Insomnia
What is insomnia?
Insomnia is an issue that negatively impacts our sleep, causing problems both at night and during the day.
Nighttime problems can include:
- Difficulties falling asleep at the start of the night (taking more than 30 minutes to fall asleep)
- Frequent or long awakenings throughout the night (waking up and staying awake for more than 30 minutes in total throughout the night)
- Early morning awakenings before your desired wake time, with difficulty falling back asleep
Daytime problems can include:
- Physical or mental fatigue – feeling exhausted and lethargic
- Negatively impacted mood, reduced enjoyment of activities, mild depression symptoms
- Difficulties with concentration or memory
- Reduced ability to function in important areas such as socialising, work performance, and other daily activities
- Some people may also experience increased levels of daytime sleepiness
If you experience these daytime and nighttime problems for 3 days or more per week, for 3 months or more, you may meet the diagnostic criteria for Insomnia Disorder (otherwise known as chronic insomnia). Even if you do not meet the full criteria, if your sleep is currently causing you a great deal of distress and negatively affecting your quality of life, you may be experiencing an insomnia issue.
How common is chronic insomnia?
It is estimated that around 10-15% of Australians, or as many as 1 in 7 people in Australia, meet the diagnostic criteria for chronic insomnia. This equates to more than 2.5 million Australians!
What causes chronic insomnia?
While acute or short-term insomnia can be caused by any number of one-off events or issues, such as jetlag, stressors, or major life changes, chronic insomnia usually occurs because we develop unhelpful behaviours and ways of thinking and feeling about sleep in response to these events. Over time, these behaviours, thoughts, and emotions can become habits, making it even more difficult for us to get a good night’s sleep.
There is also a biological component to chronic insomnia, in that some people inherit genes that make them more vulnerable to this issue.
Can I take medications for chronic insomnia?
In Australia and other developed countries, sedative medications are regularly prescribed by doctors as a first-line treatment for acute and chronic insomnia. Some common examples include benzodiazepines such as temazepam (Temaze) and diazepam (Valium), and ‘Z-class’ drugs such as zopiclone (Imovane), and zolpidem (Stilnox).
Although sedative medications are generally effective at improving sleep latency (how long it takes us to fall asleep), clinical guidelines recommend that these drugs are only used for short-term relief, due to a number of risks. These risks include risk of addiction (both tolerance and dependence), side effects such as morning grogginess, safety issues such increased risk of falls and fractures, and incidents of dangerous behaviours such as ‘sleep driving’. There is also the likelihood of experiencing ‘rebound insomnia’, which refers to insomnia that returns after these medications are stopped.
Sedative medications can also negatively affect the quality of our sleep by suppressing the time we spend in deeper stages of sleep. Deep (or slow-wave) sleep is responsible for many important functions, including tissue repair and regeneration, enhancement of immune function, brain detoxification, memory consolidation, and improved next-day mood, attention, and learning. Less time spent in deep sleep means less time for our brain and bodies to perform these crucial tasks.
Other than sedatives, many people also try melatonin supplements to address chronic insomnia. As a naturally occurring hormone in the body, melatonin is considered safer than sedative medications due to a lower likelihood of addiction, rebound insomnia, and impaired daytime functioning. Melatonin can also be helpful for resetting or realigning our body clock, particularly when we experience ‘jet-lag’. However, studies suggest that melatonin supplements tend to only have a minimal effect on sleep latency, duration, and quality, and are not recommended as a standalone treatment for chronic insomnia.
Are there other ways to address insomnia?
Lifestyle changes specifically designed to improve sleep (also known as sleep hygiene), can be helpful if you’re experiencing mild sleep difficulties. These can include:
- Creating an optimal environment for sleep (cool and dark)
- Avoiding caffeine and nicotine in the evenings and at night
- Avoiding alcohol use close to bedtime
- Avoiding heavy meals close to bedtime
- Avoiding exposure to bright lights, particularly blue-light, close to bedtime
- Engaging in regular exercise during the day
- Creating a wind-down routine or ‘sleep ritual‘ before going to bed
However, if you’re experiencing chronic insomnia, sleep hygiene alone is unlikely to be sufficient to address your sleep issues. Instead, there are specialised psychological approaches designed to treat severe and longstanding insomnia.
What is Cognitive Behavioural Therapy for Insomnia (CBT-I)?
Cognitive Behavioural Therapy for Insomina (CBT-I), is one such approach, and is recommended as a first-line treatment for chronic insomnia. CBT-I involves a thorough assessment of your sleep issue, psychoeducation about sleep, helping you to make positive changes to your sleep behaviours and routines, and giving you tools to manage thoughts and emotions that get in the way of a good night’s sleep. The approach has been developed to break the patterns and habits that contribute to chronic insomnia.
A large body of research has shown that CBT-I is safer and more effective than medications, both in treating insomnia in the short-term, as well as preventing relapse after treatment, with the improvements lasting months and even years into the future.
A standard course of CBT-I is delivered over 4-8 weeks, however this may depend on the complexity of your insomnia issue, and the presence of any other co-occuring psychological issues.
Other than CBT-I, examples of other psychological treatments for insomnia include Acceptance and Commitment Therapy for Insomnia, and various mindfulness based interventions.
I‘m taking sedative medications and have been for a long time. Can I still do CBT-I?
Yes you can. There is research to show that CBT-I is effective even while you continue to take sedative medications. If long-term use of these medications is a concern to you, we can also team up with you and your prescribing doctor on a plan to gradually wean off sleep medications (also known as a hypnotic discontinuation plan), whether during or after a course of CBT-I.
I have chronic insomnia but I don’t have any other psychological issues or concerns. Can I still get CBT-I treatment under Medicare?
Yes! Insomnia treatment is covered under Medicare’s Better Access Scheme, even if chronic insomnia is the only issue you’re seeking help for. This means that you can visit your doctor and request a Mental Health Treatment Plan (MHTP) and referral to a psychologist solely to address your sleep issues. Once you have the care plan and referral, you are eligible for Medicare rebates for up to 10 psychology sessions per calendar year.
Can I do CBT-I over telehealth?
Yes! There have been many studies showing that CBT-I over video or the phone is just as effective as CBT-delivered in-person.
Ready to tackle your chronic insomnia?
Phil is a registered psychologist with postgraduate and additional training in insomnia treatment. He has also supported many clients with their insomnia and sleep issues, including those with other common co-occurring conditions such as chronic pain, depression, anxiety, and nightmares.
Feel free to request a confidential, no-obligation phone call with Fluid Psychology by filling out our contact form or by sending an email to [email protected].