What to know about insomnia

Sleep is as vital to good health as physical activity, but finding the land of nod is a regular – and debilitating – battle for those with insomnia.

For more than 40 years, Pete Dillon has struggled with sleep – and it’s more than a mild case of bedtime blues.

“About four or five out of seven nights I have a bad sleep,” the 52-year-old says.

“Once I’m awake, I’m awake for hours. I get agitated that I can’t go to sleep, but the more I get annoyed, the harder it is to go to sleep, so I try to put it out of my mind.”

Last year, Pete was diagnosed with post-traumatic stress disorder stemming from childhood trauma – a likely cause of his insomnia.

But he is far from alone when it comes to serious sleep problems.

Almost 40 per cent of Australians report regular sleep troubles, says the Sleep Health Foundation. And of those, nearly 15 per cent have issues severe enough to possibly result in a diagnosis of insomnia.

People with insomnia may find it difficult to fall asleep, stay asleep, or to sleep for as long as they would like – or possibly all of these problems.

What causes insomnia?

Reasons for disrupted sleep are many and varied, including:

  • Poor sleep hygiene
  • Substances such as caffeine, nicotine, alcohol, amphetamines, some prescription medication
  • Stress
  • Medical issues
  • Mental health problems
  • Shift work
  • Sleep disorders such as sleep apnoea
  • Life stage (elderly people are more likely to experience insomnia)

How is insomnia diagnosed?

Insomnia is not about the hours of sleep someone gets each night.

“The diagnostic criteria include difficulty getting to sleep and/or maintaining sleep, and/or having non-restorative sleep – so getting some sleep but not feeling refreshed,” says Sleep Health Foundation psychologist Moira Junge.

“It has to (occur) at least three nights a week, for around three months, before we call it insomnia, and it must be causing marked distress, and interfering with occupational and/or social functioning, and all of this in the context of adequate opportunity for sleep.”

How insomnia affects health and wellbeing

The inability to sleep can have a significant impact, including:

  • Struggling to stay alert during the day
  • Irritability, depression or anxiety
  • Difficulty paying attention, focusing on tasks or remembering
  • Increases in errors or accidents
  • Ongoing anxiety about sleep

Some people may adopt specific rituals around promoting sleep.

“A lot of people, by the time I see them, they’ve given up every skerrick of caffeine, alcohol, they won’t go anywhere late at night, won’t watch a movie after 9pm, they have to bath at a set time – they’re doing all these things, but still in some cases haven’t slept well in, say six years,” says Moira.

Pete says he usually needs caffeine in the morning, but won’t drink coffee or tea after midday.

“Thankfully I’m self-employed, so I’ve got a bit of flexibility in my day,” he says.

“A powernap helps, but it can also be a challenge because then I’m less likely to sleep at night.”

Treatments for insomnia

Experts recommend reducing caffeine, getting regular exercise, having a regular sleep time and dimming your lights before bed to promote sleep.

“I’ve got a couple of playlists I listen to, which can help, or if I read a really dull book I’m able to get off to sleep,” says Pete.

But Moira says while good sleep hygiene practices are useful for most people, they may actually contribute to anxiety for someone debilitated by chronic insomnia.

“They’ll already have tried a lot of these things so it ramps up their hyperarousal, they get really worried nothing’s working,” she says.

Cognitive behavioural therapy for insomnia

Moira says the gold standard for treating sleep disorders is cognitive behavioural therapy for insomnia (CBTI).

CBTI aims to remove the anxiety around sleep by challenging people’s dysfunctional expectations and restricting the amount of time spent in bed, to more closely align with time spent sleeping.

“You don’t try to go to sleep, so sit up as late as you can until you’re really tired – don’t look at the clock, don’t worry about getting eight hours – sometimes I instruct people to only be in bed for six hours, and then we can gradually increase time in bed as the sleep starts to improve,” says Moira.

“Then it’s learning how to manage stress and anxiety in general – and the aim is to not be focused on hours of sleep per se, but the quality of the sleep and not being too distressed and preoccupied by their sleep.”

Medications for insomnia

A range of medications are used to assist sleep, but Moira says it’s important to realise none are designed for long-term use.

“They’re designed to be used short term or intermittently,” she says.

Medication may also be used in combination with CBTI, with the goal being to phase out the medication within just weeks or months.

Where to get help for insomnia

You could try online therapies such as free CBTI program This Way Up, or chat with your GP who can refer you to a sleep specialist.

The Australasian Sleep Association and the Sleep Health Foundation have directories of sleep specialists.

More sleep advice:

Written by Claire Burke.