Insomnia refers to difficulty falling asleep or difficulty staying asleep. It can also refer to difficulty feeling rested or refreshed after a night of sleep. Insomnia is one of the more common problems people struggle with, with an estimated 30-40% of adults reporting symptoms in a given year. A smaller percentage of these (10-15%) experience long-term symptoms (chronic) insomnia. Insomnia develops for many different reasons, and has several available treatment options.
Causes of Insomnia
Insomnia can develop from a variety of causes. Some of these may be external (medications or work shift changes) or internal (illness, anxiety, worry, emotional distress, etc.). Over time, we can develop habits that contribute to insomnia including our nighttime routine, use of electronics around bedtime, intake of caffeine or nicotine and how we deal with our stress from the day. There are many medications that contribute to insomnia, including cold and sinus medications, antidepressants, and even some herbal supplements. Our physical health can certainly impact our ability to sleep, as can things like – or even the time we eat our dinner. It can sometimes be difficult to identify all of the factors contributing to insomnia.
Treatment of Insomnia
If insomnia is not addressed, it can begin to interfere with one’s quality of life, and can even worsen conditions such as anxiety or depression. There are a variety of ways to address insomnia, including several types of therapy and medications. Each has benefits and limitations.
Behavior Therapy for Insomnia
Behavior Therapy for insomnia helps through fairly straightforward, practical modifications to a person’s environment, routine and habits in order to promote healthy and consistent sleep. Stimulus Control Therapy, Sleep Restriction Therapy and Sleep Hygiene are all examples of behavioral therapy interventions for sleep. Relaxation Training is also often used in Behavior Therapy. They can be very effective, and can have long lasting effects (because they entail learned skills). Behavior Therapy for insomnia does take time to implement, and requires some amount of effort on the part of the patient to work on tasks between therapy visits.
Cognitive Therapy for Insomnia
Cognitive Therapy for insomnia focuses on our thought processes that contribute to insomnia, and works to improve them. Our ability to cope effectively with worry, rumination or problem-solving based thinking is often something that is focused on in this form of therapy. We also develop some dysfunctional thoughts about sleep itself that can be difficult to “unlearn”. Cognitive Therapy has been demonstrated to be an effective tool for insomnia, particularly when combined with Behavior Therapy interventions (in a therapy called Cognitive Behavior Therapy, or CBT). CBT has been shown to be as effective as medications, and may be more effective in the long-term.
Medications for Insomnia
There are a variety of medication options available for insomnia. Most work right away, and can be a great option, particularly for acute, short term insomnia. If the insomnia does not improve, or returns when the medication is discontinued, other interventions may be required. Some people have a difficult time transitioning away from sleep medications, and Cognitive Behavior Therapy can help in that process. Some studies have demonstrated that people have the best outcomes for insomnia when they begin with a combined approach (medications and therapy), and transition to therapy without medications. This helps them get immediate relief, while working to replace the medication with long-term skills to promote quality sleep.
Treating Underlying Conditions
When insomnia is due to an underlying medical or psychological condition, often times that condition must be addressed before the insomnia can be resolved. Depression, Anxiety, Relationship Conflict and Stress are examples of psychological issues that can bring about insomnia. An evaluation with a therapist or your medical doctor (or both) can help you determine if this is the case.
Getting an Assessment
The first step in getting help for insomnia is to request an evaluation. Based on a thorough assessment of your sleep difficulties (usually a one hour first visit), a therapist can help put together a plan to help your insomnia. This can range from simple suggestions to improve your sleep habits, to therapy aimed at addressing underlying problems. We can also help suggest whether therapy alone may be useful, or if speaking with your family doctor about medication could be a good addition. Requesting an assessment is easy. You can call, or fill out our contact form here, and find out how we can help.