Insomnia disorder is categorised as a sleep-wake disorder, where the individual struggles to fall asleep, stay asleep and/or wakes early. Although all people may struggle with sleep occasionally, insomnia disorder requires that the disturbance in sleep causes significant distress or impairment in functioning, including occupational, emotional and social functioning. This is commonly the case because lack of sleep can impact a person’s ability to perform complex tasks and may impact cognitive performance (e.g. attention, focus, memory). In addition, the irritability experienced from lack of sleep can impact social relationships and home life.
Individuals who have insomnia disorder experience issues with sleep at least three times a week and the problem persists for at least three months. The sleep issues are also present despite enough opportunity to sleep (i.e. the sleep deprivation does not occur as a result of being too busy, or not having enough time to sleep).
Symptoms of insomnia disorder include the following:
Insomnia Disorder does not have one specific cause; however, there are numerous factors that are likely to contribute to it. These include:
Other sleep conditions share certain symptoms of Insomnia Disorder, which can at times make diagnosis more complicated. The most common sleep disorders that may be considered amongst Insomnia Disorder include:
Although Insomnia Disorder may start for various reasons as discussed, the disorder can impact a person’s thoughts, feelings, beliefs and behaviours related to sleep. These, in turn, can maintain and worsen insomnia. Cognitive-Behavioural Therapy-Insomnia (a particular type of CBT treatment specifically developed for insomnia) aims to challenge and shift beliefs and behaviours.
There are specific components included in CBT-I including:
Importantly, the individual issues faced by the person suffering from Insomnia Disorder will guide which approach is going to be useful. Psychological treatment, therefore, needs to be tailored specifically to the individual.
As described earlier, Insomnia Disorder can be influenced by stress and anxiety amongst other things. Once anxiety is associated with sleep, the individual might start having anxiety about not being able to sleep – this creates a vicious cycle. At such times, ACT may be a useful approach as it helps the person accept that sleep may not be perfect (rather than feeling anxious about). ACT looks at the issue from the perspective that fighting against the problem and working tirelessly to “fix” an issue may actually perpetuate the issue further. It also aims to help the person distance themselves from their anxious thoughts (rather than focusing on changing them), allowing natural fatigue to take over and help induce sleep.
Sleep hygiene is an approach that focuses on the routines, habits, and practices that can help with good sleep. People often engage in habits and practices that may promote arousal and brain activity rather than sending signals to sleep. Factors that are commonly explored include: diet, exercise, activities leading up to bedtime, when food and drink are consumed, involvement of caffeine, involvement of light sources prior to and in bed (as well as the type of light being used).