing music.

Cognitive restructuring techniques


The term “cognitive” refers to how we think and how our thoughts affect our emotions and behaviours. By challenging negative thoughts and replacing them with more accurate and helpful ones, patients can reduce anxiety and improve their ability to fall and stay asleep. This may involve techniques such as thought-stopping, thought substitution, and cognitive reframing.


Behavioural interventions


Behavioural interventions focus on changing behaviours and habits that can contribute to insomnia. Some common behavioural interventions used in CBT-I include:


  • Relaxation training. Patients learn relaxation techniques such as progressive muscle relaxation, deep breathing, and visualization exercises to reduce anxiety and promote relaxation.
  • Stimulus control. This involves making changes to the sleep environment and sleep routine to establish a strong association between the bed and sleep. For example, patients are encouraged to use the bed only when sleepy.
  • Sleep restriction. This technique involves reducing the time spent in bed to match the amount of sleep a patient gets. This helps build a stronger association between the bed and sleep and can help consolidate sleep.

Psychoeducational interventions


In psychoeducational interventions, the therapist teaches the patient about the connection between thoughts, feelings, behaviours, and sleep. Some common psychoeducational interventions used in CBT-I include:


  • Sleep education. Patients are taught about the physiology of sleep, the different stages of sleep, and the importance of good sleep hygiene practices.
  • Cognitive model of insomnia. Patients are taught about the cognitive model of insomnia, which describes how negative thoughts and beliefs about sleep can contribute to insomnia.
  • Sleep-promoting behaviours. Patients are taught about the behaviours and habits that can promote good sleep, such as regular exercise, healthy eating, and maintaining a regular sleep schedule.

How long does the treatment take?


The number of sessions needed for CBT-I can vary depending on the severity of a person's insomnia and their individual needs. Typically, a full course of CBT-I will involve six to eight sessions with a trained therapist, but it may require more or fewer sessions depending on the individual's progress and the complexity of their insomnia.


Is CBT-I effective?


Researchers believe that CBT-I is an effective treatment for insomnia. In addition, research has consistently shown that CBT-I can improve sleep quality and quantity in the short and long term.


Before resorting to medication, CBT-I is often the first treatment choice for chronic insomnia. It has been shown to be effective for a wide range of patients, including those with comorbid medical or psychiatric conditions.


Insomnia can be very frustrating for someone suffering from a lack of quality, consistent sleep. However, fortunately, there are effective strategies for improving sleep quality, including the following:


  • Stick to a consistent sleep routine, even on weekends.
  • Establish a calming bedtime ritual to help your body prepare for sleep.
  • Avoid stimulating activities and electronics before going to bed.
  • Limit your intake of caffeine and alcohol, especially in the evening.
  • Avoid taking naps during the day, especially in the afternoon, as it can disrupt your night-time sleep.

Insomnia can be a difficult and frustrating condition to manage, but it is curable. With the help of cognitive-behavioural therapy and good sleep hygiene practices, you can make significant progress in getting the restful sleep you need. Remember, it's important to be patient and kind to yourself as you work through this process, and don't hesitate to reach out for support from your healthcare provider or a mental health professional. Better sleep is possible, and you deserve to experience the restorative benefits it can provide.