Introduction

Most of us have experienced insomnia. The Sleep Health Foundation found almost 60 per cent of people regularly experience at least one sleep symptom (like trouble falling or staying asleep), and 14.8 per cent have symptoms which could result in a diagnosis of clinical insomnia (1).

Current research at Monash University indicates that 46 per cent of respondents so far have experienced poor sleep quality — up from 25 per cent of people just before the pandemic, according to preliminary analysis of the study results (2).

Anxiety is a common cause of sleep problems, and many people are feeling more anxious because of the current COVID-19 situation, as people are concerned about keeping healthy, and avoiding job losses and finance issues. (3)

Some people have even been having ‘corona-nightmares’. They can be due to high stress hormones and increased rumination, which happens when we feel we are under threat, says Dr Cunnington of the Melbourne Sleep Disorders Centre. Luckily, once life starts returning to normal, sleep disturbances should decrease according to Hailey Meaklim, a psychologist and researcher at St Vincent’s Hospital Sleep Centre.(2)

Insomnia is a “sleep disorder” characterized by insufficient sleep quantity or quality. Insomnia can involve difficulty in falling asleep or in maintaining sleep once it is initiated. 

Dr. Ethan Gorenstein, PhD, Associate Professor of Behavioral Medicine (in Psychiatry) at Columbia University Irving Medical Center, USA

Insomnia – some causes and reasons

  • ‘Pseudo-insomnia’
    At the present time (when some people are working from home), Dr. Gorenstein (3) makes the point that if people are working from home, they may get up later in the morning. However, they still go to bed at the same time and cannot sleep. This is not really insomnia – they are just going to bed too early.
  • Not prioritizing sleep
    Some people consider time spent sleeping as a waste, and try to make do with the minimum sleep with which they can function. During sleep, the body repairs itself, and the brain sorts through the memories from that day, so sleep is vitally important.
  • Napping
    Taking naps during the day. If we have to take a nap, it’s best to ensure it is before late afternoon, and that the total time for all naps is no more than 30 minutes per day. Otherwise, we will likely sleep less during the night.
  • Poor sleeping environment
    The bedroom should be quiet, well ventilated, and dark. The bed should be warm, but not too warm. Many people find particularly that if their feet are cold, that they cannot get to sleep. The mattress should be comfortable and the correct firmness.
  • Too much caffeine, alcohol, nicotine
    Caffeine (found in e.g. tea, coffee, chocolate) is a stimulant and it is best if we don’t take it close to bedtime. Alcohol can help us get to sleep initially, but we may well wake up later in the night. People who have insomnia should avoid it before going to bed. Nicotine is also a stimulant, and should not be taken near bedtime.
  • Eating and drinking late in the evening
    This can cause a need to visit the bathroom during the night, and thus waking from sleep. It can also cause heartburn and discomfort, which make sleep more difficult.
  • Failing to relax before bedtime
    Use of iPads and other electronic devices which emit blue light, or otherwise being too active just before bedtime can make sleep more difficult.
  • Stress and worry
    Worry about the day’s events, or forthcoming events, can cause insomnia. In 2020, people may also be anxious about COVID-19, and finances. Worry keeps the mind in thinking mode when it should be relaxing and slowing down. There are methods to resolve this involving relaxation and selective attention (see Methods section later in this article)
  • Too much media exposure
    This relates particularly to the current times, as many people like to keep up to date with the latest COVID-19 figures in their country or in their local area. However, too much media consumption can lead to negative anticipation of problems, anxiety and stress about health and finances. While we all need to keep current with the latest situation and health advice, listening or reading news reports once or twice a day is probably sufficient.
  • Medications
    The National Sleep Foundation (4) states that some medications can cause insomnia or make it worse. If this applies to you, please contact your GP or other specialist to check.
  • Various medical conditions can worsen insomnia
    If you have a chronic condition, please seek medical help to ensure that it is not contributing to insomnia.

Health effects of not sleeping

According to the National Health Service in the UK (5), lack of sleep can cause:-

  • Lowered immunity
    People who are deprived of adequate sleep can have a lower immunity then those who are well rested.
  • Weight gain
    People who sleep less than 7 hours a day tend to gain more weight and have a higher risk of becoming obese than those who sleep 7 hours.
  • Irritability, depression and anxiety
    Most of us have experienced this! Lack of sleep can make people more irritable. Chronic lack of sleep can contribute to depression and anxiety.
  • Depleted sex drive and decreased fertility
    Lack of sleep can decrease sexual desire, sexual responses, and secretion of reproductive hormones.
  • Increased risk of diabetes, and heart disease
    Studies have shown that chronic lack of sleep changes the way the body processes glucose, which can make diabetes more likely. It can also raise heart rate, cause an increase in blood pressure and higher levels of certain chemicals linked with inflammation, straining the heart.

Four stages of falling asleep

We all go through four stages as we fall asleep:-

Stage 1 – Thinking
When we get into bed, we can be thinking of the past, or anticipating (worrying?) about the future.

Stage 2 – Fantasy
As we relax, our thoughts turn to imaginings, which can be pleasant, or not so pleasant (worries, etc.). To be effective in transitioning to the next stage, the thoughts need to be pleasant.

Stage 3 – Hypnoidal
People then enter a hypnotic-type state. There is time distortion (losing track of time),

Stage 4 – Unconscious
Unaware of surroundings, and deeply asleep.

People who have difficulty getting to sleep can find it difficult to move down the four stages into sleep for the reasons given earlier in section headed “Insomnia – some causes and reasons”.

As an example, they may be worrying about the past or planning something in the future (staying in the thinking stage). They may alternatively be in pain (unable to move into fantasy stage due to thinking of their pain).

Methods of overcoming these factors and creating restful sleep

The following is a selection of techniques that can be used to help insomnia. There are many more, so feel free to look up the references at the end of this article.

Please note:  if you have any mental illness, please check with your GP or medical specialist before using the techniques marked ***, or any others which you feel may not be appropriate for you.

  • Encourage yourself to enter the ‘fantasy’ stage of sleep ***
    As stated above, many people get stuck in the ‘thinking stage’ of the 4-stage model above. We can fast-forward to the stage 2 – ‘fantasy stage’ by deliberating relaxing our muscles, and letting our thoughts flow lazily from one topic to another – e.g. thinking of yachts can lead to thoughts of the sea, then thoughts of swimming, then imagining swimming, then temperature of the water, etc.
  • Use peripheral vision ***
    When we want to get to sleep, we can start becoming aware of what we can see out of the ‘corners of our eyes’, and imagine that we can see behind us (which starts moving us into the fantasy stage of sleep). Using peripheral vision activates the parasympathetic nervous system, which has a calming influence.
  • Worry time and location during the day
    If we find that we worry about the current COVID-19 situation (or anything else) while trying to sleep, we can choose a “worry” time and location during the day and limit our worry to this time. For instance, “I will worry between 1.00 and 1.30pm, while sitting at the table”. If we start worrying at other times (and if there is no immediate need for action), we can tell ourselves to wait until the scheduled time.
    I have covered other ways to decrease anxiety in the blogpost How to look after your mental health post-lockdown.
  • Keep active
    Reasonable activity during the day can assist with sleep, due to physical tiredness.
  • Keep to a regular routine throughout the day
    The Sleep Health Foundation (6) advises that people who are self-isolating should keep to a regular routine during the day so that their body clock gets into a regular rhythm. This includes being in a light environment soon after waking up, having contact with others at a regular time, and having meals at approximately the same time each day.
  • Do not nap too much during the day
    If we nap during the day we are likely to have less sleep at night. As more people are currently working at home, there could be a temptation to nap if they have not had a good night’s sleep. Some sources state that anything longer than a 30 minutes nap during the day may lead to difficulties sleeping at night. Others recommend keeping any naps to before 3.00pm so they don’t interfere with sleep later on. However, people may need to nap if they require concentration during the day and have not slept well (e.g. driving heavy machinery, or responsible for looking after children).
  • Regular sleeping hours
    We are advised to wake up and get out of bed at the same time approximately, even at weekends, and even if we feel we haven’t slept enough. This sets up a pattern for our brain to start to feel tired at the same time each day.
  • Slow down thinking ***
    We can move our thinking to the fantasy stage by imagining our thoughts slowing down. Only dwell on pleasant thoughts – perhaps imagining a future event going well (if we are worried about it), or remembering a pleasant past event.
  • Use a box for your worries
    If we cannot think of a solution during the day, we can use a ‘box’ to keep our worries until morning. We can reassure ourselves that our subconscious will be exploring solutions during the night. We can concentrate on pleasant thoughts while going to sleep, and tell ourselves that we are glad we do not have to worry until morning.
  • Remember / imagine what it is like to be falling asleep ***
    This also involves a degree of fantasy, and pleasant memories, as we find it pleasant to be falling asleep. It also involves concentration, a feature of hypnosis.
  • Practice relaxation – “body scan” ***
    Relax muscles, starting from the toes, and working up to the head, including the muscles in the face. People sometimes need to do this more than once (i.e. toe to head, toe to head,….)
  • Concentrate on breathing ***
    As we need to pass through the hypnoidal stage before getting to sleep, focussing on our breath can help to move us towards this stage, and thus towards sleep. We can concentrate on the sound of our breath, and the feel of the air entering and leaving our lungs (cool breathing in, and warm breathing out).

This list may seem long, but we can choose one change that we feel would work for us, and try it for a week or so. Then try another. Keep a note of which changes help our sleeping. This will help us to discover any trends, and thus activities that help us get to sleep.


I hope this has been of some assistance to you. As a hypnotherapist who uses a combination of CBT (cognitive behavioural therapy) and hypnosis, I can help you use the power of your subconscious mind to increase the quality and amount of sleep.

Please feel free to contact me (Lisa) on 0403 932311 for a chat about your specific circumstances.


Please note: If you feel that your insomnia could be due to an underlying medical condition, or otherwise feel that you should seek medical advice, please see your GP or healthcare provider. This blog post is not a substitute for medical treatment, and is general advice that does not take into account your particular circumstances.

© Lisa Billingham, 2020

References

  1. Sleep Health Foundation. (2019, November 22). Chronic Insomnia Disorder in Australia. https://www.sleephealthfoundation.org.au/news/special-reports/chronic-insomnia-disorder-in-australia.html
  2. Jennings-Edquist, G. (2020, June 2). How to get some sleep during the coronavirus pandemic. ABC Life. https://www.abc.net.au/life/how-to-get-some-sleep-during-coronavirus-crisis/12292174
  3. Columbia University. (2020, May 18). COVID Q&A: Insomnia. https://www.columbiapsychiatry.org/news/covid-q-insomnia
  4. National Sleep Foundation. (n.d.). How medications may affect sleep. https://www.sleepfoundation.org/articles/how-medications-may-affect-sleep
  5. National Health Service, UK. (2018, May 30). Why lack of sleep is bad for your health. https://www.nhs.uk/live-well/sleep-and-tiredness/why-lack-of-sleep-is-bad-for-your-health/
  6. Sleep Health Foundation. (2020, February 28). Sleeping tips when staying indoors during isolation period. https://www.sleephealthfoundation.org.au/news/sleep-blog/sleeping-tips-when-staying-indoors-during-isolation-period.htm
  7. Sleep Health Foundation. (2020, March 23). Getting good sleep during the COVID-19 Pandemic https://www.sleephealthfoundation.org.au/getting-good-sleep-during-the-covid-19-pandemic.html
  8. National Health Service, UK. (2019, 4 July). 10 tips to beat insomnia. https://www.nhs.uk/live-well/sleep-and-tiredness/10-tips-to-beat-insomnia/

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