Insomnia and Other Sleep Issues

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 All of us have trouble sleeping from time to time. This is perfectly normal. Sleep problems (also known as insomnia) are often triggered by sudden life changes that lead to increased stress. For instance, following the death of a loved one, a car accident or a promotion to a new job, many people experience difficulties getting a good night’s sleep. This normal response to stress usually lasts for a short time, rarely longer than a week or two. However, some people have chronic problems sleeping which do not seem to go away. If you are one of these people, or you are having temporary insomnia, this information is a good start. It will give you some general information about sleep, as well as provide a number of helpful suggestions to aid those with sleep problems. Read it carefully, as many common sleep problems are caused by one’s own habits, and by adopting some of the following sleep-promoting behaviors, most people can get a good night’s rest without the aid of drugs. 

Taking sleeping pills is not the answer! For people whose only complaint is I can’t sleep well or I can’t get to sleep easily, taking sleeping pills may do more harm than good. Most evidence now recommends against the regular use of sedative drugs (like Ativan, Trazadone, Imovane, and barbiturates) for the following reasons: 

• Sedatives change nervous system activities during sleep; for example, they may reduce the normal periods of dreaming. 
• After taking sedatives for awhile and then stopping, many people report having sleep-disrupting dreams, which cause them to wake up feeling tired even after a full night’s sleep.  
• The human body develops tolerance to sedatives after their repeated use. After a while, you have to take more and more sedatives to make you feel sleepy.  
• A person can become psychologically dependent on sleeping preparations; if you are convinced that is the only way you can get a good night’s sleep, you will not be able to go to sleep without a drug. This is a dangerous pattern and can leas to other health issues down the line.

How Effective Are Sleeping Pills?

Studies show that sleeping pills aren’t all that helpful in promoting a good night’s rest. Most people who take sleep aids fall asleep about eight to 20 minutes faster than those without medicine. On average, you might get an additional 35 minutes of shuteye and that is it.  Generally, sleep aids should be for short-term use. They may be most helpful if a stressful life event, like a divorce or death in the family, is keeping you awake.  But once the stress has passed you want to stop using them as soon as possible.

Researcher suggest that 7-8 hours per 24-hour period is the most satisfactory amount. Generally, the amount of sleep required is an individual matter. Some people feel rested after 5 to 6 hours of sleep; others sleep 9-10 hours. Most adults sleep about 7 hours in a 24-hour period. Children sleep more than adults and, in most cases, the elderly sleep less than they did as younger adults 

 Many factors can cause sleep problems. Your medical provider will help you find the reasons why you have difficulty. Some common causes are: 

•  Stress: Any abrupt change in your life – such as adjusting to college or graduate school, the end of a relationship, or serious illness – can cause stress and, possibly, sleep loss. Stress-induced sleep loss may last several days but rarely more than three weeks. Medication is usually unnecessary for this condition. 
• Physical illness and psychological problems: Illnesses, particularly ones that cause pain, or problems breathing at night,  frequent urination, or leg cramping/spasms.  Talk to your doctor about treating these underlying causes of sleep disturbance. 
• Anxiety and Depression also are common causes of disrupted sleep. Often people with Anxiety have trouble falling alseep, while those with Depression may fall asleep easily but wake up in the middle of the night and have a hard time falling back to sleep. Counseling and/or medication for the anxiety or depression help the underlying problem usually help the sleep problem as well.. 

Sleep Hygiene refers to "good habits" to ensure you are setting yourself up for a good night sleep and not falling into the many traps that can interfere with a good night's sleep.

 Your Sleep Hygiene Checklist

• Stop pre-sleep electronic use- at least 1 hour of no screen time allows the brain to relax.
• Use bed only for sleep.  
• Remove naps during the day as these can cause you to sleep less at night.
• Keep a fixed bedtime and a fixed wake-up time.  This helps reset your circadian clock.
• Avoid caffeine and alcohol. Both of these substances can make it hard to fall asleep or can cause you to be woken up more easily through the night.
• Do relaxing activities pre-sleep. 
• Make a worry list so you don't have to keep all the worries in you head when you are falling asleep.
• Do quite slow activities pre-sleep, listen to quite music in a dim lit room or read a book, take a bath, doodle, write down your thoughts, play a guitar.
• Improve your sleeping environment by ensuring your room is dark, cool, comfortable and quiet
• Exercise at the right time. 
• Talk to your doctor about joining the OHIP covered Sleep Counselling Group in Collingwood 
• Learn about CBTi-Cognitive Behavior Therapy for Insomnia-this method of sleep psychotherapy has been shown to make the most significant impact on your quality and quantity of sleep.  Please see the resources below to learn how to find a CBTi Therapist which can be done remotely, or via an App on your phone.

 CBT-i, or Cognitive Behavioral Therapy for Insomnia, is a non-medication approach to treating insomnia by addressing the thoughts and behaviors that contribute to sleep problems. It is usually taught through a trained CBT-i Therapist and their are well recognized Apps that can also guide  you through the process.  It is usually an 5-6 week program and is considered the first-line treatment for insomnia.  CBT-i is considered to be one of the most effective, safe treatments for insomnia, with long lasting benefits. 

How CBT-i Works

• Addresses the Underlying Issues: CBT-i aims to address the factors that contribute to insomnia, including: 
  • Conditioned Arousal: The association of bed with wakefulness and anxiety. 
  • Sleep-Related Worries: Excessive worry about sleep and not being able to sleep. 
  • Ineffective Sleep Habits: Behaviors that may have initially helped with sleep but now hinder it. 
• Techniques Used in CBT-i:
  • Stimulus Control: Associating the bed with sleep and the bedroom with rest. 
  • Sleep Restriction: Limiting time in bed to improve sleep efficiency. 
  • Relaxation Techniques: Practices like deep breathing and progressive muscle relaxation to reduce anxiety and promote relaxation. 
  • Cognitive Restructuring: Identifying and changing negative thoughts and beliefs about sleep 
• Benefits of CBT-i:
  • Improved Sleep Quality: Helps people fall asleep faster, stay asleep longer, and feel more rested during the day. 
  • Reduced Need for Medication: Can help people reduce or eliminate their reliance on sleeping pills. 
  • Long-Term Benefits: The skills and strategies learned during CBT-i can be used to manage sleep problems over time. 

Who Can Benefit from CBT-i?

• People with Insomnia: CBT-i is effective for both short-term and chronic insomnia. 
• People with Co-occurring Conditions: It can also be helpful for people with other mental health conditions like depression, anxiety, and PTSD, as well as other health conditions like cancer. 
• People who are Taking Sleeping Pills: CBT-i can help people reduce their reliance on sleeping pills and to be able to stop them completely in many cases.

How to Access CBT-i

• Therapist-Led CBT-i: Working with a therapist trained in CBT-i can provide personalized support and guidance. 
• Self-Guided CBT-i: There are also self-guided CBT-i programs and resources available. 
• Mobile Apps: There are mobile apps like CBT-i Coach that can be used in conjunction with therapy or on their own. 
• Telemedicine: CBT-i is now commonly delivered remotely, making it more accessible.  

Links to CBT-i Resources

• CBT-i Canadian Therapists Directory:   https://cbti.directory/search-for-a-clinician/home-directory/usa/canadian-cbti-providers
• Insomnia Help Canada:  https://www.insomnia-help.net/
• Canada Sleep Research Consortium:   https://www.researchsleep.ca/insomnia
• Mobile Apps: CBT-i Coach, Sleep Reset, and Restful 

If you are still having a hard time falling asleep, here are some additional suggestions. You don’t have to do all of them, but choosing one or two will help most people get a good night’s sleep. 

• Get some exercise each day. Regular walks, bicycle rides or whatever exercise you enjoy will help you sleep better, as long as you avoid vigorous exercise right before bedtime. 

• Take a warm bath 45 minutes before bedtime. This will help relax tense muscles and set the mood for sleep. 

• Drink a glass of warm milk 30 minutes before bedtime. Milk contains an amino acid, L-tryptophane, used by the brain to facilitate sleep, or try an herbal tea (like chamomile or peppermint) with natural relaxing effects. 

• Learn relaxation/tension release exercises (like deep breathing or progressive muscle relaxation).

See notes below about how to do The Wave as a relaxation technique to try before bed.

• If you can’t fall asleep within 20 minutes of going to bed, get up and pursue some relaxing activity in another room, such as reading or knitting. Do not lie in bed fretting about getting to sleep. This is very important. 

• Return to bed only when you feel sleepy. After you have returned to bed, if you haven’t fallen asleep in 20 minutes, repeat the process as many times as necessary. 

• Set your alarm for the same time every morning regardless of how much you have slept. Although it may take a number of days, this will help your body develop a consistent sleep rhythm. 

• Look closely at your life and try to locate stressors that you can eliminate. Talk to a friend/family about these stressors and see what ideas they have about resolving them. Talking to a friend/family can be helpful medicine in itself for many problems. 

 The Wave is a progressive relaxation exercise for falling asleep. In this exercise you will be tensing your entire body, from your toes to your forehead, and then relaxing. This exercise will help you rid your body of tension that may be interfering with your sleep. 

1. Lay in bed and begin by paying attention to your breathing. Breathe deeply and concentrate on the words, in and out. As you breathe in, say in; as you breathe out, say out. Saying these words as you breathe can help keep your mind on deep breathing. If other thoughts come into your mind, don’t get upset, simply go back to the words in and out. The thoughts will pass away. 

2. Imagine a warm wave touching your toes. • Curl your toes as hard as you can. • Curl the arch of your foot, keeping your toes curled. • Tense your ankle. Do not relax your toes or arch, but keep adding tense body parts. • Tense your calves, holding your foot tense. • Pull in your stomach, and hold it. • Pull in your diaphragm, and hold it. • Holding your feet, legs and torso tense, tense your back and chest and shoulders. • Tense your arms and make a fist. • Tense your neck. • Press your eyelids and tense your forehead, frowning as hard as you can. • Tense your scalp. 

3. Hold the tension from head to foot for 5 seconds. Then release, allowing your body to relax, and breathe deeply. 

4. Repeat The Wave of tension and relaxation from toe to scalp at least 3 times. If you are particularly tense and have a very hard time falling asleep, you may want to do it 6 or 7 times. 

5. Each time you relax the tension, allow yourself to enjoy the fullness of your breath, riding your breath out, and just allowing the breath to flow back in. Repeat in your mind, in and out, in and out. 

6. Each time you relax, feel the weight of your body on the bed, and feel each part of the body, its warmth, whether it is tingling, whether it feels light and floating or heavy and dull. Then repeat this progressive tension exercise, like a wave up the body.