How many of you feel truly well-rested in the morning? How many can get to sleep within a few minutes of switching the lights off? How many remain asleep with no long and frustrating night-time awakenings? I’m guessing it’s a pretty small percentage.
We rarely receive education about sleep, and we rarely receive treatment for it. That’s despite the fact that we try to spend around a third of our lives doing it! The first step with any problem is always awareness, so I’d like to give a brief overview of two major types of sleep disorders – Insomnia and Circadian Rhythm Disorders.
Insomnia refers to a difficulty in initiating and maintaining sleep and occupies the confusing position of referring to both a condition and a symptom of other conditions. Many different mental health conditions can result in insomnia as a symptom, including Major Depressive Disorder and various forms of Anxiety disorders. As an independent condition itself, however, insomnia is often divided into three main categories:
Sleep Onset Insomnia refers to a difficulty in initiating sleep. Someone experiencing Sleep Onset Insomnia might find themselves restlessly tossing and turning while trying to get to sleep, or find their mind swarming with worries and concerns that felt trivial during the day but suddenly demand attention.
Sleep Maintenance Insomnia refers to a difficulty in staying asleep for the whole night. It’s worth mentioning that brief awakenings throughout the night are completely normal. Most people wake several times throughout the night, but often those awakenings are so brief, that they simply turn over, go back to sleep, and forget them entirely in the morning. What turns awakenings into a problem is when they last for 20 or 30 minutes. A couple of 30-minute awakenings a night starts to reduce our total sleep time by a significant amount.
Early Morning Awakening Insomnia, as its name suggests, refers to someone consistently waking up well before they’d like to.
The precise cause of insomnia can vary from person to person, and as such, so does the treatment. For some people, Sleep Hygiene tips can be sufficient for recovery, which will be the focus of a future blog! For others, they may require an intervention called CBT-i, or Cognitive Behavioural Therapy for Insomnia. This therapy can examine the thoughts and behaviours which underlie the sleep condition in more depth and provide strategies to manage both.
Circadian Rhythm Disorders
Circadian Rhythms are roughly 24-hour cycles that are part of our body’s internal clock. We have circadian rhythms for body temperature, the production of various hormones, and for our sleep-wake cycle. This sleep-wake cycle can get pushed back or delayed over time. A late night can lead to a sleep-in, which can lead to another late night, and before long, our sleep cycle might have been pushed back by two or three hours. Whereas previously we might have been out cold by 10 PM, now it is 1 AM, and we’re still awake, and we’re not feeling alert and awake until 10 or 11 in the morning. This is known as Delayed Sleep Phase Disorder. Our circadian rhythm can also become advanced or pushed forwards by several hours, leading to Advanced Sleep Phase Disorder. While this is rarer, advancement can be just as debilitating as a circadian rhythm delay.
Often, Circadian Rhythm Disorders are treated through Bright Light Therapy. This therapy involves using a bright light as a natural way of advancing or delaying our body’s circadian rhythm as needed. Other treatments include the use of melatonin, which is a naturally-occurring hormone that promotes sleepiness. Both treatments can form part of a CBT-i treatment plan.
Circadian Rhythm Disorders and Insomnia can often look similar initially, which is why it is important to discuss your symptoms in detail with a psychologist or other health professional. Sleep affects everything in life. Unfortunately, this also means that many different things affect sleep, and so determining the precise cause of a sleep problem requires careful assessment. However, treatments are available and effective, with CBT-i considered a gold-standard treatment for a variety of sleep conditions. If you are struggling with sleep, it is advisable to discuss options with your GP or book in to see a mental health professional with experience in the area.
If any activity is taking up almost a third of your life, it is worth making sure that you are getting the best experience possible.
Please feel free to continue to read about sleep and my Three Tips for Better Sleep Health here>