Understanding Sleep and Insomnia

by | Jun 12, 2024 | Sleep and Insomnia | 0 comments

Sleep plays a vital role in overall health and wellbeing. Insufficient sleep can impact your ability to learn, remember information, and regulate mood. 1 It can also influence your physical wellbeing, such as cardiovascular health, immune system, appetite, and the repair of cells, tissues, and muscles. 1, 2 Nonetheless, approximately 33-42% of Australian adults reported having difficulties falling or maintaining sleep a few times a week in the 2016 national survey. 3

How do we define insomnia?

Insomnia can be defined as having one of the following sleep difficulties for at least 3 nights per week: 4

  • Difficulty initiating or maintaining sleep
  • Early morning awakening and not being able to return to sleep

People experiencing insomnia often describe feeling dissatisfied with the amount or quality of sleep, even when there is an adequate opportunity for sleep. It is classified as persistent if you experience insomnia symptoms for more than 3 months. It is estimated that around 12-15% of Australians experience chronic insomnia. 5

Having difficulties falling asleep or frequent awakenings can be very frustrating. You may find yourself worrying about feeling sleepy or fatigued the following day and how it may impact your ability to concentrate and meet your commitments. These automatic thoughts may increase the feeling of anxiety, leading to wakefulness at night and difficulties in relaxing and falling asleep. You may enter a vicious cycle of insomnia, resulting in distress and difficulties functioning during work, study, or social situations.

Understanding the nature of sleep is the first step to improve sleep quality

We often assume that our brain and body shut down during sleep. In fact, sleep is quite complex and dynamic.

  • The brain stays active during sleep. It has periods of Rapid Eye Movement (REM) sleep and non-REM sleep (please see Figure 1). 6

Figure 1. A hypnogram that illustrates the pattern of brain activities in different sleep stages and cycles. From “Stages of Sleep”, by Australian Psychological Society, 2023, topic 1, point 19. 6

  1. Non-REM sleep stage 1: Your body transitions between wakefulness and sleep. It may last for approximately 5-10 minutes.
  2. Non-REM sleep stage 2: Light sleep occurs. This phase is associated with learning and memory.
  3. Non-REM sleep stage 3: Deep sleep occurs. Your body repairs tissues and strengthens the immune system.
  4. REM sleep: Your eyes move rapidly, and most dreams occur in this phase. The brain’s activity in this phase closely resembles its activity during wakefulness, with a temporary loss of muscle tone to prevent injuries from acting out dreams.
  • You may go through 3-5 cycles of sleep every night. Most deep sleep occurs during the first half of the night. As we get older, we may experience less deep sleep and more light sleep.
  • Sleep pressure, which drives us to sleep, builds up over the period of wakefulness and decreases during sleep.
  • Melatonin and exposure to sunlight can help regulate our internal biological clock (i.e., circadian rhythms). Your body naturally produces melatonin in darkness to prepare you for sleep, while exposure to sunlight is associated with an increase in serotonin level. Serotonin has an important role in regulating body functions, including mood and sleep. 7
  • The use of alcohol, nicotine, or caffeine before bedtime is reported to disrupt sleep cycles and reduce sleep quality. 8, 9, 10, 11

How can your psychologist help you with insomnia?

Cognitive Behavioural Therapy for insomnia (CBTi) is considered to be the most effective long-term treatment for chronic insomnia. 3, 12 Some strategies that you will learn, and your psychologist will guide you through are:

  • Using behavioural strategies to help our brain unlearn the association between bed and wakefulness and relearn the connection between bed and sleep (i.e., Sleep Efficiency Training and Bed Equals Sleep Therapy).
  • Addressing automatic thoughts about sleep. It aims to reduce sleep-related anxiety and thus wakefulness during bedtime.
  • Exploring healthy sleep practices and relaxation techniques. If you are interested to know more, please check out our previous blog post Sleep and Mindfulness.
  • If you recover from the current insomnia episode after treatment, congratulations! It can be helpful to review the strategies used to ensure that you have the resources to manage future episodes if needed.

Experiencing insomnia can be challenging mentally and physically. Our psychologists, Sharon Li and Anita Missiha can support you through these difficult times and tailor a CBTi treatment plan according to your circumstances.

Author: Insightful Living Co. Psychologist Sharon Li

References

  1. National Institutes of Health. (2011). Your guide to healthy sleep. (11-5271). https://www.nhlbi.nih.gov/resources/your-guide-healthy-sleep
  2. Australian Institute of Health and Welfare. (2021). Sleep Problems as a risk factor for chronic conditions. (Catalogue number PHE 296). https://www.aihw.gov.au/reports/risk-factors/sleep-problems-as-a-risk-factor/summary
  3. Adams, R. J., Appleton, S. L., Taylor, A. W., Gill, T. K., Lang, C., McEvoy, R. D., & Antic, N. A. (2017). Sleep health of Australian adults in 2016: Results of the 2016 Sleep Health Foundation national survey. Sleep health, 3(1), 35–42. https://doi.org/10.1016/j.sleh.2016.11.005
  4. American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787
  5. Reynolds, A. C., Appleton, S. L., Gill, T. K., Adams, R. J. (2019). Chronic insomnia disorder in Australia: A report to the Sleep Health Foundation. https://www.sleephealthfoundation.org.au/special-sleep-reports/chronic-insomnia-disorder-in-australia
  6. Australian Psychological Society. (2023). Cognitive behavioural therapy for insomnia (CBTi) certified skills course.
  7. Rhee, H. J., Vries, E., Coomans, C. P., & Velde, P. (2016). Sunlight: For better or for worse? A review of positive and negative effects of sun exposure. Cancer Research Frontiers, 2(2), 156-183. https://doi.org/10.17980/2016.156
  8. Garcia, A. N. & Salloum, I. M. (2015). Polysomnographic sleep disturbances in nicotine, caffeine, alcohol, cocaine, opioid, and cannabis use: A focused review. The American Journal on Addictions, 24, 590-598. https://doi.org/10.1111/ajad.12291
  9. Colrain, I. M., Nicholas, C. L., & Baker, F. C. (2014). Alcohol and the sleeping brain. Handbook of Clinical Neurology, 125, 415-431. https://doi.org/10.1016/B978-0-444-62619-6.00024-0
  10. Singh, N., Wanjari, A., & Sinha, A. H. (2023). Effects of Nicotine on the Central Nervous System and Sleep Quality in Relation to Other Stimulants: A Narrative Review. Cureus, 15(11), e49162. https://doi.org/10.7759/cureus.49162
  11. Gardiner, C., Weakley, J., Burke, L. M., Roach, G. D., Sargent, C., Maniar, N., Townshend, A., & Halson, S. L. (2023). The effect of caffeine on subsequent sleep: A systematic review and meta-analysis. Sleep medicine reviews, 69, 101764. https://doi.org/10.1016/j.smrv.2023.101764
  12. Australian Psychological Society. (2018). Evidence-based psychological interventions in the treatment of mental disorders: A review of the literature (4th ed). https://psychology.org.au/getmedia/23c6a11b-2600-4e19-9a1d-6ff9c2f26fae/evidence-based-psych-interventions.pdf

Submit a Comment

Your email address will not be published. Required fields are marked *