How’s your sleep?
An article by Dr. Ken Harrison
As a counselling psychologist one of the things I often ask about is how well people sleep. It is an important question considering that sleep disturbance is estimated to affect some 13% to 24% of Canadian adults and may apply to nearly as many children. Insomnia is one type of sleep disturbance that includes variations on difficulty initiating or maintaining sleep (the most common complaint), early waking, and nonrestorative or poor quality sleep.
As a rule of thumb, if it takes more than 30 minutes to fall asleep, night-time waking occurs for more than 30 minutes, or total sleep time is less than 6.5 hours per night, and this occurs 3 or more nights per week for more than one month, chronic insomnia could be a problem. Initial onset of sleep difficulties is often triggered by the presence of emotional or physical discomfort. More chronic versions of insomnia may be preceded by significant life changes, enduring periods of stress or emotional upset, and a number of medical diagnoses. Early efforts to address those emotional, psychological, and medical factors would surely be a good preventative measure.
Insomnia is a symptom shared by a number of psychological conditions including anxiety, depression, substance abuse, trauma, and stress, making it an important point of inquiry; however, it is also viewed as a separate matter that can act as a vulnerability factor in the development of these and other psychological conditions. Impairment of daytime functioning on everyday tasks at home and work, may occur due to the effects that insomnia has on alertness, attention and concentration, memory and learning, fine motor functions and reaction time, emotional- and self-regulation, and tempering the emotional tone of memories. Increased sensitivity to minor irritations, loss of pleasure in family and social life, and problems negotiating interpersonal relationships may follow. It is estimated that insomnia creates a significant economic burden on the healthcare system and a more costly impact through motor vehicle and workplace accidents, reduced productivity, lower job satisfaction, and absenteeism.
Although many initial episodes of insomnia resolve with time, they can form the basis for chronic insomnia. Considering the ensuing risks to psychological and physical health, early detection and treatment is important. Insomnia is also associated with a number of medical diagnoses, making it a good idea to consult with a physician on the matter. Still, comparatively few people who suffer chronic insomnia consult a healthcare provider and may delay treatment until the condition becomes more severe and persistent. This is unfortunate considering that there are effective medical and psychological treatments for insomnia.
There are several useful psychological interventions that support resumption of restorative sleep patterns. Regardless of the physical or psychological circumstances that may have provoked the initial sleep disturbance, there is evidence that insomnia is often maintained by poor sleep routines, which can be corrected through behavioural changes that create more sleep friendly practices. When mental and physiological arousal is a key feature of insomnia, effective interventions are available to down-regulate the level of daytime and night time arousal that interferes with good restorative sleep. This may include various practices that enhance mental and physical relaxation, or stress management.
Finally, it is well known that maladaptive thoughts and beliefs can contribute to onset and maintenance of insomnia. This often includes misguided negative thoughts about sleep disturbance itself, but may extend to the broader practice of engaging in maladaptive thinking in everyday matters that also plays a role in mood problems like anger, depression, and anxiety. This group of sleep enhancing strategies are components of Cognitive-Behavioural Therapy for Insomnia (CBT-I), which many psychologists and mental health practitioners are capable of providing.