Why doesn’t insomnia settle down once people make lifestyle changes?

In this audio interview, David Cunnington and Giselle Withers (clinical psychologist) discuss insomnia and the role of changes to thinking and behaviour in perpetuating insomnia symptoms.

Audio Timeline:

  • 00:00 – 00:37 What is insomnia?
  • 00:37 – 01:15 Acute vs chronic insomnia
  • 01:15 – 02:45 Changes to thinking and behaviour around sleep in insomnia
  • 02:45 – 03:18 Role of psychologists in managing insomnia

Related blog post links:


Giselle Withers: So David, one of the most common presentations in sleep disorders would be insomnia. So how would you describe what insomnia is and what are the causes of insomnia?

David Cunnington: That’s a good question. So insomnia is really trouble getting to sleep, trouble staying asleep and when we’re thinking of it as a clinical disorder, it’s really something that has been going on for weeks or months, so not just trouble for one or two nights. We all get that simple stresses and things.

That’s how we differentiate acute versus chronic insomnia. So acute insomnia we all get. Jetlag or an exam the next day, we just don’t sleep well. You take away that external factor and sleep settles back down to normal. So that’s an acute insomnia. That’s not what we see in the clinic because people don’t come to see us for that.

What we really see in the clinic is what we call chronic insomnia. With the chronic not relating to how bad it is but how long it has been going. That’s usually at least four weeks and often months and as you know, we often see people with years of symptoms.

The way that really differs from acute insomnia is once people have had trouble with sleep for a period of time, they just start to think about sleep differently and behave around sleep differently. I’ve often put into place different strategies and trying different things. That actually becomes part of the problem.

So when we’re seeing people with insomnia, by the time they come and see us as health professionals, there’s not just that acute trigger or the thing that tipped them off in the first place because that’s often long gone. That’s often in the distant past.

What’s keeping it going is often just this changed thinking about sleep which can almost become like an anxiety about sleep. It’s really as simple as think about sleep and the hair on the back of the next stands up type of response where other people would describe them nodding off in front of the television before I go to bed. Then getting to bed and I just feel myself becoming more alert just on shifting into the bedroom and then can’t switch off.

So it can be that type of response and there can be changes in behaviour. So people are feeling tired, wishing for more sleep, so going to bed earlier to try and create more opportunity or laying in later, missing out on activities they’ve previously enjoyed like going for a walk in the morning or going to the gym just to catch that bit of extra sleep. Often it’s that thinking and behaviour that keeps things going. So that people will make a lifestyle change. They will de-stress. They will be eating well. They will be doing all the things, do the lifestyle change, still not sleeping well and it’s because there are those perpetuating factors there.

That’s really the big difference between chronic insomnia and acute insomnia. From my mind as a physician, as a medical specialist, that’s really where the role of someone like yourself, a psychologist is, is because in getting insomnia better, a lot of it is about changing thinking and changing behaviour. You’re an expert in that.

So, it’s really a ripe area for working with psychology and that’s where the research shows techniques like cognitive behavioural therapy of insomnia are a really great strategy for managing insomnia.

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