Sleep disruption and insomnia treatment

Are you tired of not getting enough sleep? 

Do you have trouble falling or staying asleep? 

Don’t seem to have enough energy no matter how much you try to sleep? 

We hear these concerns from people often in our practice. Sleep is easily affected by issues such as stress, anxiety,  low mood,  trauma and  other  issues  that  people  commonly  come  in to therapy  for. According to Harvard University, about 30% to 50% of adults in the general population experience occasional insomnia. Another 10% or more people experience chronic unrelenting issues with insomnia.

The fact that so many people struggle with good quality sleep is concerning because good sleep quality is the foundation upon which our well-being rests. Literally speaking, if we do not get enough quality sleep and rest, our well-being suffers. 

Sleep can also be thought of as the ‘canary in the coal mine’, where sleep disruption often signifies other problems or health issues in a person’s life. For instance, sleep can be affected by stress, low mood, and concerns such as PTSD, grief, chronic pain, and adjustment difficulties. As a result, improving the quality of one’s sleep is an important part of most treatment plans. There are also insomnia treatment plans.

Located in Hamilton Ontario, Psychologist Dr. Jennifer Barbera or one of her associates can help you to identify the cause of your sleep disruption, as well as work with you on improving the quality of your sleep. Also available online across Ontario. 

Book an appointment or contact us to discuss how we can assist you.

To  learn  more  about  sleep  disruption,  review the  information  on  insomnia  below  and  read  our  blog  post  on  insomnia.

What is insomnia?

Although most people need approximately 7-9 hours of continuous sleep to feel optimally rested, insomnia is not defined by the amount of hours that  one actually sleeps. People can vary in the exact amount of sleep they need to feel well-rested. 

Insomnia is defined by someone not getting an adequate quality of sleep, and then experiencing disruptions in their day-to-day functioning as a result of the sleep disruption. 

To understand about quality of sleep, it's important to realize that there are many different kinds of sleep. For instance, when someone is asleep, they will shift through different stages of sleep, such as REM sleep and non-REM sleep. 

REM sleep is thought to be very important for restorative processes such as stress recovery and memory reconsolidation. Difficulties in achieving restorative sleep can arise because REM sleep is disrupted when someone wakes up or becomes restless throughout their sleep cycle. This frequently occurs in individuals suffering from PTSD and associated nightmares or someone experiencing increased stress. 

People need continuous sleep to move through their normal sleep cycles effectively. The less one's sleep is disrupted; generally, the better quality of sleep one has. Because of this, the length of one's sleep is not as important as the quality of their sleep. The effects of poor sleep quality on health and well-being make sleep and insomnia one of the most important mental health concerns.

What  causes  Insomnia?

Determining the exact cause of sleep disruption may be challenging because so many issues (both physical and emotional) can cause disruptions to sleep. Sometimes the cause is obvious such as when someone is experiencing nightmares due to PTSD or is experiencing physical pain due to injury. Other times the exact cause may be more difficult to detect. 

This is where keeping a sleep diary or a sleep record can really help. A sleep diary or record is a log of your day-to-day routines and habits and usually includes the following information:

-What time did you go to bed?

-How long did it take you to fall asleep?

-Approximately how many times a night did you wake up?

-If known, what was the reason for waking up?

-What time did you get out of bed?

-Approximately how many hours total did you sleep?

-How many caffeinated beverages did you consume, and what time?

Then, to narrow down potential factors affecting your sleep, the record can note:

-What other stimulants and/or medications did you take? 

-Did you drink alcohol? If so, how much? 

-Did you exercise? If so, what type and at what time?

-How fatigued were you during the day?

-Did you nap? 

-Did you consume food within 3 hours of bedtime?

All of this information can be used to help your therapist, psychologist, or doctor assist you and come up with a treatment plan for your insomnia.

Potential causes of insomnia to consider include:

-Psychological symptoms or conditions such as stress, anxiety, depression, grief,  PTSD burnout, or stimuli overload.

-Physical illness such as arthritis, gastrointestinal difficulties, thyroid imbalances, and physical injury and associated pain can all cause sleep disruption and should be ruled out. 

-Sleep disorders, such as sleep apnea can also cause insomnia. If the cause of your insomnia is unknown, it may help to inquire with your family doctor to see whether a referral to a sleep clinic is appropriate. 

-Neurological disorders such as stroke, head injury, or Parkinson's disease can cause sleep disruption or insomnia.

-Excessive stimulant use, such as caffeine may interfere with some people's sleep. Some people are sensitive to very small amounts of caffeine and may not be aware of that impact.

-Medications such as certain antidepressants, diuretics, etc. can affect sleep quality.

-Lack of physical exercise may cause or exacerbate sleep problems.

-An inconsistent sleep schedule, which may be caused by prolonged shift work, can disrupt natural sleep cycles and lead to insomnia.

Many of these potential causes or contributors to sleep disruption are addressed in insomnia treatment. Treatment is available in Hamilton or online across Ontario.

The effects of insomnia  or sleep disruption often start with increased stress and anxiety throughout the night about the fact that one is not sleeping. 

This can lead to significant difficulty in getting out of bed on time because of increased fatigue and grogginess. 

The effects of disrupted sleep then continue throughout the day by disrupting concentration or one's ability to focus. 

It can also be more difficult to process and recall information  and  make  decisions. People can also experience increased irritability and lower mood.  They may  also  be  more  prone  to  tearfulness and  experience disruptions  in  their  ability  to  tolerate  or  cope  with  stress.

These  changes have an impact on our ability to perform certain roles such as work and can take a toll on our relationships. 

Our quality of life can be compromised.

Overall, insomnia can affect:

-our stress level

-our ability to feel rested

-our ability to get up on time

-our ability to concentrate

-our productivity

-our mood

-our relationships

-our important roles such as parenting, work, and school

-our well-being and health. 

Insomnia treatment can help to reduce these impacts. 

Strategies to help address insomnia and improve sleep are referred to as "sleep hygiene." To help ensure the best possible quality of sleep, the following practices are recommended:

-Stick to a routine. Having a sleep routine is essential for optimally resetting your circadian rhythm. This means going to bed at the same time every night and waking up consistently at the same time. Try and do this even on the weekend. 

-Set an alarm to remind you about going to bed and getting up at routine times.

-Use your bed only for sleep or sex and not for other activities. Designating your bed for sleep and sex only helps to ensure that your body will associate your bed mostly with rest.

-If you don't fall asleep after 20 to 30 minutes, get out of bed. Read or listen to a meditation and then re-attempt to fall asleep. This helps to ensure your bed doesn't become associated with restlessness and also can help to tire your further so that it is easier to fall asleep. 

-Keep your clock turned away. It can be very tempting to look at the time, but this will only increase your frustration, which will have a negative impact on sleep. 

-Do not nap during the day, even if you are tired. Wait as long as you can and then go to bed early if needed to help keep your sleep routine established and to avoid changes to your circadian rhythm. 

-Get plenty of exercise- ideally at least 30 minutes a day. Engage in vigorous exercise, if possible.

-Remember that downtime shouldn't be bedtime. Ensure that you wind down at least an hour before bedtime. Reading or relaxing is preferable to screen time as some studies have shown that screen time negatively affects sleep quality, especially for some people that are phot-sensitive.

-Avoid caffeine, especially after lunch.

-Eat enough earlier in the day so that you do not go to bed hungry and do not eat for 3 hours before bed, if possible.

-Make sure your room is dark and as comfortable as possible. If possible, invest in a good quality mattress. Remember that you will spend approximately 1/3 of your lifetime in bed!

When insomnia persists, try these additional therapeutic strategies:

-If you find yourself worrying or thinking at night when you are trying to sleep, try implementing a worry diary. This means writing down what is on your mind and then reassuring yourself that you will come back to it if needed, it won't be forgotten now that it is written down.  Don't forget about also keeping a sleep record. A sleep record can help inform a comprehensive insomnia treatment plan. 

-If you are having trouble falling asleep or waking up and feeling increasingly frustrated, remember to use acceptance strategies. An acceptance strategy is key to reducing frustration. 

-Another valuable approach is to use a guided sleep meditation or a sleep hypnosis. These are available for free on YouTube. We have also included some guided sleep meditations below. 

You can also try out an app such as Calm or Headspace. There is always a free version of most apps.

If you are attending to all the above sleep hygiene practices and sleep strategies and still find that you have insomnia, it may be time to consult a doctor. 

Consider consulting with your family doctor, a naturopathic doctor, or a psychologist  or  therapist  that  works  directly  with  a  psychologist. 

Therapists are also often trained on how to assist with sleep disruption. Your doctor or therapist will start with identifying potential causes of your sleep disruption to ensure nothing significant has been missed. Then your therapist will assist with more formally implementing the sleep hygiene practices discussed above. If these are not enough, your therapist can usually assist by implementing a more formal treatment plan for insomnia.  The  specific  plan  will  depend  on what  other  ocntributing  factors  are  identified.  

When insomnia persists despite ongoing efforts, it's important to make sure you are addressing any underlying issues related to your physical health or mental health. For instance, stress, depression, anxiety and particularly PTSD can have very disruptive effects on sleep. 

While other potential issues are being worked on, making progress  to  improve sleep can take time. For  this  reason, sometimes people can benefit from a sleep aid in the meantime. 

It can be helpful to discuss sleep  aid  options with a doctor or even a pharmacist.

Because sleep medications can have side-effects or possible dependency issues, consider visiting a naturopathic doctor in case your insomnia can be addressed with more natural or holistic means. 

You can also contact us to set up a consultation. See how a psychologist or therapist can help address your insomnia. We are available in Hamilton, or Online anywhere in Ontario.