Insomnia is a term used to describe when someone has difficulty initiating sleep or maintaining sleep. Most Australians will report insomnia at some point in their lives and at any one time, 30% of Australians are describing symptoms of insomnia. Insomnia is so common that it can be regarded as a natural part of life to some extent, but when it causes stress and trouble, it can be assessed, investigated and more often than not, treated effectively.
The emergence of the 24-hour society whereby we have less recreation time, are surrounded by distractions, light and noise, and the ability to entertain ourselves on our computers means that average sleep times are decreasing and good sleep habits are being forgotten. Insomnia treatment revolves around recognition of these factors and teasing out the causes that are relevant to you.
Insomnia has many faces. Some people are so overwhelmed by insomnia because it is so deeply ingrained. They may be completely addicted to tablets and certain habits which may in fact be counter-productive and haven’t provided them a cure. Other people will have worsening insomnia at certain times of stress. Typical groups affected by insomnia include women going through menopause, individuals going through bereavement or a life crisis and professionals who work indoors, particularly over the winter period.
It’s important to differentiate whether the insomnia is of a short duration or longer duration, what treatments have been trialed and what lifestyle and thought processes may be contributing to it. Looking at sleep patterns and identifying triggers and perpetuating influences on poor sleep is at the heart of insomnia assessment. From there, a treatment plan is formed to tackle the contributory and perpetuating factors, sometimes tackling them one by one. Often insomnia is linked in with other sleep disorders, such as snoring, poor sleep habits, sleep apnoea or restless legs. Sleep testing is usually performed at some stage to look at the interaction between these and to identify other factors which may contribute to insomnia. Other health issues that may impact on sleep can be addressed and improved such as hay fever, asthma, musculoskeletal and back discomfort, pain syndromes, depression, passing urine overnight, breathlessness, etc.
An appropriate treatment plan for insomnia is determined by the contributory and perpetuating factors mentioned above. It usually involves working with a sleep psychologist or sleep counsellor, overcoming medical factors, excluding other components such as sleep apnoea, in addition to improving habits and thought processes which are conducive to a better night’s sleep. The latest effective treatment is cognitive behavioural therapy (CBT), which has been shown to cure or improve people 80% of the time and get them off long term medications. Working with a sleep counsellor or sleep psychologist is therefore usually part of the treatment program. A review by a specialised sleep psychiatrist or neurologist to look for overwhelming anxiety or depressive symptoms is sometimes required.