Insomnia and sleep problems

Why sleep is important

We spend a third of our lives asleep and for good reason. Sleep is essential for our physical and mental health. It is as important to our lives as breathing or eating. There is a strong correlation between sleep and health.

Sleep is helpful for maintaining cognitive skills such as memory, speech and brain development. Without sleep, we can’t think flexibly or concentrate effectively. Our moods and mental health are linked to our sleep health.

Typically, seven to eight hours of sleep per night is needed to perform your best. The body's ability to function declines if sleep isn't in the seven to eight hour range.

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What insomnia is

People with insomnia have one or more of the following symptoms:

• Difficulty falling asleep
• Difficulty staying asleep
• Waking up too early in the morning

If you have any of the above sleep problems, the good news is that you can improve your sleep quality.

You may be worried about many things concerning your academic and personal life. Acknowledging your concerns and increasing your ability to live with uncertainty can be one of the ways to sleep better.

Up to 60% of all college students suffer from poor sleep quality, and just under 8% meet all criteria of an insomnia disorder, which is a medical diagnosis. (Schlarb, 2017)

Insomnia disorders tend to involve serious medical conditions, such as sleep apnoea or narcolepsy. If you feel you are experiencing serious health or emotional problems from poor sleep, please consult a doctor as your first action.

Occasional insomnia is natural, particularly during times of stress. But if sleep disturbance becomes a regular occurrence, it can be a good idea to seek help.

Types of insomnia

Insomnia - which is another way of describing the symptoms of sleep disturbance – varies, but generally, there are two broad categories: transient and chronic.

• Acute insomnia - a brief episode of difficulty sleeping
• Chronic insomnia - a long-term pattern of difficulty sleeping
• Comorbid insomnia - insomnia that occurs with another condition
• Onset insomnia - difficulty falling asleep at the beginning of the night
• Maintenance insomnia - the inability to stay asleep

Of these, acute insomnia is the most common. It may also be referred to as adjustment insomnia because it is usually a reaction to a stressful event, such as a bereavement or a major life transition.

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Signs of insomnia

You may have insomnia if you regularly:

• Find it difficult getting to sleep
• Wake up throughout out the night and can’t return to sleep
• Wake up too early and cannot go back to sleep
• Lie awake at night
• Still feel tired after waking up
• Feeling frequently tired
• Frequent irritability
• Find it difficult to concentrate during the day because you're tired

Many people can get by with little sleep and function well in the daytime. Insomnia describes when your daytime functioning suffers due to disturbed night-time sleep.

Extended sleep problems can also weaken your immune system, increasing your susceptibility to illness, particularly during the winter season.

Insomnia patterns

Insomnia usually takes one or more of the following forms:

• Difficulty falling asleep - more common among young people
• Sleeping lightly and restlessly, waking often, lying awake in the middle of the night - more common in people over 40. In younger people, it may be associated with depression
• Waking early and being unable to get back to sleep - this is more common in older people and anyone worrying about something in particular

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Why people develop insomnia

There can be many reasons, including:

• Common emotional upsets - such as anxiety, fear, bereavement, stress, work problems, financial stress or unsatisfactory sex life can lead to disturbed sleep

• Environmental issues - sleeping in a noisy, uncomfortable or unfamiliar area can inhibit sleep

• Substance use / misuse - the use of drugs, particularly stimulants such as caffeine, medications, cocaine, amphetamines, or misuse of over-the-counter or prescription drugs

• Physical Pain - painful injuries can cause sleep disturbance as it prevents relaxation necessary for sleep. Being in pain can also awaken someone who has rolled over in their sleep onto the painful part of their body

  Additionally, medical conditions such as rheumatoid arthritis and hyperthyroidism can cause sleep disorders

• Mental illness disorders - can also create sleep disorders. These can include illnesses ranging from clinical depression to various anxiety disorders, schizophrenia, and obsessive-compulsive disorders. While not a mental disorder, this can also include post-traumatic stress disorder (PTSD)

• Sleep apnoea - sleep apnoea is a condition associated with respiratory problems. When a person’s breathing is irregular during sleep, that person’s sleep will be disturbed. People with sleep apnoea may not remember either waking during the night nor having breathing problems

  They may instead experience extreme sleepiness during the day and not understand why. Sleep apnoea conditions can cause problems with the respiratory system and the muscles involved in breathing and should receive medical attention

Certain medications can also affect sleep.

The above are only a few possible causes of sleep disorders. You should contact your GP if you feel that lack of sleep has begun to seriously affect your health or your ability to cope with everyday life.

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What you can do about insomnia

You can actually improve your ability to sleep well if you seek help. Help can come from many sources including making practical changes in your lifestyle in order to sleep better, seeking medical help from your doctor as well as obtaining emotional support from a counsellor.

Change your environment

You need to determine if you need to improve any of the following

• Is your bedroom generally comfortable?
• Do you have any sleep distractions in your bedroom, such as a computer or TV?
• Is your bedroom quiet, warm and dark enough?
• Do you have noisy neighbours?
• Do you have a snoring partner?

Consider if these basic problems need to be addressed first.

Change your lifestyle

Consider if you need to change any of the following lifestyle conditions:

• Do you need to cut out or cut down on stimulants such as coffee, tea, alcohol, nicotine, cola drinks, food additives, ‘junk food’, slimming pills or appetite suppressants?
• Do you need to drink fewer fluids in the hour before bedtime?
• Do you need to establish more regular sleeping and waking patterns?
• Do you need to stop falling asleep in front of the TV?
• Do you exercise regularly?

Avoid the following

• Sleeping during the day no matter how tired you are going to bed in a worried or upset state
• Going to bed too early
• Taking stimulants to keep you awake, or sedatives or alcohol to help you sleep
• Having arguments at bedtime or in bed
• Using your bed for waking activities such as: watching TV, writing, smoking, computer use, eating, telephoning, etc
• Focusing on angry thoughts because you can’t sleep
• Lying in bed awake for more than 30 minutes
• Eating, drinking or smoking when you get up during the night

The above are just a few ideas based on reasons some people stay awake. You can easily improve your sleeping habits by exploring with a counsellor any upsetting or suppressed feelings that may trouble you.

Alcohol and sleep

Alcohol can be a source of not sleeping as it makes you thirsty and produces adrenaline in your body. Reducing the amount you drink may help improve your sleep. Avoiding late-night drinking can also help.

Foods that can cause Insomnia

Diet must be considered for those with sleep problems.

Have a good look at what you’re eating. Certain obvious foods such as chocolate, teas and soda, can be problems if excessively eaten, but even certain healthy foods can contribute to our anxiety and insomnia.

Foods that have the capacity to overstimulate your nervous system:

• Caffeine
• Alcohol
• Sugar, flour and other refined carbohydrates
• Fried foods - due to the body’s difficulty with breaking them down
• Spicy foods - due to indigestion and irritation to the digestive system
• Liquids - try to stay hydrated, but possibly stop consuming any liquids after 8pm
• Nightshades - plants in the nightshade family (ie potatoes, tomatoes, eggplant, peppers and goji berries) produce natural pesticides called glycoalkaloids, which kill predators like insects and worms, but are also toxic to human cells

Foods that help you to sleep

Conversely, by eating certain sleep-inducing foods in moderation you may be able to enhance your sleep.

Foods that can help you to sleep:

• Poultry - chicken or turkey has tryptophan, an amino acid that helps your body to make serotonin a relaxing mood hormone
• Whole grains / complex carbs - eg popcorn, oatmeal or whole wheat crackers - but not white bread or refined pastas. Whole grains also encourage tryptophan
• Fish - contains vitamin B6 creates melatonin, which is normally triggered by being in the dark
• Yogurt / milk / cheese - the calcium in dairy products processes the hormones that help you sleep, i.e., tryptophan and melatonin
• Kale - is also rich in calcium
• Bananas - the potassium in bananas helps you to stay asleep

By having a light snack before bed (heavy meals may interfere with sleep), you may find that foods with tryptophan may induce sleep.

Relaxation

Anxiety can interfere with your ability to sleep. If you are depressed, worried or anxious here are a few suggestions:

• Change or resolve the things causing you stress when possible
• Accept situations you can’t change
• Keep your mind and body as relaxed as much as possible throughout the day
• Give yourself enough time to do the things you need to do - including eating
• Don’t take on too much and avoid unrealistic demands
• Live in the present, rather than worrying about the past or fearing the future
• Talk to your partner if there are problems in your relationship
• Have some relaxing, non-competitive activities - something you do just for pleasure, for fun
• Give yourself some ‘quiet time’ each day
• Practise a relaxation technique or breathing exercises regularly

There are many ways that you can learn to relax. Often by addressing difficult feelings directly, you may feel your anxiety levels decrease and that you begin to feel better.

Self-esteem

People who suffer from insomnia tend to have lower self-esteem and be less confident than others. Working on improving your confidence or self-esteem will probably help you sleep better. Counselling can help in this area.

Depression

Depression can often cause insomnia. Signs of depression include:

• Waking in the middle of the night or early morning and unable to get back to sleep
• Loss of interest, energy and appetite
• Aggression and anti-social behaviour
• Aches and pains that have no physical explanation

If you are depressed it makes sense to seek some help. Speak to your GP or come to the Counselling Service to speak to a counsellor.

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Treatment of insomnia

There can be many reasons for insomnia.

Two people may experience similar levels of stress, but the person with less support and less effective coping skills may experience sleep disturbance due to internalising unpleasant feelings that they agonise over during the hours they should be sleeping.

At other times, insomnia may be a result of illness, medication side effects or emotional problems. As stated previously, if you experience sleep problems, consulting your GP in order to rule out medical problems is always an essential first step.

Before any pharmacological approaches are considered, ask yourself if there are practical measures that can be addressed first.

For example, it may be helpful to:

• Sort out the environment in which you are trying to sleep
• Deal more effectively with the sources of personal stress
• Get help with financial problems
• Take more regular exercise
• Learn forms of relaxation therapy, such as meditation, mindfulness or hypnotherapy
• Engage in counselling

Medications

Some treatable physical conditions that can cause sleep problems can be managed through medications. One example is an undiagnosed over- or under-active thyroid, which may cause an inability to sleep.

Once medically diagnosed, however, this condition can help the individual to enjoy regular sleeping patterns.

While medications such as sleeping tablets and other sedatives may be helpful in the short-run, there is a well-known risk involved of them potentially causing dependence over longer periods, including:

• Psychological dependence - where the individual cannot psychologically accept that they can sleep without drugs and/or
• Physical dependence - where withdrawal symptoms and accidents can occur when the person with sleep disorder wants to discontinue their use

A discussion with a qualified medical practitioner is always advisable to find out what would work best for you.

Therapy treatments

Counselling approaches

There are many types of therapies available, which vary in their approach to working with your issues.

Cognitive therapy focuses primarily on how thinking affects feelings and behaviours. It involves helping clients develop skills for modifying beliefs, identifying distorted thinking, relating to others in different ways, and changing behaviours.

Integrative therapy focuses on integrating both thinking and feelings in order to help people cope better and solve problems.

Hypnotherapy approaches

Hypnotherapy can be useful in a variety of ways of helping to rapidly improve sleeping.

Often by working with a hypnotherapist, you can develop the ability to relax and have more consistent, good quality sleep.

Additionally, learning self-hypnosis can help you to allow yourself to relax. See the Goldsmiths Counselling Service videos on how to learn about and experience self-hypnosis.

Getting additional help

The reasons for insomnia can vary amongst individuals. They may have medical causes, and these should certainly be explored initially with your GP.

There are often underlying emotional issues that counselling may be able to help with to alleviate the problem. It is helpful to explore both medical and emotional support approaches simultaneously in order to achieve healthy sleeping habits.

Insomnia can be a serious problem, so it is okay to seek help to resolve it.

It is not a problem that you will have to endure for the rest of your life – if you seek help, you will be able to improve your ability to enjoy consistently good quality sleep.

Getting help at Goldsmiths

We support students to cope with emotional difficulties while helping them to maintain good mental health through a variety of initiatives, including:

• Online advice
• Counselling support
• Wellbeing videos
• Multi-faith chaplaincy

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Things to try to improve your sleep

• Establish a regular bedtime and waking-up time

• Setting a sleep routine is an established way to combat insomnia. By keeping to a regular pattern of sleeping that never varies, you can establish helpful patterns for your body that reinforce sleep

• Establish relaxation techniques just before bedtime. By doing things such as having a hot bath or a cup of chamomile tea, you can facilitate a sleepy state. There is a scientific basis for taking a hot bath as the resulting decreased body temperature immediately afterwards will cause you to feel sleepy

• Avoid taking naps that exceed 90 minutes. Brief naps can be helpful, but over-long naps make it more difficult to sleep when it is bedtime

• Don’t try to sleep if you are anxious. If you are worried or tossing and turning, leave the bedroom and do something you find dull or tedious until you feel drowsy

• Use light to help you wake up. If you have problems rising, use bright lights and curtains to let the daylight wake you

Sleep apps and websites

• Good Thinking - website approved by the NHS, Public Health England and the Mayor of London’s office

• Insight Timer - website with a range of free resources from professionals and celebrities

• Calm - app aimed at helping to still the mind and build self-esteem in order to improve sleep

• Headspace - website with meditation as well as sleep improvement section