If you have trouble falling or staying asleep, you're certainly not alone. Insomnia may affect your mind and body, and it’s something you are likely to experience on occasion throughout your life, especially during times of high stress. Insomnia is a very common sleep disorder and medical condition that affects millions of people worldwide, yet the number of doctors and healthcare providers trained in treating Sleep Disorders like insomnia is unfortunately not enough to meet the demand. This means that millions of people go undiagnosed or are unable to get timely treatment for their sleep problems. There are many classic signs of insomnia, and it’s important to recognize them in the short-term, so sleep disruption doesn’t turn into a chronic sleep problem, like chronic insomnia disorder.
While insomnia looks a little bit different for everyone, insomnia may involve one or more of the following: difficulty falling asleep, difficulty staying asleep, waking up too early, or non- restorative/poor quality sleep. These classic signs are typically diagnosed or categorized as
1) sleep onset insomnia;
2) sleep maintenance insomnia (or middle insomnia); or
3) late insomnia. Additionally, you can have one or a combination of the above at any given time.
To further clarify, if you have trouble falling asleep, that may mean that it takes you longer than 30 minutes to fall asleep at the beginning of your night, and if you have trouble staying asleep, that may mean that you are usually awake beyond 30 minutes during the night. If you're waking up too early that may also mean that you're waking up at least 30 minutes before your desired wake up time. Insomnia may also be associated with daytime fatigue, changes in your mood (e.g., more irritability, low mood), increased levels of anxiety or depression, difficulty concentrating, lack of focus, brain fog, decreased energy or motivation, spending lots of extra time in bed tossing and turning, being preoccupied with sleep during the day, having sleep anxiety or worrying about your sleep, developing a fear of sleep, and also feeling “tired but wired” before bed or during the night (e.g., your body feels tired or exhausted, but you have trouble calming your mind of racing thoughts).
It's also important to distinguish insomnia from sleep deprivation. This is something that the media often confuses and tends to increase worry about sleep. It's important to note that insomnia has nothing to do with the number of hours of sleep you get, but rather how efficient you sleep, or the quality of your sleep. This is very different from experiencing sleep deprivation, or insufficient sleep, which essentially means that you are not getting enough sleep. Another way to think about this is that with insomnia you have adequate opportunity and circumstances to sleep, but you are not able to sleep well. With sleep deprivation on the other hand, you have adequate ability to sleep, but your opportunity to sleep is reduced or restricted (whether that is intentional e.g., pulling an all-nighter or binge watching your favorite TV show; or not intentional e.g., experiencing chronic pain, being a shift worker, or being a new parent/having a newborn).
Insomnia can be a primary sleep disorder, and it can also be comorbid, or occur at the same time/in addition to another sleep disorder, medical or physical health condition, or another mental health condition. It could also be a symptom of a medical or mental health condition. In general, sleep disorders can be ruled out with a traditional sleep study, which is usually performed via a qualified sleep specialist. For example, a sleep study can help to rule out any underlying sleep-disordered breathing (e.g., persistent snoring, grinding/clenching teeth, sleep apnea) or restless legs syndrome.
Let's explore the different types of insomnia and things you can try in the short-term to improve your sleep quality.
Insomnia is generally classified into two main groups. One is short-term or acute insomnia, and the other is long-term or chronic insomnia. Short-term or acute insomnia, also known as adjustment insomnia, is usually a normal response to stress or as an adjustment to a stressful event or stressful time in your life. Short-term insomnia usually lasts a night or two, maybe a couple of weeks, up to a month, and usually resolves on its own. When insomnia does not resolve on its own and it ends up happening on a regular basis, It can become a long-term or chronic problem. The defining feature of chronic insomnia is the frequency of nights that you experience insomnia symptoms. In order to meet the criteria and diagnosis for having chronic insomnia, you have to be experiencing one or more of the classic signs of insomnia for at least three nights a week for at least three months.
Chronic insomnia is also associated with chronic sleep medication use, and while sleeping pills may be helpful on a short-term basis, most sleeping pills (whether prescribed or over-the- counter) are intended to be temporary solutions. The good news is that insomnia is treatable, and it is often the combination of learning evidence-based strategies and making lifestyle changes that have the biggest impact on improving your sleep.
Now that you’ve identified the classic signs of insomnia and the different types of insomnia, you may be wondering about how to address insomnia. Here are several things you can try in the short-term to improve your overall sleep quality. These strategies are science-backed and are a great starting place.
1. Keep a consistent wake up time every morning, even on non-work days or on the weekends. This helps ensure that you keep your circadian rhythm, or internal body clock, on a consistent schedule. It can be helpful to use an alarm clock to stick to this.
2. Try to maintain the same wake up time every morning, no matter what time you eventually fall asleep or how well you sleep. This helps you build up your sleep pressure, and you're more likely to have better quality sleep the following night as a result.
3. Avoid looking at the clock when you're awake during the night, as this can be mentally alerting and make it more challenging to fall back to sleep.
4. Keep your bed as a place for sleep only as much as possible. Try not to do other wakeful activities in bed, as this can make your brain think that being awake in bed is okay. You want your brain to associate your bed and your bedroom with sleep only.
5. Try not to get into bed unless you are sleepy (i.e., you can fall asleep in less than 15 to 20 minutes, give or take). This ensures that you get into bed when you're actually ready to fall asleep, and this strengthens your bed-sleep connection.
6. Create a calming wind-down routine or "buffer zone” before bed. This allows you to go from "doing" mode to just "being" mode (e.g., Yoga Nidra, gentle stretching, meditation, breathing, watching a favorite show, reading an enjoyable book, listening to calming music using our SleepBand). Aim for at least 30-60 min before bed.
7. Try to get natural sunlight within the hour after you wake up to set your circadian rhythm for the day and to help boost your mood and energy levels. Morning sun has been shown to be beneficial for improving overall sleep quality, and it’s even better if you can get it at the same time everyday. Aim for 15 to 20 minutes within the hour after you wake up, ideally without sunglasses before 10 or 11 a.m.
As with making any lifestyle changes, please consult with your doctor before doing so, and please don't stare at the sun.
If you have tried a number of different strategies yet you still find that you are struggling to sleep well, please consider seeing a qualified sleep specialist to discuss your treatment options, including the first-line treatment for chronic insomnia called Cognitive Behavioral Therapy for insomnia (CBT-I). CBT-I is a non-medication multicomponent treatment approach for adults with chronic insomnia. Many people find that they often need a personalized approach, and this is where CBT-I may be a helpful option.
While prioritizing your sleep and ensuring that you get enough sleep every night is important, experiencing the classic signs of insomnia (whether acute/short-term or chronic/long-term) has more to do with the quality of your sleep. One of the best things that you can do in the short- term is try to focus on improving your overall sleep quality and not focus too much on the number of hours. Sleep is just like shoe size; one size does not fit all. The recommendation for adults (age 18+) is 7 to 9 hours (per the National Sleep Foundation), but there's a wide range of sleep needs that may be appropriate for you. Everyone is different, and sleep needs vary on an individual basis (i.e., anywhere from five to 11 hours may be appropriate for some adults). Some people need more and some people need less than eight hours. You may not need the “magic number 8,” and that is okay, as long as you are achieving high-quality sleep on a regular basis. Focus on your sleep quality in the short-term for the best long-term sleep improvement.
Author Dr. Sara PsyD
Learn More at firstname.lastname@example.org