Over the last couple of months I found myself suffering from a fairly acute secondary insomnia. It starts the same way every night. I go to bed at a reasonable hour, I fall straight to sleep and then at around 2:30am I wake up I'm awake and that’s me done for the rest of the night.
I've never been a great sleeper and I've battled on and off with insomnia for my entire adult life. For me it’s generally what’s referred to as “sleep-maintenance insomnia.” In a nutshell that means that I can mostly fall asleep quickly but I have trouble staying asleep.
Occasionally I also suffer from “sleep-onset insomnia” which is when I have trouble getting to sleep. This often occurs when I go to bed a little wired from the day I’ve had (or from watching an intense game of footy!)
So while I'm busy doing the work to improve my sleep, I thought I'd share the three key questions to ask yourself if like me, you can't seem to get a good night’s sleep.
What is insomnia anyway?
Firstly let's take a step back and address the question, what is insomnia? There are so many parts to insomnia it's hard to address in one definition however, in its basic form, insomnia is a sleep disorder whereby you have trouble either falling asleep and/or staying asleep.
Sometimes insomnia is acute meaning short term anywhere from 1 night to a few weeks and, for others it's chronic and long term. For many of us it comes and goes.
Insomnia can either be a primary condition which means it’s not linked to other health conditions or problems, or, it can be a secondary condition linked to other health conditions such as asthma, depression, arthritis or certain medications that we take. Secondary insomnia can even be linked to too much alcohol.
As I mentioned above, insomnia can either be sleep-onset, meaning you have trouble getting to sleep or sleep-maintenance, meaning that you’re either having trouble staying asleep or waking up too early in the morning or, a mix of both.
As a long term insomnia sufferer I understand the anxiety that comes with lack of sleep and I know that the longer it goes on, the stronger the anxiety and that fuels a more intense bout of insomnia. As much as you can, it's important to remember to go back to your basics and address the underlying issues causing the insomnia.
I’ve been addressing my own current insomnia using a cognitive behavioural approach and in particular, addressing the underlying behaviours that impact my ability to get a good night rest. Here are the questions I’ve asked myself.
What’s your bedtime routine?
Do you have a proper wind down routine? Or do you jump straight into bed after a full on day of work and family commitments? It's not sexy and often that's not fun but good sleep hygiene can really help you get a great night's sleep. A good routine involves going to bed at the same time every night, eliminating blue light at least an hour before bed, avoiding caffeine or other stimulants in the afternoon or later and having an hour before bed to suitably wind down doing something you enjoy such as reading a book, listening to relaxing music or even having a bath.
Have you taken time to park your thoughts?
Everything feels more important at night, right? When my insomnia at its worst, I’m typically awake from 3am-ish with thoughts swirling around my head on replay. It’s often not even important. Recently, I ruminated for HOURS over the fact that I’d left my washing out and it was raining. In the brightness of day it’s an easy fix – I’ll simply re-wash them. BUT, in the silence of night, the sound of those thoughts is deafening!
If rumination is a big part of how you do insomnia then setting your thoughts down for the night is an absolute must. When I’m at my best I write a parked thoughts list before bed. It creates a sense of freedom knowing that my thoughts are safe and ready to be picked up tomorrow. I don’t need to ruminate in order to remember them for the morning.
If I wake up to the sound of rain and start worrying about my washing (you can sub in any random worry right here), then I revert to a cognitive approach and remind myself that the world doesn’t react to my worry. My worrying doesn’t stop the rain, and therefore I may as well let it go. This approach allows me to stop trying to control those things out of my control and focus back in my own circle of control.
What’s your sleep environment like?
Do you often wake up too hot or too cold? Is your room dark enough? Or you being woken up at night by too much noise? Your sleeping environment is incredibly important. Make sure your bedroom is comfortable, dark and quiet and, maintains a decent temperature. If you struggle with waking up from the light or too much noise try wearing an eye mask or listening to some quiet music [preferably something slow, classical and without words]. Even a white noise machine can offer you relief.
Often when I’m experiencing long periods of sleep maintenance insomnia my hormones are out of whack. I’ll find that my cortisol is too high or spiking at night and I’ve got lower that ideal levels of melatonin. If you’ve tried everything on the list with little or no change then you may consider getting your hormones tested. If they are out of balance, your specialist can then work with you to create the right treatment plan for you.
Insomnia is a multi-faceted condition that requires a multi-faceted approach. My sleep is always better when I use a CBT approach coupled with a range of great tools. In my next blog I’ll share some of the tools that make the biggest difference to my sleep.
Have a winning day!