More about insomnia

1 January 2013

More about insomnia

Menopause and Insomnia

According to one sleep expert many women with insomnia concerns in the late 30s and 40s are actually experiencing the transition to menopause known as perimenopause.

Sleep at this time can be impacted at this time by:

1. Hormonal changes – fluctuations in oestrogen and progesterone .

2. Hot flushes – sleep disturbed by waking up hot and sweating.

3. Depression/mood swings (hormonal changes may not be the only cause).

4. Coincidental social issues – stress of moving to new phase in life with kids, career, home, etc.

If you are finding symptoms of periomenopause are keeping you up or waking you up on an ongoing basis, see your GP or NP for advice.

Help yourself by keeping your room as cool as you can, skipping alcohol and tobacco, and keeping a cloth in bucket of ice near the bed so you can cool yourself off quickly.

Anna Clarkson says when your hormones are in a flux, it is even more important to address the other factors impacting on sleep that you have control over like eating a healthy diet, exercise, regular bedtime routines, reducing stress levels, and avoiding caffeine before bedtime.

*Largely drawn from an Ask the Expert article by Joyce Walsleben RN, PhD (head of behavioural sleep medicine at New York University) found on the National Sleep Foundation website: www.sleepfoundation.org

What’s natural about sleeping?

There are two natural body mechanisms that influence sleep:

Sleep/wake homeostasis tells our bodies after we’ve been awake for a long time and the need for restorative sleep is accumulating and so creates a drive that balances sleep and wakefulness.

Circadian rhythm or biological clock regulates the timing of periods of sleepiness and wakefulness throughout the day.

This clock responds to light and dark signals from the eye. Light in the morning signals it is time to be awake, to produce hormones like cortisol, and to delay the release of hormones like melatonin. When the eyes signal to the clock that it is dark, then melatonin (associated with sleep onset) is produced, so melatonin levels rise in the evening and stay elevated throughout the night, promoting sleep.

Regular bed times and waking times helps keep the sleep drive and circadian clock working smoothly.

Cognitive behaviour therapy (CBT) approaches to treating insomnia

Research studies indicate that CBT therapy (using combinations of the below therapies) is an effective treatment for chronic insomnia. The research also shows that all of them (with the exception of sleep hygiene and cognitive restructuring) can be effective standalone therapies for insomnia.

Stimulation Control Therapy

Training to re-associate the bed and bedroom with sleep and re-establish a consistent sleep-wake schedule.

Sleep Hygiene education

Becoming aware of lifestyle (including diet and exercise) and environmental factors that could hinder or help people sleep.

Relaxation training

Training people in techniques such as progressive muscle relaxation and abdominal breathing to help induce relaxation and reduce anxiety.

Cognitive therapy/restructuring

Identifying and changing unhelpful beliefs, attitudes, or misconceptions people may have about sleep, insomnia, and its consequences.

Sleep Restriction/Rescheduling Therapy

Restricting the time allowed in bed to equal the average amount of time the person actually spends sleeping (never less than 5.5 hours) and slowly increasing it as sleeping quality improves (which needs to be done under supervision of a sleep specialist and used only after other interventions fail).

Practice parameters for the psychological and behavioural treatment of insomnia: an update (2006), an American Academy of Sleep Medicine report. Cochrane Review’s italCognitive behavioural therapy for insomnia*** (2009). NB protocol stage only.

Some sleeping tips

Lifestyle and environment

• Have your bedroom cool and dark for sleeping.

• No ‘blue’ electronic light in room at night (i.e. clocks, stereo lights, iPad).

• Reduce caffeine/alcohol intake and avoid before bedtime.

• Get light exposure in the morning (boost melatonin).

Bed is for sleep

• Bedroom only for sleeping and sex (no TV, smart phone, iPad etc.).

• Aim for regular bedtime and waking time.

• Establish regular relaxing bedtime routine .

• If can’t get to sleep or wake at night, get up after 15–20 minutes.

• Go to dimly lit, warm place, write down any worries, read a magazine for 20 minutes and try again.

Relaxation

• Try a hot bath at night

• Abdominal breathing.

• Progressive muscle relaxation.

• Guided imagery.

• Meditation.

• Mindfulness.

Changing thoughts about sleep

• Don’t beat yourself up if you are not getting 7.5–8 hours’ sleep a night. Everybody’s sleeping needs are individual.

• If you are only sleeping six hours a night and feel fine during the day, then no problem (but you do need roughly six hours a night to consolidate memory).

• It is normal to wake in the night. In times gone by, it was typical for people to sleep in two bouts and have a big break in the night.

• Once awake, switch the mental channel from worrying about sleep to your ideal holiday or what you would do if you won Lotto.

• Consider using mindfulness: really get in touch with your five senses and be in the moment rather than thinking about the past.

Shift work tips

During night (to stay awake)

• Keep mobile.

• Have bright light (to suppress melatonin).

• Do more active things early in the night (difficult for nursing).

• Consider having a 15-minute nap during coffee break to keep you alert during the night.

• Have caffeine before shift but not during shift as it has a long half-life.

Helping sleep (post shift)

• Keep sunglasses on when driving home in morning.

• Keeping room dark (have blackout curtains).

• Turn phone off.

• Establish regular bedtime routine for whichever shift you are on.

• Eat regular light meals.

• Get regular exercise.

Stress management

• Reduce: work on cutting out or reducing unnecessary stress in your life.

• Relax: use relaxation techniques to reduce the stress response – i.e. adrenalin that can keep you awake.

• Release: Use exercise, humour, etc. to release tension in your body.

• Reorganise: build resilience by instilling healthy habits like good diet, exercise, and sleep into your life.

• Rethink: change your thoughts about stressors in your life or learn to accept them.

*Based on Richard Blonna’s 5 Rs of Coping model