Understanding and Treating Insomnia

Understanding and Treating Insomnia
June 6, 2017 by
Understanding and Treating Insomnia

Sleep is a vital part of healthy human functioning and sleep disorders such as insomnia can affect our wellbeing in a variety of ways. This review summarises some of the most important consequences of sleep disorders and evaluates the current state of insomnia treatment in psychology.

Consequences of Sleep Disturbances at Different Life Stages

Between 15 and 35% of infants suffer from some kind of sleep disorder. The odds of this are increased if the mother was depressed during pregnancy or if the family are highly disorganized after the baby is born. Training the parents in how to control their infant’s sleep is often highly effective.

Toddlers require sleep in order to deal with the world around them. Impaired sleep reduces a toddler’s ability to cope with challenges and increases their levels of anxiety. Long lasting sleep problems at this stage can predict mood disorders and even substance abuse in later life.

If sleep issues and insomnia persist into childhood they can cause significant problems further down the line. Anxiety disorders, alcoholism, poor cognitive functioning and increased behaviour problems can all result from sleep deprivation during childhood.

It is common for teenagers to experience sleep problems, partially due to high levels of TV, phone and computer use in the evenings, which interfere with the sleep cycle, causing teenagers to have difficulty falling asleep at bedtime and consequently feeling excessively tired the next day. These high levels of tiredness can then impair their performance at school and increase irritability throughout the day.

For adults, disturbances in sleep have negative effects on cognitive functioning, memory, attention and alertness. A strong link has been found between insomnia and depression and lower rates of sleep can even predict higher mortality rates later in life. Sleep disorder rates become much higher in older adulthood, with over 50% of adults over the age of 65 suffering from insomnia according to one study.

Causes of Insomnia

Developing insomnia is a combination of the “three P’s”: predisposing conditions, precipitating circumstances and perpetuating factors.

Some genetic factors and family history may increase the risk of developing insomnia, but a more significant vulnerability factor is hyperarousal. Hyperarousal is the tendency to show higher levels of brain activity during the night, that prevent you from “switching off” and getting to sleep. Interestingly, people with insomnia also often show lever levels of brain activity during the day- their brains are too active at night and not active enough during the day.

Even when these predisposing factors are present there still needs to be some precipitating circumstance or direct cause to trigger the onset of insomnia. This can often be something like illness, stress at work, or difficulties with family.

After a few bad nights of sleep caused by these stress factors, a person may begin to worry about their lack of sleep and the effect it is having on them. This only serves to make the problem worse and can lead to the problem becoming chronic. Once sleep difficulties have begun the fragmented nature of sleep leads to further disturbance of a person’s sleep rhythms and the balance that the brain maintains between desire for sleep and desire for wakefulness. These perpetuating factors can create a negative cycle where lack of sleep leads to further difficulty in getting to sleep and the problem persists.

Insomnia Prevalence

6% of the population are diagnosed with insomnia. A much higher percentage experience some of the symptoms: as many as 30 to 48% of people experience some level of sleeplessness or other symptoms. Women are around 40% more likely to suffer from insomnia than men.

Insomnia Treatment


Various forms of prescribed or over the counter medicine for improved sleep are available. Often these can be effective but come with some undesirable side effects, so the minimum effective dosage should always be used to keep these effects to a minimum.

Cognitive Behavioural Therapy for Insomnia:

The principles of CBT can be used in insomnia treatment by identifying unhelpful beliefs about sleep and reframing them to be more conducive to getting a proper night’s rest. Misconceptions and incorrect beliefs about sleep and energy levels can be corrected to reduce worry and correct some of the bad habits which form as a result of sleep deprivation. CBT for insomnia is not widely used as a standalone treatment but can be effective when used in conjunction with other kinds of therapy.

Stimulus Control Therapy:

Often regarded the gold-standard insomnia cure, SCT works on the basis that for people with insomnia the bed and bedroom are no longer places of rest associated with sleep and relaxation. Instead the bedroom is often a place associated with stress, worry and lying awake in frustration.

The aim of SCT is to strengthen the bed and bedroom as cues for sleep by avoiding using the room for other purposes and only trying to sleep when sleepy, as well as avoiding napping during the day to establish a stable sleep rhythm. If the patient is unable to sleep after ten minutes of lying awake, they are instructed to leave the bedroom and go somewhere else until they are sleepy, so that the bed becomes strongly associated with sleep and not with lying awake. This approach is considered the most effective insomnia treatment available.

Sleep Restriction Therapy:

SRT is underpinned by the idea that a person with insomnia spends too long lying awake in bed, leading to fragmented sleep and variable cycles of sleep and wakefulness. SRT therefore aims to limit time spent in bed and consolidate sleep into a single, regular time so as to re-establish a proper sleep rhythm.  A fixed time to be in bed is established and them slowly increased until normal sleep functioning is restored.

Sleep Hygiene and Education:

Sleep hygiene education is a process of educating the patient about such things as sleep cycles, bodily rhythms and brain activity, and teaching healthy behaviours which encourage sleep. These include the avoidance of caffeine and alcohol and other positive lifestyle choices. SHE is often used as part of other insomnia treatment principles to support other types of therapy.

Relaxation and Meditation:

Using relaxation techniques and meditation to reduce arousal before bedtime is an effective way to combat hyperarousal and promote sleep. Progressive muscle relaxation, breathing exercises and mindfulness meditation have all been used in this way and can be an effective form of insomnia cure, especially if used alongside other forms of therapy.


Insomnia impairs the mind in various ways, from reducing your ability to concentrate and remain alert to damaging your ability to express and process emotions. Long-term insomnia can even have severe health consequences later in life. For this reason it is essential for researchers to continue to advance our understanding of how to cure insomnia. If you struggle with sleep it is vital to receive effective insomnia treatment as soon as possible to avoid the detrimental effects of long-term sleep deprivation.

Source :

Authors: Richard R. Bootzin and Dana R. Epstein
Journal: Annual Review of Clinical Psychology
Source Title:Understanding and Treating Insomnia
Publish Date: Apr, 11