Insomnia

Insomnia

Insomnia is defined as a lack of sleep quality that begins to negatively affect your activities during the day. Insomnia can be acute where it only lasts for a short period of life all the way through to chronic which could last for years or in some cases be a lifelong issue. The severity of the condition can also be classified into mild, moderate and severe with mild insomnia only causing minor issues during the day and severe insomnia becoming extremely debilitating.

Insomnia that is caused by an existing health condition is referred to as 'Comorbid Insomnia'. For example, a person may be suffering from Sleep Apnoea which causes them to stop breathing during the night and as a result they are not sleeping properly.

Some people have more difficulty falling asleep in the first place which is called 'Onset Insomnia' whilst others struggle to remain asleep for a full night of rest and this is a called 'Maintenance Insomnia'. A person with maintenance insomnia may wake up in the middle of the night and be unable to fall asleep again.

If any of those sound like you then continue reading for more information.

What Does Insomnia Feel Like?

Most of us have had a bad sleep at least a few times in our life. Insomnia obviously makes people feel tired and fatigued. They are likely to feel unrefreshed in the morning and this can negatively affect their mood so they may seem grumpy or unhappy. If the insomnia continues, they may eventually experience despair and depression. Someone suffering insomnia may have difficulty performing tasks that require focus, attention or memory. They may fall asleep during the day and be preoccupied with thoughts concerning their inability to have a restful sleep. It is somewhat of a downward spiral so if someone you know has insomnia, please try to understand what they are going through and that their bad mood is not personal. Encourage them to seek professional help and actively participate in their sleep therapy programme.

What Causes Insomnia?

Insomnia has many causes and may exist alongside other health conditions.

Some of the conditions most associated with insomnia include:

If there is no clear cause for insomnia, then it is labelled as 'Primary Insomnia'.

How Does Insomnia Affect our Health?

Insomnia can have so many negative effects on our health. It reduces our overall quality of life as we are not able to feel refreshed and rested.

Some common symptoms may include:

Will Insomnia Go Away?

In some cases, insomnia only lasts for a short period. It could be that you go through a stressful period of life and once it passes your insomnia also goes away however for some people insomnia lingers and becomes chronic. In these cases, it's unlikely to go away without finding the cause and working with specific strategies over longer periods of time to address the issues. If you have been having trouble getting to sleep or staying asleep more than three nights a week for three months, then you are entering chronic insomnia territory and need to seek professional help.

Should I Use Drugs to Treat Insomnia?

The short answer is No. It's best to avoid using drugs to treat insomnia where possible. The class of drugs commonly used to treat insomnia are known as Hypnotics. These medications are used primarily to initiate, sustain or lengthen sleep. In cases of chronic insomnia, your doctor may prescribe you these drugs to help you sleep however it is best to exhaust all other possible solutions before trying drugs. An article published in Sleep Medicine Review (2019) found that whilst there is an increased risk of mortality associated with regular use of hypnotic medications, there is no increased risk of mortality from experiencing insomnia. The authors suggest the use of Cognitive Behavioural Therapy in the first instance to deal with the reality of suffering from insomnia.

Which Doctor Should I See for Insomnia?

Your GP is always the first person to approach if you have a health condition such as Insomnia. They will be able to assess you and decide if you need a referral to other sleep specialists. There are services available that can conduct a very thorough study of your sleeping patterns which you may need to have done if you continue facing insomnia issues. Sleep studies can be carried out at a location specifically designed to monitor your sleep. Less thorough studies can be done with equipment that you can install at your home.

Why Do Women Experience Insomnia During Pregnancy?

Insomnia is quite common during pregnancy especially in the first trimester. There are many symptoms that a woman is experiencing that can contribute to sleep issues such as nausea, cramps, abdominal discomfort, heartburn and frequent urination to name a few. Some hormones also fluctuate drastically during this time which can affect sleep quality. In addition, there may be some anxiety related to the pregnancy, birth and the reality of caring for a newborn child. This is a major life change and it's natural for a certain degree of concern however if you are having major issues that are negatively impacting your life then speak to your GP and a psychologist if necessary.

Why Do Women Experience Insomnia During and After Menopause?

The hormone balance in the body is one of the ways that the body regulates its sleep patterns. During menopause, the female body ceases the production of the hormones oestrogen and progesterone and this affects the overall hormone balance. It's quite common for post-menopausal women to be less satisfied with their sleep. Some of the treatment options for post-menopausal insomnia include hormone replacement therapy, nutritional supplementation and sleep medications. It's important to see your GP for a diagnosis and treatment recommendations.

Can Insomnia Kill You?

There are very rare cases where people have been unable to sleep due to a specific health condition (fatal familial insomnia) and this has led to death however in most cases insomnia will not be the direct cause of death. Chronic insomnia can lead to a breakdown of your health and this could indirectly cause death due to accident, suicide or the failure of a bodily system. Whilst Insomnia is not usually fatal, it needs to be taken seriously and treated as soon as possible so if you or anyone you know is suffering from chronic insomnia please seek professional help immediately.

How Can I Sleep Better?

There are many practical things that can affect your sleep quality. Let's start with the basics.

Reduce or Eliminate Noise

Noise can obviously affect your ability to get a good night's sleep. If you live in a noisy area, you may need to invest in some good earplugs to help you block out the noise that is preventing a restful sleep.

Reduce or Eliminate Light

You may live near light sources such as streetlights that are entering your sleeping area. If this is the case, you will either need to invest in a block out blind or at the very least buy a comfortable eye mask. Light is one of the main factors that regulates your sleep and wake cycles so don't underestimate its effects.

And what about the light sources from within your house? Using your phone or other devices just before bed can negatively impact your sleep so install a blue light filter on your devices and try to have an hour or so without using your device prior to retiring.

Increase Comfort

Ok, so now you have created a dark and quiet sleeping environment but are your comfortable? We all have different preferences when it comes to our mattresses. If you have eliminated other negative influences and are still having issues sleeping it may be necessary to purchase a new mattress. You may find your current mattress too hard or too soft or perhaps it's just sagging with age and needs to be replaced.

Another major factor with sleep comfort is your pillow. Don't be afraid to spend a bit of money on a good pillow. Regular restful sleep is extremely valuable and will pay for itself many times over.

Exercise During the Day

Getting a good amount of exercise during the day can help to ensure that you are tired by the end of the day. You may have a job that is mentally demanding and so you feel exhausted at the end of the day, but your body may not be worn out. In cases like this it is crucial to schedule in enough regular exercise to balance things out and ensure that you are genuinely physically tired by the time you hit your mattress in the evenings. Make sure you get at least 30 minutes of moderate intensity exercise each day and you will be pleasantly surprised with the results over time. As with many of these lifestyle changes, it may not be miraculous overnight but once it becomes a routine and a habit you will really start to reap the rewards with more high quality sleep.

Keep to a Regular Schedule

The regularity of your sleeping schedule is super important. Our body has several systems to create our sleep cycles and they work so much better when we go to sleep and wake up in a predictable pattern. Aim to get into bed at the same time every night. Let's say you want to sleep 8 hours. If you get into bed at 9:30 PM and spend 30 minutes falling asleep and then you wake up at 6:00 AM. There are your 8 hours of sleep and if you repeat that sleeping schedule at the same time daily you will notice a steady increase in your sleep quality.

Obviously, your sleeping pattern will change if you live far from the equator as the days will be much longer in summer and shorter in winter however that pattern changes at a slow pace that your body can easily adapt to.

Create an Evening Routine

The regularity of your sleeping schedule is super important. Our body has several systems to create our sleep cycles and they work so much better when we go to sleep and wake up in a predictable pattern. Aim to get into bed at the same time every night. Let's say you want to sleep 8 hours. If you get into bed at 9:30 PM and spend 30 minutes falling asleep and then you wake up at 6:00 AM. There are your 8 hours of sleep and if you repeat that sleeping schedule at the same time daily you will notice a steady increase in your sleep quality.

Obviously, your sleeping pattern will change if you live far from the equator as the days will be much longer in summer and shorter in winter however that pattern changes at a slow pace that your body can easily adapt to.

You need to design a routine which helps you wind down effectively. There is no right way to create your routine as different things work for different people however here are some basic guidelines:

Things to avoid a few hours before bed:

  • Screen time (especially the blue light spectrum)
  • Vigorous exercise (this will Rev you up and keep you awake)
  • Thinking about life problems (Try your best to save that for the morning when you are fresh)
  • Eating and consuming drinks other than water or herbal tea

Things to Try Adding to Your Evening Routine:

  • Meditation
  • Progressive Relaxation
  • Slow breathing exercises
  • Reading a book
  • Giving and receiving a massage
  • Dimming the lights and using golden light instead of blue light
  • Drinking a calming herbal tea such as camomile or valerian

How Can Massage Help with Insomnia?

Several scientific studies have shown improvements in sleep pattern and quality of life following massage therapy however the current research lacks both breadth and depth. What is clear is that massage of moderate pressure can increase parasympathetic nervous system activity. When the parasympathetic nervous system is activated your heart rate and breathing slow down and you enter the “Rest and Digest” mode. Your digestive motility increases as your system uses this time of rest to utilise the nutrients you have ingested for repair and regeneration. Massage is a powerful way of encouraging the body to enter this state and it isn't uncommon for people that normally struggle to sleep to find that themselves falling asleep on the massage table.

Massage as an Entrainment Device

Many people find it difficult to consciously relax. They may have the best intentions of implementing a meditation or relaxation regimen but when it comes to sitting quietly and allowing their mind to come to rest, they simply find it impossible to do so. This is where massage really shines because it can act as an entrainment device. Yes, that's a fancy word but it means that two systems come into sync with each other. Basically, the slow soothing strokes of the massage therapist create a slow rhythm for the client's body and mind to synchronise with. The massage may start at a regular pace and slow down over the course of the treatment and as the massage slows down, the mental activity of the client also slows down at the same time. This is a way of almost lulling someone to sleep and it really works.

Conclusion

Whilst massage is not likely to be the magic bullet for chronic insomnia it could very well be an essential part of your overall strategy in getting enough quality sleep. Massage will help to train your body to relax by activating the parasympathetic nervous system. Massage should be used as part of an overall strategy designed by you, your GP and other sleep specialists. Please don't underestimate the importance of sleep for your quality of life. It truly is one of the most important factors at the end of the day.


References

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Sjöling M, Ljadas K, Appelberg J, Englund E. Is tactile massage (touch massage) a treatment option for primary insomnia?. Eur J Integr Med. 2010;2(4):202. doi:10.1016/j.eujim.2010.09.064

Hachul H, Oliveira D, Bittencourt L, Andersen M, Tufik S. The beneficial effects of massage therapy for insomnia in postmenopausal women. Sleep Science. 2014;7(2):114-116. doi:10.1016/j.slsci.2014.09.005

Oliveira D, Hachul H, Goto V, Tufik S, Bittencourt L. Effect of therapeutic massage on insomnia and climacteric symptoms in postmenopausal women. Climacteric. 2011;15(1):21-29. doi:10.3109/13697137.2011.587557

Diego M, Field T. Moderate Pressure Massage Elicits a Parasympathetic Nervous System Response. International Journal of Neuroscience. 2009;119(5):630-638. doi:10.1080/00207450802329605

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Nelson N. Massage therapy: understanding the mechanisms of action on blood pressure. A scoping review. Journal of the American Society of Hypertension. 2015;9(10):785-793. doi:10.1016/j.jash.2015.07.009

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Zhou Y.F., Wei Y.L., Zhang P.L., Gao S., Ning G.L., Zhang Z.Q. Multi-central controlled study on three-part massage therapy for treatment of insomnia of deficiency of both the heart and spleen. Zhongguo Zhen Jiu. 2006;26:385–388.

Lovato N, Lack L. Insomnia and mortality: A meta-analysis. Sleep Med Rev. 2019;43:71-83. doi:10.1016/j.smrv.2018.10.004