If you have trouble getting to sleep, staying asleep, or wake feeling unrefreshed and tired, you may be experiencing insomnia.

Nearly half the population experience a few nights or more of poor sleep at some point in their lives and around 10% of adults experience chronic insomnia. Chronic insomnia is a period of at least three months when sleep is disturbed for more than three nights a week, despite adequate opportunity for sleep, causing distress or disturbance in a person’s life.

Consequences of insomnia

There are a number of short-term consequences you may experience after a poor night’s sleep, which include:

• difficulty concentrating, feeling less alert
• forgetfulness
• mood changes, such as feeling down, more irritable or anxious
• negative thinking
• making more mistakes or errors
• slower reaction times which can increase the risk of accidents or injuries.

There are also some long-term consequences of chronic insomnia

• weight gain
• increased risk of cardiovascular problems
• increase risk of Type 2 diabetes
• increase risk of depression and anxiety disorders

Many people who have insomnia are prescribed sleep medication for the sedation effects to help with sleep. While medication may be helpful in the short term, they have a number of side effects including daytime drowsiness, constipation or diarrhoea, dry mouth, dizziness, stomach pains and gas. These side effects may outweigh the benefits of the drug you take. Also, some medications can become addictive and cause problems with memory and attention.

Also, unlike psychological treatments, sleeping pills are unlikely to address the underlying causes of your insomnia, so they won’t offer you a long-term solution.

Psychological therapy for Insomnia

Cognitive behavioural therapy for insomnia (CBTi) is an evidenced based psychological treatment for insomnia (non-drug treatment), that teaches you how to set up conditions that support natural, healthy sleep. The aim of the approach is to help you to:

• change unhelpful sleep habits and behaviours
• change unhelpful thinking patterns that interfere with sleep
• help you learn to relax the mind and body, reduce tension, stress and frustration often associated with insomnia

The five key components of CBTi are:

1. Sleep hygiene involves setting up a good foundation for sleep with steps such as reducing caffeine and alcohol intake, increasing daily exercise, creating a comfortable and relaxing bedroom environment for sleep, etc.
2. Stimulus control suggests that you only use the bed for deep rest and sleep, which mean getting out of bed and going to the lounge room if you can’t sleep, returning to bed only when you feel sleepy. It also means keeping all stimulating activities, such as watching TV, using your phone or computer, out of the bedroom.
3. Sleep consolidation involves matching the time in bed more closely to the average time you are actually sleeping to reduce the time you are awake in bed. This might mean going to bed later or getting up earlier.
4. Relaxation training involves actively learning how to release tension in the mind and body using a range of techniques to slow down your breathing rate, relax the muscles and focus the mind on peaceful images.
5. Cognitive Therapy is the skill of identifying unhelpful thinking patterns and learning to generate more balanced and helpful thinking about sleep.

A psychologist trained in CBTi can help you determine which of these CBTi components will be beneficial and can help you implement these strategies week by week as you progress through treatment. Typically, a CBTi program will take about 4-6 weeks depending on the nature and history of the sleep problems.

Mindfulness training for sleep

A new development in CBTi treatment is the addition of mindfulness training, which is called Mindfulness based therapy for insomnia (MBTI). Mindfulness training involves learning how to bring awareness to the present moment non-judgmentally, and sustaining attention in this way. The practice of meditation is central to mindfulness training, however, it is the quality of attention and attitude learned through practicing meditation that leads to the psychological benefits for sleep.

While it is not easy to summarise the personal qualities developed through mindfulness training, the seven key qualities are:

• Patience
• Acceptance
• Trust
• Non-striving
• Letting go
• Non-judgement
• Beginners mind

Each of these qualities have enormous benefits for managing wakefulness and can help to reduce negative thinking patterns and behaviours that perpetuate insomnia.

Mindfulness training helps improve to improve sleep by:

• reducing stress, tension and hyperarousal
• assisting to relax the mind and body
• improving the regulation (calming) of emotions
• reducing reactivity when faced with challenging situations
• reducing rumination and overthinking at night time
• increasing awareness of best time to go to bed (when sleepy, not just tired)

While this is a newer treatment approach for insomnia, the results from research into the benefits of MBTI have been impressive.

Online self-help program for insomnia

Dr Giselle Withers has developed an online treatment program for insomnia called Sleep: A Mindful Way. The program offers training in mindfulness and all five components of CBTi using video lessons and written exercises to help you overcome insomnia. The program was evaluated in an independent study by Monash University with the results showing that 75% of people who completed the program recovered from insomnia. Find out more about the online sleep course here.

Treatment for insomnia on the Gold Coast

Dr Giselle Withers is an experienced Clinical Psychologist at Avoka Health on the Gold Coast, who can help you overcome insomnia and other sleep problems. Giselle has advanced training at a doctoral level in mental health assessment and psychological therapy, and has over 20 years of experience treating insomnia and a range of other mental health problems.  Giselle has a compassionate and non-judgemental counselling style, and will work with you to understand the causes of your sleep problems, overcome these factors, and help you sleep better.

Your first step

If you have been not been sleeping well for more than a few weeks, an important first step is to talk to your general practitioner (GP). Your GP can provide an initial assessment to look at your overall health and symptoms, and discuss treatment options with you. If appropriate, your GP can prepare a Mental Health Treatment Plan which will allow you to access a Medicare rebate for your psychology sessions.  Getting the right support early can help prevent insomnia and other symptoms deteriorating further, and can help you start making the right changes to sleep well and feel better during the day.

Making a booking with Dr Giselle Withers

To make psychology appointment with Giselle please contact Avoka Health using the link below.

If you have a GP referral, you can ask your GP to send this directly to Giselle or you can email a copy to Giselle yourself before your first appointment.