Sleep Problems

Book a therapist to help with sleep problems

A sleep problem is an ongoing difficulty in getting enough sleep so that you feel able to function well during waking hours. Sleep problems are very common, with a recent study showing that up to one in three adults claim to have difficulties sleeping. Greater incidences of sleep problems have been found in women, children, and the elderly.

Contents

  1. What are Sleep Problems?
  2. What are the signs of Sleep Problems?
  3. Misunderstandings about Sleep Problems
  4. What are the causes of Sleep Problems?
  5. How are Sleep Problems diagnosed?
  6. Recommended treatment for Sleep Problems
  7. Related psychological issues to Sleep Problems
  8. What is the risk if Sleep Problems are unaddressed?
  9. Useful resources for dealing with Sleep Problems

What are Sleep Problems?


A sleep problem is an ongoing difficulty in getting enough sleep so that you feel able to function well during waking hours.

Sleep problems are very common, with a recent study showing that up to one in three adults claim to have difficulties sleeping. Greater incidences of sleep problems have been found in women, children, and the elderly.

While we have all experienced poor sleep during times of extreme stress, suffering from a few nights of missed sleep before returning back to a normal sleeping pattern is not a sign of a sleep problem.

You do not have to suffer from insomnia to have a sleep problem. In reality, insomnia is just one of a number of issues that fall under the umbrella of 'sleep problems.'

There are four main categories of sleep problems:

Getting to sleep: This issue is commonly known as ‘insomnia.’ An individual will commonly lie awake instead of sleeping, or you may be unable to sleep during the hours allotted but find yourself wanting to sleep during daytime hours instead.

Staying asleep: This can mean waking up one or several times during the night, having trouble falling back to sleep again, and/or waking up much earlier than desired.

Quality of sleep: Always feeling tired no matter how much sleep you may get, or tossing and turning often in bed.

Schedule of sleep: Even though you may be able to sleep, it is at hours when everyone else is asleep. This may affect your ability to hold down a job or otherwise live a normal life.

What are the signs of sleep problems?


The sign of a general sleep problem can include the following:
  • Problems getting to sleep.
  • Problems staying asleep.
  • Sleeping, but only lightly.
  • Persistent or frequent nightmares.
  • Waking up in the night and finding yourself unable to fall back to sleep.
  • Waking up particularly early in the morning and being unable to fall back to sleep.
  • Constant daytime fatigue and ongoing lack of energy.
  • Repetitive activities like driving, reading, or watching television cause you to nod off.
  • Feeling exhausted despite sleeping for many hours every night.
  • A reliance on sleep aids, such as over the counter medication, to get any sleep.
  • The need for daily naps.
  • Overconsumption of caffeinated beverages to fight tiredness.
  • Problems concentrating or thinking clearly.
  • Emotions that seem too ‘at the surface,’ or over reactive and unstable.
  • Slow psychical and cognitive responses.

The above symptoms include the signs of the common sleep ‘disorder,’ insomnia. Sometimes divided into difficulty falling sleep (sleep onset insomnia) and difficulty staying asleep (sleep maintenance insomnia), it is in general the inability to get enough sleep to feel rested during your waking hours.

There are other sleep disorders besides insomnia. These tend to be more genetic and brain-based than regular sleep problems, which have more marked symptoms and can be stress and anxiety-related.

The five main sleep disorders and their symptoms include:

Sleep apnoea: This involves issues with your upper airways, meaning you can sporadically stop breathing while sleeping and suddenly wake up.
  • Find that you are often told that you snore or gasp during the night.
  • Dryness in the throat and chest pain when you wake up.
It is important if you suspect that you have sleep apnoea you seek help, as it can be life threatening. It is easily treatable with a mask that monitors airflow.

Restless leg syndrome: This is a recognised neurological condition connected to an imbalance of dopamine in the brain.
  • A consistent urge to move your legs and arms even when at rest.
  • An unbearable tingling or itching sensation in your leg as you try to sleep.
  • Waking up with muscle cramps.

Narcolepsy: This is a disorder where the part of your brain that regulates sleep is dysfunctional, so you experience uncontrollable sleepiness in the daytime.
  • Unable to stay awake, particularly at inopportune moments such as when driving or at work.
  • Starting to have dreams before you are properly asleep.
  • Often experiencing vivid hallucinations or ‘hearing things’ as you begin to fall asleep.
  • Strong emotional responses like laughter or anger usually result in weaker muscle coordination.

Idiopathic hypersomnia: This involves excessive oversleeping or sleepiness with no explainable cause, but is a different condition from Narcolepsy.
  • Often sleeping more than 10 hours at night and waking up feeling ‘drunk’ on sleep.
  • Manage to gain quality deep sleep (unlike narcolepsy) but still find yourself feeling tired.
  • Possible loss of appetite.
  • Problems with memory and thinking clearly.
  • Daytime naps don’t feel refreshing (unlike narcolepsy, where they do.)

Delayed sleep phase disorder: This involves having an inner ‘sleep clock’ on a very different setting than those of others.
  • Find it difficult to fall asleep up until 2am, at the earliest, despite all your efforts to fall asleep earlier. (Different to ‘being a night owl.)
  • Sleep well when you do sleep, just at irregular and unsocial hours.
  • You can allow your own biological clock develop a regular sleep pattern but it doesn't match the healthy sleeping patterns of others.
  • You are possibly a teenager (but this disorder can carry over into adulthood.)

Misunderstandings about Sleep Problems


Many people often think they have a sleep problem just because they don’t sleep for eight hours a night.

It is not true that we all need eight hours sleep. There are no specific rules about sleep, other than that you can tell if you get enough by how refreshed and clear-minded you feel during the daytime. In general you require less sleep the older you get, with babies sleeping up to seventeen hours per day and an older person maybe needing less than six hours. This also depends on how active you are.
If you are sleeping few hours but feel energised the next day, you don’t have a sleep problem.

It is also not true that just because stress has temporarily disrupted your sleep patterns that you now have a sleep problem. If you are experiencing a challenging few weeks, such as starting a new job or moving house, it is normal to have temporarily disturbed sleep. Try improving your sleep hygiene (see the ‘Treatment’ section below for more information) and see if your sleep returns to normal before assuming you have an issue. A real sleep problem is ongoing, and diagnosis generally requires that the issues have persisted for at least a month.

What are the causes of sleep problems?


If you have a sleep ‘disorder,’ it can related to the way your brain works and might therefore be biological and genetic.

Or, your problems with sleep can be physical and related to another health condition you are unaware of. For example, your hormones are going through changes or medication you are taking is affecting your sleeping pattern.

Sleep problems are frequently environmental – caused by other factors going on in elsewhere your life. When life becomes challenging, many of us ten to worry instead of sleep, and this anxiety can flood our bodies with cortisol that makes it even harder to relax.

Common causes of sleep problems may include:
  • Stress and anxiety
  • Depression
  • Bereavement
  • A new environment you aren’t used to
  • Changes to your schedule or daily routine (new shifts, new job, jet lag)
  • A fault in your sleep setup (uncomfortable bed, light levels, noise levels, etc)
  • Medication
  • Health issues (chronic pain, bladder problems)
  • Hormonal problems
  • Mental health disorders (PTSD, schizophrenia, bipolar disorder)
  • Overuse of caffeine
  • Alcohol and drug use

If we are stressing about sleep itself, we can often end up creating a sleep problem or exaccerbating an existing sleep problem. If an individual is worried because they aren’t getting the apparently ‘normal’ eight hours sleep per night and believe something is wrong with them, this worry itself can lead to poor sleep at night.


How are sleep problems diagnosed?


If your troubles with sleep are persistent and ongoing to the extent that they are negatively affecting our work and relationships; if you have had insomnia for four or more weeks; and/or if you have trued general sleep advice (such as that listed below) with no improvement, then it’s a good idea to consult your General Practitioner.

Your GP can ask you a series of question and possibly run different health checks to determine what might be at the root of your issues with sleep, and whether it might be a medical condition or related to another health problem.

If you have any symptoms of a sleep disorder, like snoring and gasping in your sleep and waking up unable to breath, or falling asleep during daily activities such as driving that ultimately may place you in constant danger, it is important to make an appointment with your GP as soon as possible.


Recommended treatment for Sleep Problems


Your GP may begin by discussing good sleep hygiene with you to identify any practical steps that can be taken to resolve the sleeping problems you feel you are experiencing. These steps can include:
  • Keeping a regular sleep schedule, including weekends.
  • Giving enough hours to sleep.
  • Ensuring your bedroom is cool, dark, and quiet to create the best possible environment for sleep.
  • Replacing your mattress and discussing sleeping schedules and routines with your partner.
  • Removing electronic equipment from your bedroom (their light disrupts sleep.)
  • Making exercise a regular part of your routine.
  • Putting electronics (Phone, computer, TV, iPad) away a few hours before bed.
  • Reducing or eliminating caffeine, alcohol, cigarettes, and any other stimulant.

They might give you a short-term prescription for sleeping pills, but this is not a preferred treatment for sleeping problems in the UK and they are not recommended for long-term use.

If your insomnia appears anxiety and mood related they might refer you for Cognitive Behavioural Therapy (CBT) to help change thoughts and behaviours that are contributing to your inability to sleep.

Your GP may refer you to a sleep clinic or pass your cass on to a sleep specialist if they suspect you have a sleep disorder or feel your require some form of treatment.


Related psychological issues to Sleep Problems


Psychological issues, such as depression and anxiety, are commonly associated with the development of sleep problems. It can often be difficult to pinpoint which developed first, as insomnia can result in anxiety and depression.

Low moods and insomnia can become interlinked. For example, mild depression may cause sleeplessness which then leads to more depression and anxiety as it’s harder to manage your moods if you are exhausted. It is therefore important to treat the sleep problem and the anxiety and/or depression.

Other related psychological issues to sleep problems include:
  • Post-tramautic stress disorder
  • Panic disorder
  • Bipolar disorder
  • Schizophrenia

Your GP or mental health professional can help you investigate and identify if any of these issues are causing your sleep problems.

What is the risk if sleep problems are unaddressed?


Good sleep plays an important role in maintaining our cognitive functioning, regulating our moods, and boosting our immune system. A lack of sleep can affect our daily functioning, leading to mood swings, depression, relationship issues, increased risk of cold and flu, and general feelings of ill health and exhaustion.

Lack of sleep can lead to premature aging. Extra cortisol is released within the body if you are not gaining enough sleep, which leads to a break down of collagen and a spike in blood pressure. Your body may also struggle to release enough growth hormone needed for healthy bone density and muscle mass.

Poor sleep can also lead to obesity. Studies have shown a relationship between sleeping and the production of peptides - the chemical that regulates our appetite. If you don't sleep enough you might lose your proper body response that tells you when you are satiated, leaving you susceptible to overeating.

Useful resources for dealing with Sleep Problems


Useful Websites
The NHS Better Sleep
NHS Scotland Guide to Sleep
The Sleep Council's Good Night Guide
helpguide.org Sleep Pages

Counselling and Therapeutic Services and Organisations

There are many trained professionals who will be able to support you such as your GP, as well as counsellors and psychotherapists, if your sleeping problem is related to depression or anxiety.

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