Article by Dr Ruth Dyson

Insomnia is defined as difficulty falling asleep or staying asleep, early morning waking or non-restorative sleep. People with insomnia may feel dissatisfied with their sleep and it often results in daytime symptoms such as fatigue, low energy, difficulty concentrating, mood disturbances, and decreased performance in work or at school. Based on duration it can be categorised as short term (less than four weeks) or long term (more than four weeks). Insomnia is common and can affect up to one third of the general population (1,2). It tends to become more prevalent with increasing age.

Insomnia may start in response to stress or another factor but then develop into a conditioned response so even when the initial causative factor is resolved the insomnia persists. The person begins to associate going to bed with insomnia and it can become a habit, a self-fulfiling prophaecy. Insomnia can also be secondary to an underlying condition for example; depression, stress, medications, alcohol, chronic pain, sleep apnoea or restless legs syndrome.

Symptoms associated with insomnia may be related to the lack of sleep itself or may be a sign of an underlying cause. It is important to take a full history to identify what may be causing the insomnia and give clues to how best to address the problem. Questionnaires can be used to assess the level of daytime sleepiness (the Epworth score) especially if a cause such as sleep apnoea is suspected. Tests may be advised to look for underlying causes e.g. blood tests to check iron levels in restless legs or thyroid function tests if someone is feeling aggitated.

The treatment of insomnia is to address any underlying medical causes and treat these appropriately. Pain should be adequately managed and treatment for other causes considered. If you feel an underlying medical condition is contributing to your insomnia then an assessment with one of our Integrated Medicine Doctors may help to address the cause and improve your sleep. Good “sleep hygine” with a regular bedtime routine, avoiding caffine and reducing or time-limiting the use of technology is essential and often helps to resolve the issue.

Stress is a major precipitating and perpetuating factor in insomnia. Hypnotherapy can help reduce stress and aid relaxation and hence is very valuable where stress is a factor. It can also help to break the habit of insomnia and create a positive expectation of improved sleep. Using self-hypnosis techniques can be very empowering and give a sense of control over your sleep patterns.  

References

Morphy,H., Dunn,K.M., Boardman,H.F. and Croft,P.R. (2007) Epidemiology of insomnia: a longitudinal study in a UK population. Sleep. 30(3), 274-280

The Great British Bedtime Report 2017 produced by The Sleep Council - https://sleepcouncil.org.uk/wp-content/uploads/2018/04/The-Great-British-Bedtime-Report-2017.pdf