Insomnia Treatment

Insomnia is a frequent and persistent difficulty in initiating or maintaining sleep that results in general sleep dissatisfaction, impairment in daytime function and occurs despite adequate time and circumstances each night to obtain necessary sleep. It can be ongoing or short-term, in isolation of or caused by daytime stressors, mental disorders, medical conditions or substance use. It is a psychological issue that can usually be solved by a change in routine or behaviours during the day.

A single night sleep study is not able to diagnose insomnia, but it can be a useful tool in evaluating how close someone’s perceived sleep is to their actual total sleep time. Some people have highly disrupted sleep that they misperceive as being awake throughout. A level 1 or 2 sleep study is the only way to accurately determine total sleep time as well as the distribution of sleep stages.

Sleep is closely linked with overall health. If you don’t want to get into the specifics, the general rule of thumb is doing healthy things will give you the best chance of a good sleep. Exercise, eating right and lowering stress are all key to achieving a better sleep.

• Regular exercise helps to lower stress levels and has been proven in many studies to significantly aid sleep onset and duration. At least some light exercise should be performed daily but any vigorous exercise should be avoided within an hour of going to bed.
• Managing or reducing stress during the day can greatly help improve sleep. Stress and poor sleep have mutual causality; if going to bed is a stressful experience because you expect to struggle to sleep, it will lessen your likelihood of getting to sleep, which will increase your stress.
• Keep a healthy, balanced diet. Vitamin B, magnesium and protein are all important to have during the day. These are found in foods such as dried fruit, wholemeal bread, cereals, lean meats, poultry, eggs, seafood, dairy products, nuts and seeds.
• Drink water throughout the day. The recommended daily intake for an adult is around 1.5 litres.
• Reduce stress; this can mean practising meditation or mindfulness, having good time management during the day, or not wasting your time lying in bed worrying about the day or what you are going to do tomorrow.
• Yoga (or at least stretching); stress can take the form of muscle tension. Light stretching can alleviate some of this tension and allow you to fully relax your body and mind.

Sleep hygiene is about setting a routine of best practices to allow yourself the best chance of getting a good sleep every night. If you struggle to fall or stay asleep, behavioural modifications to your daily routine may be all you need. Changing routines can take time and require good discipline. There are many ways to improve your sleep hygiene.

Force your brain to associate bed with sleep:

• Maintain a regular bedtime schedule; this means having a set bed time every night, including weekends, and a set wake-up time, at which time you get out of bed and not lie in.
• Use your bedroom and especially your bed only for sleep; you want your brain to associate going to bed with sleeping, not watching TV or scrolling the internet. Sex is the only exception to the rule, the serotonin produced and stress release actually aids sleep. If your bedroom is your only space for working or relaxing, some form of division between the work area and the sleep area can suffice.
• If you haven’t fallen asleep within about 20-30 minutes of going to bed, get up and do something relaxing in dim light until you feel sleepy again. Don’t watch the clock and stress about getting this timing exactly right. It will be annoying and take discipline to practice this, but after a week or two it will help train your body to associate bed with sleep.

Give yourself the best conditions for sleep:

• Your sleeping environment should be comfortable and quiet. If there is persistent noise that is outside of your control, consider sleeping with earplugs or a white noise generator.
• Stay away from screens and bright lights at least 30 minutes before bed; any form of bright light suppresses melatonin (the key hormone for sleep).
• Find ways to calm yourself as your regular bed time is approaching. Don’t watch any scary or thrilling movies before bed, as this increases adrenaline. Try an oil diffuser (camomile, lemon balm, lime, rosemary, sandalwood, lavender or jasmine).
• Take a warm shower or bath before bed; your body’s core temperature reduces after getting out of warm water which your brain associates with night time and will naturally fall into sleep easier.
• Air room; open a window for ten minutes before going to bed and after waking in the morning. Stuffy air is high in carbon dioxide and relatively low in oxygen which leads to more awakenings as the brain is not working as efficiently. Studies have shown a well-ventilated sleeping environment leads to better sleep and subsequent improvement in logic tests.
• Cool room temperature; hot rooms are not conducive to a good sleep as the body needs to reduce its core temperature by around 0.5-1⁰C to enter REM sleep (Dreaming state which is the most important sleep stage). Too cold a room will wake you from REM as the most of the body’s muscles are not functioning, meaning the body is unable to shiver. Anywhere between 15-20⁰C will provide the best chance for quality sleep.

Watch what you consume:

• Avoid aged and processed meats, cheese, soy products and over-ripe fruit before bed as these contain tyrosine, tyramine or glutamate which all stimulate our awake hormones.
• Foods that aid sleep include skinless poultry, leafy green vegetables, mushrooms, nuts and milk as they contain tryptophan which is turned into serotonin which is key for the production of melatonin which is what makes us sleepy.
• Limit stimulants; a maximum of three cups of coffee a day and none after 4pm. Cigarettes are also a common stimulant and reduce the quality of sleep. Caffeine is also found in most teas and chocolates.
• Limit alcohol intake; alcohol may help with sleep onset but it suppresses REM sleep, shortening sleep duration and increasing sleep disruptions in the second half of the night. Alcohol is also linked with worse sleep apnea symptoms.
• Infusion teas such as lemon balm, camomile or verbena can be relaxing and contain no caffeine.