Conditions associated with insomnia
Did you know that it is far more common for insomnia to be associated with another problem than it is for it to occur on its own? Up to 10% of the population have insomnia, a sleeping problem characterised by difficulty falling or staying asleep and causing daytime fatigue. Research has shown that in up to 90% of cases, insomnia co-occurs with another psychological or medical condition. The most commonly associated problems are described below. If you think you might be experiencing any of these issues, consult a health professional as soon as possible.
Trouble sleeping is one of the symptoms of depression and to make matters more confusing, sleeping problems can also lead people to become depressed. It’s the old chicken or the egg conundrum. Until recently, insomnia was classified as a primary or secondary condition. Primary insomnia referred to insomnia that was not associated with any other problem or condition, and secondary insomnia referred to insomnia co-occurring with another disorder or issue. The term ‘secondary’ led to the assumption that insomnia was a symptom of another problem and if the primary problem was treated, the insomnia would resolve itself. However, research now suggests that insomnia may precede some problems like depression and that no matter how it begins or what condition it is associated with, insomnia requires its own evidence-based treatment alongside treatment for any co-occurring problems or disorders. Sleeping patterns for individuals with clinical depression include trouble falling asleep, but the most common issue is waking up too early and/or not being able to get back to sleep. Other symptoms of clinical depression include: changes in appetite, low energy, fatigue, low motivation, low mood, not enjoying things you used to enjoy, withdrawal from others, feelings of guilt and hopelessness, and thoughts of worthlessness and suicide. If you are experiencing these symptoms, see your GP or a mental health professional like a psychiatrist or clinical psychologist who can assess your symptoms, and recommend the appropriate treatment which should include psychological therapy and possibly anti-depressant medication. If you have suicidal thoughts, even for only one day, seek assistance immediately to ensure your safety and to receive the appropriate support.
Anxiety and Stress
Anxiety is often characterized by excessive worry and is one of the main culprits interfering with our sleep. When worry leads to problems sleeping, you feel fatigued during the day, which makes you feel less capable of dealing with life’s demands resulting in even higher levels of anxiety and stress. There are a number of strategies to break the stress–sleep cycle including: relaxation exercises like progressive muscle relaxation, dealing with worries during the day rather than letting them flood your brain at night, and ensuring you are attending to your self-care needs to keep your stress levels as low as possible. Often insomnia is actually maintained by worries associated with your sleeping problem. These concerns can be grouped into two categories: Judgemental thoughts about your inability to get to sleep and worries about what will happen if you can’t get to sleep.
“I’m never going to be able to sleep!”
Not with that attitude. Pessimism is not going to help. In fact, the belief that you will be able to sleep, or sleep self-efficacy, is linked to lower severity of insomnia and better outcomes in treatment. Replace your thought with something more realistic like, “I have the information and tools I need to get to sleep” or “I am working on getting a better night’s sleep.”
“I am the worst sleeper!”
Labeling yourself as a loser in the sleep department is self-defeating; if you are finding replacing your thoughts with more realistic ones difficult, then you can use the mindfulness technique of just noticing when you are having the thought and then noticing that thought being replaced by another, without getting involved or attaching too much meaning to the thoughts themselves.
“I’ve been awake FOREVER!”
It probably feels like forever, but this is highly likely to be an exaggeration of the facts. Focus on making your environment as sleep-friendly as possible and remember that you can still benefit from resting calmly.
“I hate this!”
Fair enough. Not being able to sleep can be extremely frustrating. But working yourself up into an emotional state is counterproductive. Calm yourself down by doing breathing and relaxation exercises.
Worries about how you will cope the next day
“I have to get to sleep (or else)!”
Putting yourself under pressure is the opposite of the mindset that prepares you for falling and staying asleep. Tell yourself that you can cope whether you get sleep or not. This is likely to take the pressure off, putting yourself in a better position to have a good night’s sleep.
“I can’t function without sleep!”
Not only can your thoughts be unhelpful, but they are often inaccurate. Remember, your beliefs are not facts. You may not be at your best with little to no sleep, but if you had an objective look at your ability to cope in the past, you will most likely find that you have been able to function to an adequate degree in at least some areas in your life. If you can dispute this thought effectively, then you are likely to feel less anxious and stressed about the next day’s work/home/life demands. And, if you’re less stressed, you might even be able to get some sleep!
In some cases, this thought may be accurate. If so, you won’t solve your problems by worrying about them at night. Prepare for this during the day by planning what you will do if you are not able function well enough to complete your usual responsibilities. Being prepared for this possibility will reduce your worries about it at night, and put you in a better position to fall asleep.
You can also try replacing these counterproductive thoughts with some of our positive sleep affirmations.
Stimulants contained in food, drinks and other substances interfere with sleep. Well-known stimulants like caffeine (coffee, tea, fizzy drinks) and high doses of nicotine (cigarettes) can keep you up at night. Alcohol is often used to induce sleep but this is counterproductive, as it usually leads to restless and disturbed sleep throughout the night.
But, there is another substance that can be detrimental to getting your sleeping back on track—sleeping pills. Sleeping pills are part of a class of prescription medication called benzodiazepines, the most common being Valium. These medications can be helpful for short-term sleeping problems that may occur due to specific stressors like the death of a loved one, a stressful incident or severe jet lag. But for longer term insomnia, sleeping medications do not address the factors that are causing or maintaining the problem. Furthermore, the recommended maximum duration of use for this class of drugs is two weeks. Unfortunately, many people take them for much longer than that, which can lead to increased tolerance and dependence. Continued use will also interfere with strategies that you implement to train your body to adopt a healthier sleeping pattern. If you have been prescribed a benzodiazepine by your treating doctor, make sure that you are taking them as prescribed. If you want to reduce or cease your use of this medication, only do so under the supervision of your treating doctor or psychiatrist. It is not recommended to cease long-term use suddenly or by yourself as you may experience severe withdrawal effects.
If you are prescribed any over-the-counter medications, ask your doctor or pharmacist if they can lead to sleeping problems. In addition to prescription medication, illicit substances are also detrimental to your sleep functioning. If you are using any medications or substances, it is important to disclose this to your treating doctor so they can fully assess the impact of these substances on your problems sleeping. You may need to consider treatment for substance use or dependence as a pathway to improving your sleep.
Another Sleep Disorder
Sleep apnea is a sleep disorder involving interrupted breathing (usually for 10 seconds to one minute) until the person wakes up in their effort to breathe again. This disorder often affects older adults, particularly those who have gained weight and lost muscle tone. Loud snoring, feeling groggy when you wake up, and feeling tired during the day are common symptoms of sleep apnea. If you suspect that sleep apnea is disrupting your sleep, speak with a health professional immediately, as this can be a life-threatening issue. Also be sure that you do not take any sedative medications or substances before sleep as this may prevent you from waking to resume breathing.
Everyone knows what it feels like to have a bad dream and it’s normal to have a nightmare now and then. However, some people may experience severe disruptions to their sleep due to recurrent and vivid nightmares. There are ways to alter the impact of your nightmares by writing them down and then re-scripting them (often with an alternative pleasing ending) and then rehearsing your new version while you are awake. This process both exposes you to the nightmare making it less scary and anxiety-provoking, and it prepares your mind to modify the nightmare when you’re sleeping so it doesn’t cause distress and wake you up. Nightmares can be associated with a history of trauma and are a common symptom of post-traumatic stress disorder. If this is the case for you, consult a mental health professional who specializes in trauma to assist you with this and other associated symptoms of trauma.
A Medical/Physical Condition
Sleeping problems often co-exist with other medical and physical problems and illnesses including pregnancy, chronic pain, Alzheimer’s disease, Parkinson’s disease, cancer, heart disease, stroke and head injuries. Insomnia may be; a byproduct of physical discomfort caused by the condition, due to the brain changes associated with the condition, and/or a side effect of medications taken to treat the condition. Consult a health professional to ascertain the causes of your insomnia and ensure that appropriate attention is given to treat insomnia alongside your medical or physical condition.
Please note: This article is not to be used as medical advice. Please consult a medical professional before using any sleep treatments. This post may contain affiliate links.
Dr Lillian Nejad
Lillian is a clinical psychologist at Omnipsych and author of LIFEBLOCKERS: The Sleep Edition (2018) providing the latest research-backed strategies to overcome insomnia. She has also produced the relaxation CD, “Relaxation: Techniques to Reduce Anxiety & Stress and Enhance Well-being” and co-authored the book, Treating Stress & Anxiety: A Practitioner’s Guide to Evidence-Based Approaches.