Good Night, Sleep Tight … Don't Let Insomnia Bite!

Written By Amber Reed

Sleeping - everybody does it, but it comes more easily to some than to others. Up to 70 million of American adults (NIH) and up to 50% of children (American Academy of Family Physicians) struggle with falling and staying asleep. Consequently, they are not getting sufficient or good quality sleep. A sleep disorder diagnosis is given when the symptoms persist over time and are significant enough to affect physical, emotional, or cognitive well-being. There are a variety of sleep disorders and it can be hard for a layperson to know if their sleep problems are a variation of a normal and age-appropriate sleep pattern, or if they have a sleep disorder. It is therefore recommended to discuss sleep concerns with a healthcare professional who can help provide referrals for treatment if it is considered necessary. 

In this blog post, I will focus on insomnia. We often use the term loosely when we “don’t sleep well”. The clinical definition, however, is quite specific:

  • Insomnia is considered to be a 24-hour disorder with symptoms manifesting at night as well as during the day. 

  • The main nighttime symptoms include difficulty falling and staying asleep, waking frequently during the night, and waking up too early. 

  • In the daytime, the lack of sleep causes the person to feel tired, have difficulty focusing and making decisions, and affects the overall mood negatively. 

  • “Acute insomnia” describes a short-term sleep disorder where symptoms are present less than three months.

  • “Chronic insomnia” is diagnosed when the symptoms are present at least three nights a week for a minimum of three months. In addition, the negative daytime symptoms must significantly impair a person’s functioning (e.g. family, social, work) in the daytime.

According to Walker et al, “ chronic insomnia is the most prevalent sleep disorder, occurring in approximately 6–10% of the population, and is a risk factor for multiple medical and psychiatric disorders.“ Unfortunately, many people wait years before seeking help from a sleep specialist. Instead, they try different (ineffective) strategies, among them are sleep hygiene and hypnotic medication (sleep aids).  

While sleep hygiene is a necessary part of the treatment, it is not a sufficient treatment for Chronic Insomnia. Generally, it is a good first step to find out if making minor changes can solve the sleep problem. Therefore, sleep hygiene is an appropriate approach if a person has mildly disordered sleep that doesn't interfere with their well-being and functioning in a significant way.

Many people who experience difficulty falling and staying asleep, rely on over-the-counter and prescription sleep aids. However, sleep aids are a) intended for short term use (4-6 weeks) only and b) not an effective long-term solution. People tend to stay on sleep medication because of a psychological dependence (fear of even more disordered sleep without the medication), not because their sleep is improved. 

The American College of Physicians’ (ACP) 2016 recommendation for chronic insomnia states that “all adult patients should receive (Cognitive Behavioral Therapy for Insomnia) CBT-I as the first step in treatment. If CBT-I alone does not help to improve insomnia, patients and clinicians should discuss medicines.” (Qaseem et al., 2016). You may not have heard of Cognitive Behavioral Therapy for Insomnia and wonder what it is:

CBT-I is a highly effective, evidence-based, short-term treatment (6-8 sessions) and produces positive changes for some after only 2 sessions (Stanford Healthcare). The treatment involves identifying and changing sleep-related behaviors that perpetuate difficulties initiating and/or maintaining sleep. In my practice as a psychotherapist who is trained in CBT-I, I have seen first hand the positive impact on my clients’ sleep and sense of overall well-being.

Again, please speak to your physical health or mental healthcare provider if you are struggling with significant sleep problems. While many sleep problems (such as chronic insomnia) are treatable, some sleep disorders can lead to serious health problems if they aren’t treated. If you are ready to “sleep tight and not let insomnia bite” and would like to find out if CBT-I is the right treatment for you, you can book sessions here.

Resources: 

Amber Reed
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