Insomnia: All in the Mind?
News reports and magazine articles are constantly reminding us of the importance of a good night’s sleep for our health and life expectancy. While this is common sense, it is of little help to the many sufferers of insomnia enduring a seemingly endless struggle to get exactly that – a deep, restorative, sleep all night long. And therein lies the problem for many of my clients. They are worn down and defeated - and to them, the prospect of achieving what should be a natural process has begun to feel unobtainable.
Fortunately it is possible to overcome insomnia, which affects at least one in ten people in the UK. They may find it hard to fall asleep, wake up in the early hours of the morning, or wake up many times in the night, possibly for long stretches. This can lead to feeling exhausted, tense and irritable. Insomniacs typically wake up feeling deprived of a refreshing night’s rest. They may become increasingly worried about sleep deprivation and the effect it has on their lives.
A Google search will provide useful information about ‘sleep hygiene’ – such as avoiding screens and other stimulants, creating a cool comfortable sleep environment, setting regular sleep times and a bedtime routine. Deep body relaxation and breathing exercises are also highly effective. However, from a CBT (cognitive behavioural therapy) perspective, the cycle of worry - which may escalate to become anxiety - is the focus, and the likely root of the problem.
Millie came to me feeling exhausted and stressed. ‘I just have to get a good night’s sleep, it’s unbearable! I lie awake all night, my mind racing, and the next day I just can’t function, I dread going into work, I just can’t stand this any more. I don’t know what’s happened to me.’
Reading Millie’s perspective on her insomnia provides a telling insight into her state of mind. She is not only putting herself under immense pressure to sleep well every night, but her assessment of how bad it is when she doesn’t is extreme. She is also reinforcing messages to herself that she absolutely can’t bear this situation and has changed into someone she no longer understands.
In this case, anxiety about sleeping extends into a vicious cycle, creating stress during the day, and at night, feelings of restlessness, clock watching, and exasperation, culminating in a building pressure and demand that ‘sleep has to happen!’ And if not, it all feels rather pessimistic and hopeless.
The sense of threat induced by this way of thinking remains simmering beneath the surface. The original source of the sleep disruption – perhaps a fear of redundancy, exam stress, relationship or financial difficulties – may also impact on the mind and body, creating an additional layer of disturbance. Even when sleeping, it can catapult us into wakefulness, with adrenalin rushing through the body putting us on an instant high alert. The heart beats loudly; the mind races. Drifting back off to sleep feels like a struggle
Luckily there are effective ways to change this. Explaining to Millie that her ‘beliefs’ about insomnia and her way of thinking about it were blocking her helped her to understand that a less pressured, flexible stance would create a calmer, more constructive approach that might enable her to manage the situation better. She agreed that it didn’t make sense to demand perfect sleep every night, as this was simply not possible – and ultimately made it less likely.
Together, we developed a healthier belief based on wishing for a good night’s sleep while accepting that it may not happen. Furthermore, Millie began to see that in reality, although bad, her case was not hopeless. She could cope because she still functioned the following day and did manage to catch up at some point. If she has a bad night, she relaxes and gets some sleep even if it’s not as much as she would like. She can remind herself that she is someone who has slept well in the past and this is just a phase she is going through; one from which she will move on.
CBT follows a process that helps integrate new ways and bring about desired changes.
Everyone will have different reactions to their insomnia but it’s encouraging – and to most people, a relief – to find that they can be helped through CBT. It increases confidence in their ability to train the mind and body to cope with sleep issues. The reinforcement of a healthy new way of thinking about sleep also prepares the way for techniques such as mindfulness and self hypnosis to help calm the mind, override the chattering mind and let go of thoughts.
Out of interest, I recently asked my son, who sleeps deeply every night, no matter how stressed he is - and goes straight back to sleep if he wakes up in the night - how he does this. He said, ‘I just lie there and don’t think about it’. Bliss! And possibly more achievable than you may have thought.