Many of us are finding it more difficult to fall and stay asleep — and those nights of tossing and turning make for difficult days. YAM talks to experts to find out what you can do to change some habits and enjoy solid nights of zzzzs.
By Carolyn Camilleri
Most people have sleep issues at some point in their lives, and we all know how it feels to drag our way through the day when we haven’t had a good night’s sleep. But there is a big difference between occasional sleepless nights and chronic insomnia.
The first step is to determine whether your own sleeplessness is something you can fix yourself or if you need help.
Lorraine Irlam, a registered clinical counsellor and insomnia therapist, specializes in cognitive behavioural therapy for insomnia (CBT-I) at her practice, Insomnia Help Canada. Some of the people she works with have had chronic insomnia for decades.
“People even describe it as traumatic when you lose your ability to do something as basic as sleep,”says Irlam. “Although we call it a sleep disorder, it’s not just a disorder of sleep — it’s a 24-hour disorder that impacts daily functioning and our ability to work and enjoy life and socialize and think and remember.”
An insomnia disorder is defined as occurring at least three or more nights a week over a period of three months. But even before that, in the acute short-term phase, how we respond to a lack of sleep can make it worse
“The things we typically do to catch up on sleep are the very things that start to disrupt the sleep regulation systems,” says Irlam.
Sleeping in, napping and going to bed early are all short-term fixes that make us feel better for that day, but they come with a heavy price when they become habits.
“To right the ship again is to kind of do the opposite — short-term pain for long-term gain — but really it’s the only way to fix the causes of chronic insomnia,” she says.
COMMON CAUSES OF INSOMNIA
Very often, insomnia is triggered by stress – and it’s normal.
“Acute, short-term insomnia is a natural and normal response to stress,” says Irlam. “Evolutionarily speaking, it keeps us alive in times of danger, when the lion may be lurking outside the cave, for example.”
The stress can be negative (everyone has their own list and knows what is on it) or positive (i.e., a new relationship, baby or puppy).“It’s how one reacts to the acute insomnia that largely determines whether their sleep goes back to normal once the trigger passes or whether they go on to develop long-term chronic insomnia,” says Irlam.
Of course, it isn’t only major life stresses that keeps us tossing and turning.
“Sleep issues can be multi-factorial, and certainly lots of things contribute to it, but there’s a couple of things we know for sure contribute to it,” says Dr. Mark Sherman, a family physician and mindfulness meditation teacher in Victoria, as well as one of the founders of the BC Association for Living Mindfully (BCALM), a non-profit society that helps people with a number of challenges, including depression, anxiety, chronic pain, sleep issues and other chronic stress conditions.
“When we’re worried about uncertainty, which there’s lots of right now, when we’re worried about getting COVID, when we’re looking at the news about vaccines and variants, and all of this stuff, we carry these into our sleep and pre-sleep patterns,” says Sherman. “Anxiety disorders are more common right now as well, and I think those two are interrelated.”
Physical health is another potential and common cause of insomnia. In fact, it is so common that it comes up for discussion with almost every person under the care of Dr. Lisa Polinsky, a licensed naturopathic physician in Victoria.
“In my experience — 20-odd years as a naturopath — every person I speak to, pretty much on every visit, we’ll talk about sleep,” says Polinsky. “And what I’m noticing this year, in particular, is that younger people are having more difficulty.”
But while insomnia can be a stand-alone problem, it can also be symptomatic of a range of other issues, including hormonal imbalance, food sensitivities, and anxiety and/or depression. Polinsky asks questions: What’s your difficulty? Is it with falling asleep? Is it staying asleep? Is it feeling rested when you wake up in the morning?
“All of those are factors with identifying what might be the reason, and causal factors for insomnia or challenges with sleep can be very different,” she says.
For example, difficulty falling asleep may be related to worry and stress, while waking in the middle of the night could be related to hormones and chronic stress.
“Our adrenal glands, which buffer us from stress, are great for short term, but, over long term, they’ll start to become a little bit heightened or disordered, and that’s when you get that early waking, basically in the middle of the night, and often wide awake and sometimes hungry,” says Polinsky.
Others might wake up too early in the morning, and some might have it all: difficulty falling asleep, difficulty staying asleep, waking up too early — overall poor-quality sleep that doesn’t restore them.
The last year has added some other insomnia-causing factors — for example, the increased use of technology, in particular screen use and blue light, and the decrease in physical activity, especially with stay-at-home orders and gym and recreation centre closures. Because everyone knows one of the best ways to improve sleep is with regular activity and exercise. All of it is a recipe for widespread insomnia
CLEANING UP YOUR ROUTINE
Addressing sleeplessness on your own starts with some simple changes to daily habits.
“If I was to give one piece of advice, one recommendation to people, it is to try and maintain as much structure as you can,” says Irlam. That means going to bed and getting up at the same time every day and getting outside.
“Daylight is great for the circadian rhythm, and exercise improves sleep as well as mood,” she adds. Sherman recommends trying some of the many apps available now — Insight Timer, Headspace, TheMindfulness App, Buddhify and Calm.
“All of these wonderful apps have lots of guided things that, for some people with mild sleep disorders, can really help — even the first time,” he says.
Polinsky offers three tips to help set the stage for a better night’s sleep: a completely dark room (try blackout blinds or an eye mask), the temperature set to a cool 18 ̊ to 19 ̊C and no technology.
“Put away your iPhones and e-book and all of that, at least a couple hours before bedtime,” she says. But wait: Aren’t all those meditation and sleep apps using technology? And what about my e-book?
“I would say there’s a balance there because I am also a huge fan of meditation, and most of these apps are listening to guided imagery or meditation to help calm the mind,” says Polinsky. Sherman says it’s the phone that needs to be put away — the source of so much stress during the day —and an e-reader can be improved by setting it to low light or night mode or by using a blue light filter or glasses
If you want to level up your sleep routine and learn some life-changing habits to reduce stress and improve sleep, consider mindfulness meditation.
“Mindfulness is kind of this practice of paying attention, in a particular way on purpose, in the present moment and without judgment,” says Sherman.It is not a clearing of the mind — Sherman compares that to trying to push a beach ball underwater: the harder you try, the harder it becomes.
Instead, mindfulness-based stress management provides people with a number of tools.“One is the ability to relax,” says Sherman.
“We teach certain very specific relaxation techniques, like bodyscan and relaxation breaths, that people can use to settle that fight-or-flight nervous system that leads to arousal at a time when we want to be sleeping and relaxing.”
Another technique is teaching the brain to focus on and engage with something seemingly mundane:the breath, a sound or a body sensation.
“As we focus on it, with increasing concentration and curiosity, all of those worries kind of fall away because we’re not giving them airtime,” says Sherman.
“We gradually teach the mind to focus and concentrate, and it slows down on its own, and that allows us to sleep.”For some people, success comes quickly, after one or two online sessions, and others may need the full eight-week online course offered by BCALM, the Art of Living Mindfully.
COGNITIVE BEHAVIOURAL THERAPY (CBT)
Some people are going to need more than a cleaned-up sleep routine. It may be reassuring to know that while insomnia might start seeming “neurotic” — for example, when just the thought of going to bed or simply setting the alarm clock fuels insomnia — it’s not all in your head.“
There truly is a strong physiological component once the sleep regulations systems become disrupted during the original phase of acute insomnia,” says Irlam. “Fortunately, there are also concrete, evidence-based strategies to get sleep — and quality of life — back on track again.”CBT for insomnia (CBT-I) is actually quite different from regular CBT, but there are some overlaps.
Irlam says most people with chronic insomnia, even if they didn’t have anxiety before, eventually develop sleep-related anxiety, and that’s where regular CBT strategies can be helpful. But even then, those strategies are specific to insomnia.
CBT-I helps to repair and strengthen the sleep regulation systems and develop healthy sleep patterns again, including learning how to use light to fall asleep and stay asleep and how to calm middle-of-the-night anxiety. Unless there are underlying issues, such as anxiety or depression, CBT-I itself is very short-term:typically, five to eight online sessions are ideal for most people
If you are struggling with sleeplessness, don’t wait to do something about it.
“Restorative sleep is such a key part of a healthy experience, and if it’s starting to be impacted, then the earlier a person addresses it, the better,” says Polinsky.
“It can affect mental health, and it can affect motivation. Sleep, when it’s improved, helps you to have a bit more of a perspective on your life. It can raise it to, ‘Oh, I can see choices.’ Sleep is such a key piece for all other choices we make in the day.”
For someone with insomnia, waking up after a solid night’s sleep and making good choices can feel like a bit like a miracle.
“Acute, short-term insomnia is a natural and normal response to stress. Evolutionarily speaking, it keeps us alive in times of danger, when the lion may be lurking outside the cave, for example.”
Denise McMorris, a medical herbalist at The Canadian Vitamin Shop on Broad Street in Victoria, says quite a number of herbal remedies are sedating — hops, lemon balm and California poppy, for example. L-theanine, an extract from green tea, is also very popular and has a calming, relaxing effect.
“A lot of folks use 5-HTP (5-hydroxytryptophan), which is a precursor to serotonin,” says McMorris.“Serotonin is a neurotransmitter that is involved in normal sleep-wake cycles, and that’s another natural alternative that some folks find effective.”
“Then, of course, there are lots of formulas that combine all of the above or in different combinations,” she adds. “Not to forget melatonin.”
But you don’t want to just grab something off the shelf — talk to someone like McMorris first and be sure to mention any medications you are already taking.
“If you’re on antidepressants, then you need to stay away from certain things like St. John’s wort and even hops,” she says. “Then there are ones that interfere with birth control pills, so we have to be careful about that sort of thing — there’s a bit of a knowledge base required.”
The last year has added some other insomnia-causing factors — for example, the increased use of technology and the decrease in physical activity, especially with stay-at-home orders and gym and recreation centre closures.The Bedroom ResetSet yourself up for sleep success. These finds make falling asleep — and staying asleep — a little bit easier.