What is insomnia?
All of us will have trouble with sleep at some point in any given year. For some, it will only be around predictable times of stress or times when sleep is disturbed, such as travel, busy periods at work, illness, or emotional times. But for others, up to 1 in 6 Australians, they can have difficulty sleeping every night, even when there are not other things going on to disturb sleep.
Insomnia is defined as difficulty getting to sleep, staying asleep or having sleep that isn’t restorative despite having adequate opportunity for sleep. If symptoms have been present for more than 3 months, and are causing problems with how people feel during the day, it is called chronic insomnia. The term chronic relates to how long symptoms have been present rather than how bad or severe symptoms are. One of the tools we use in the clinic to measure insomnia severity is the Insomnia Severity Index. It can be helpful not only to work out how much insomnia is impacting on people, but also to track their response to treatment.
How common is insomnia?
Insomnia is a very common disorder that has significant long-term health consequences. Australian population surveys have shown between 13-33% of the adult population have regular difficulty either getting to sleep or staying asleep. Insomnia can occur as a primary disorder (by itself), or more commonly co-morbid with other physical or mental disorders. Around 50% of patients with depression have co-morbid insomnia, and depression and sleep disturbance are the first and third most common psychological reasons for people to see their general practitioner (GP). Other conditions commonly associated with insomnia are: pain, anxiety, and poor physical health such as obesity and poor physical fitness.
What are the consequences of insomnia?
Episodes of acute, or short-term insomnia, don’t seem to cause health problems. However, long-term or chronic (more than 3 months) of insomnia, can lead to longer-term problems. Chronic insomnia can lead to problems with physical and mental health. People sleeping less than 5 hours per night have an increased risk of high blood pressure, and people who are not sleeping well over months have increased risk of developing depression and anxiety.
But, what you hear in the media, that unless you get 8 hours of un-disturbed sleep each night there are serious consequences, is not true for people with insomnia. In fact, it’s important for people with insomnia to ignore those sorts of media stories as they tend to increase worry about sleep and make insomnia worse. That data more refers to people who don’t allow themselves enough time for sleep, rather than people with insomnia, who allow plenty of time but sleep just doesn’t fill that space.
How is insomnia managed?
Generally acute insomnia is triggered by precipitating events such as ill health, change of medication or circumstances, or stress. Once the precipitating event passes, sleep settles back in to its usual pattern. Hence treatment for acute insomnia is focussed on avoiding or withdrawing the whatever the acute street or factor disturbing sleep is, if possible, and if needed using sleeping tablets, such as hypnotics for a short-term (up to 4 weeks) if symptoms are significant. This is what is done in general practice with 95% of GP consultations for insomnia resulting in the prescription of a hypnotic, mainly benzodiazepines such as temazepam.
However, if patients have repeated episodes of acute insomnia or ongoing co-morbidities, insomnia symptoms can persist and evolve into chronic insomnia, which requires a different treatment approach. Once people have had difficulty sleeping for over 3 months, they have usually begun to behave and think about sleep differently, in ways that actually perpetuate their sleep difficulties. The long-term course is then generally one of symptoms being present most of the time, sometimes a little better and sometimes worse, rather than going away, well after the acute precipitating circumstances have passed. Therefore the treatment approach needs to match this, with a long-term approach, teaching people about sleep, and how to think and behave around sleep to best manage their symptoms. An example of this form of treatment is called cognitive behavioural therapy (CBT).
If I think I have insomnia what should I do?
If you have symptoms of acute insomnia (less than 3 months) and can recognise factors that are interfering with sleep, try to manage those factors and your sleep should gradually improve. However, if symptoms have been going on for longer, or haven’t settled despite addressing things you think may be impacting on sleep you should consider talking to a health professional such as your GP.
It may be helpful to complete these and take them when you see your GP:
- Article on insomnia in The Medical journal of Australia. I wrote this together with my colleagues, Dr Moira Junge (psychologist) and Dr Tony Fernando (psychiatrist). It is written a little more technically, for health professionals.
- Editorial on sleeping tablets for insomnia in the British Medical Journal.
Need more information about how you can sleep better?
At Sleephub we understand the struggle people endure with sleeping problems which is why we have created a comprehensive FAQs page with information for those seeking information about sleep disorders and potential solutions.