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How do we try to influence our sleep?
Many people experiencing insomnia try to manage it on their own before seeking professional help. As we have mentioned in previous articles, this often involves extending the time spent in bed—going to sleep earlier while waiting for sleep to come, or staying in bed longer to make up for lost rest. It also includes using stimulants like coffee or tea during the day, or alcohol in the evening to help with sleep; reading or watching TV in bed; taking daytime naps; checking the clock at night to see how much time is left before waking up; limiting activity after a sleepless night; or taking over-the-counter sleep aids.
What factors contribute to the development of insomnia?
We have also discussed the three groups of factors that contribute to the development of insomnia: predisposing, precipitating, and perpetuating. The first group includes genetic predisposition and personality traits. These factors make individuals more prone to reacting with arousal and anxiety in various situations, which in turn affects sleep. Relevant personality traits include high emotional reactivity, sensitivity, excessive worrying, and ruminating on past events. Such individuals are more frequently in a state of arousal and tension. If these predispositions are present and "precipitating" factors occur—such as stress related to various life situations—a period of poor sleep may follow. This can lead to short-term insomnia, which is a perfectly normal reaction to anxiety or agitation. When the "trigger" weakens or disappears, sleep should return to normal. However, it sometimes happens that short-term insomnia develops into a chronic form. This is driven by perpetuating factors. Paradoxically, these are usually actions taken in good faith to improve sleep quality. Most commonly, this involves watching TV in bed when unable to sleep, drinking alcohol, or extending time in bed by going to sleep earlier or trying to "catch up" on sleep by sleeping longer.
This strategy perpetuates sleep problems; sleep becomes shallower, there are more awakenings, and the body stops associating the bed with sleep. The more we think about not being able to sleep while waiting for it to arrive, the harder it becomes to fall asleep. This leads to worry and anxiety about the situation and its consequences—such as the negative impact on health and daily functioning—which creates a vicious cycle of thoughts. The body reacts with even greater arousal, which in turn worsens the insomnia. The harder we try to force sleep, the more the problem deepens.
Our loved ones often cannot understand what we are experiencing and, in an attempt to advise us, say things like, "Just lie down and think about sleep," "Try harder," "Don't think about anything at all and you'll fall asleep," "Get tired before bed," or "Don't overthink it, just wait for sleep." They have good intentions and want to help, but this is contrary to the nature of insomnia, where the more you focus on sleep and the problems associated with it, or on actions intended to induce sleep, the more counterproductive they become.
For healthy individuals, sleep happens automatically. This is in contrast to patients with insomnia, who plan their sleep and often think about it from the moment they wake up, fearing what the next night will bring. They cannot switch off the state of alertness that causes the excessive physiological arousal we mentioned earlier. Attention and planning are processes associated with activity and wakefulness, not sleep. Proper sleep comes on its own, without any effort directed toward it. The situation is difficult for patients because their attempts to improve their condition ultimately make it worse. This is a frustrating experience. Many people begin using sleeping pills because they feel increasingly helpless and powerless.
The most effective therapy for insomnia
Pharmacotherapy is used for insomnia if the response to therapy is insufficient. These two processes can also run in parallel. The recommended treatment for this disorder is cognitive-behavioral therapy (CBT). It is an effective, non-pharmacological way to treat mental health disorders. Specialists also use it to treat depression, anxiety disorders, and various types of phobias.
It is also successfully used for insomnia because it focuses on removing the factors that perpetuate the condition. This method has a clearly defined goal, is structured, and is short-term. It focuses primarily on the here and now, rather than the past. By using various therapeutic techniques, a psychotherapist can help address ingrained habits, reactions, thoughts, and behaviors to teach the patient new, desirable responses. The effects of the therapy are long-lasting. The effectiveness of cognitive-behavioral therapy has been confirmed in numerous studies, which have shown that patients who undergo it sleep significantly better and experience less anxiety and distress.
