4. Aim
To begin to understand more
about Insomnia, the types,
signs and symptoms, causes
and treatment and support
options.
5. Objectives
Recognise the importance of sleep and assess
your own sleep quality
Define what we mean by Insomnia
Identify the symptoms and effects of sleep
deprivation
Examine some facts and figures relating to
Insomnia
Describe the causes of Insomnia
Identify the main types
Identify other sleep related disorders
Discuss the importance of good sleep hygiene
Describe helpful strategies, treatment and support
options
Complete a case study
6. The importance
of sleep
Sleep helps to repair the body
Sleep is good for the heart
Sleep reduces stress
Sleep improves our memory
Sleep can control body weight
Sleep can improve our well being
7. Sleep – Is it a
problem
for you?
Assess your sleep quality
8. Insomnia –
Finding a
definition
Insomnia is the inability to obtain
an adequate amount or quality of
sleep. The difficulty can be in
falling asleep, remaining asleep, or
both. People with insomnia do not
feel refreshed when they wake up
( WebMD 2005 )
9. Some Symptoms
Difficulty falling asleep despite being tired
Waking up frequently during the night
Trouble getting back to sleep when awakened
Tossing and turning
Racing mind
Relying on sleeping pills or alcohol to fall
asleep
Waking up too early in the morning
Daytime drowsiness, fatigue, or irritability
Difficulty concentrating during the day
Lack of mental alertness
Mood alterations
Headaches ( migraine )
10.
11. To Sleep
A flock of sheep that leisurely pass by
One after one; the sound of rain, and
bees
Murmuring; the fall of rivers, winds and
seas,
Smooth fields, white sheets of water,
and pure sky -
I've thought of all by turns, and still I lie
Sleepless...
~William Wordsworth, "To Sleep"
12. Facts and Stats!
What %? of the country is said to be
suffering from insomnia?
20%
40%
60%
26. Treatment Options
Counselling / talking treatments
Prescribed Medication
Over the counter Medication
Herbal remedies
Notes de l'éditeur
If you can just introduce yourself, give me an idea of where you work, what
Breaks – We will aim to have a break after an hour, the loo – out and to your right before you get to the other door exit. Handouts - I have a little booklet at the end for you to take away, by all means take notes, sometimes writing things down and key points for you can consolidate information as it happens. Health and Safety – No planned alarm tests, follow the green man if the alarm does sound, it’s a completely non smoking building so smokers must stand outside, wires etc
We spend approx a third of our lives asleep, that’s nature telling how important it really is!!, but what are the phsyical and mental advantages to being asleep? – Group exercise. We all feel so much better after a good night's sleep. Our thoughts are clearer, our reactions faster and our emotions are less fragile after a few hours of sleep. Sleep helps to repair the body – Without getting too technical in the biology and chemistry dept our bodies produces extra protein molecules while we are sleeping, and these help to mend our body cells. The damage from all kinds of things, such as stress, pollutants, infection, sun exposure and so on, is repaired while you're happily in the land of nod. A healthy, deep sleep allows our body to release a significant amount of growth hormone that boost the immune system and aids in the growth and repair of the body. It is good for the heart – Our heart and cardiovascular system is constantly under pressure, and one of the benefits of sleep is that it helps to reduce the levels of stress and inflammation in the body. High levels of 'inflammatory markers' are linked to heart attacks, heart disease and strokes. Sleep can also help keep blood pressure and cholesterol levels (which play a role in heart disease) lower. Sleep reduces stress - A good night's sleep can lower blood pressure and the elevated levels of stress hormones which are a natural result of today's fast paced lifestyle. There are physical effects of stress such as excess 'wear and tear' on your body, and an increase in the aging and degeneration of organs, cells and other body parts. By reducing high levels of stress, sleep helps to reverse these effects and encourages a state of relaxation. Sleep improves our memory - That 'foggy' feeling that you struggle with when deprived of sleep makes it difficult to concentrate. This often leads to not being able to 'commit to memory' facts, faces, or even conversations! Sleeping well eliminates these difficulties because as you sleep, your brain is busy organising and correlating memories. One of the great benefits of sleep is that it allows your brain to better process new experiences and knowledge, increasing your understanding and retention. Which might account for where the phrase ‘sleep on it’ comes from. Sleep can control bodyweight - One of the lesser known benefits of sleep is that it helps regulate the hormones that affect and control your appetite. Studies have shown that when your body is deprived of sleep, the normal hormone balances are interrupted and your appetite increases. Unfortunately this increase in appetite doesn't lead to a craving for fruits and veggies, no, instead your body longs for food high in calories, fats and carbohydrates! making sure that getting enough sleep becomes even more of a priority. Sleep and well being - Psychologists have argued that our brains are still as active in the deep stages of sleep, e.g the REM stage of sleep, dreaming is said to give us greater opportunities for understanding, self knowledge and well being.
Exercise – This exercise is about pinpointing triggers and possible patterns which maybe affecting your sleep, it could form the basis of a sleep diary if you were ever to start keeping one. Now track back to yesterday…and try and answer these questions?, its not a diagnostic exercise, but it is useful to establish for ourselves where difficulties sometimes occur. SHEEP!!! Go through each point briefly, get people to give examples, but do in group.
Insomnia is a common symptom, not an actual mental health condition as such, it affects millions of people that may be caused by many conditions, diseases, or circumstances. Now, I can hear you how did Insomnia get its name? - It's from the Latin insomnia "want of sleep," from in- "not" + somnus "sleep." So we know that people with insomnia have poor sleep quality, have difficulty falling asleep, remaining asleep and have that unrefreshed feeling come the morning, but what other symptoms might be occuring for someone?
One important thing about symptoms, is that they are very individual to us in the respect that each and every one of us is different. So, some of the classic symptoms of sleep disturbance were highlighted in that last exercise. This is not to say that if you can tick the box to many of these that you have a sleep problem, but if you are consistently struggling with these factors then you might
Cognitive impairment – Confusion, forgetfulness, concentration, feeling groggy. Moral judgement – the way we judge and treat others according to our thoughts, feelings, ethics, personal opinions – can be misjudged. Hallucinations- Sometimes called hypnogogic, from the Greek meaning "abduction, transport, leading away" etc. usually happening in a state of drowsiness and before sleep. Can be very mild in a lot of cases. For the average person, simple auditory or visual changes happen, light sounds, simple visual patterns, sometimes they maybe quite vivid but they are usually not disturbing mentally. Type 1 diabetes occurs when the body produces no insulin. It is often referred to as insulin-dependent diabetes. It is also sometimes known as juvenile diabetes or early-onset diabetes because it usually develops before the age of 40, often during the teenage years. Type 2 diabetes occurs when not enough insulin is produced by the body for it to function properly, or when the body’s cells do not react to insulin. This is called insulin resistance. 90% of all diabetics have Type 2, common over the age of 40. Decreased temperature – Link to Hypothyroidism, a hormone deficiency, affecting the regulatation the body's growth, metabolism, digestion, body temperature and heartbeat. One of the other symptoms is intolerance to cold.
20% - the same % is said to occur across the world, one article I read once said that most people don’t even know they are suffering from it, if the case remains that people don’t recognise it, come forward for a solution or possible treatment then there must be many more people coping with the problem than we realise. We certainly are not sleeping enough, a poll by a web based project called metro naps found 60% of people are only getting 5 hrs sleep a night ….the recommended sleeping hours for adults is what? – 8 hrs , in this poll, only 23% of people were getting this.
True – About 1.5 / 2 times more likely than men – Why? - Sometimes perimenopausal (the time leading up to menopause) women have trouble falling asleep and staying asleep; hot flashes and night sweats often can disturb sleep. Pregnancy also can affect how well a woman sleeps, discomfort, leg cramps, frequent trips to the loo, also there are studies that generally women are more prone to anxiety and depression which in themselves could lead to problems with falling and staying asleep – we could ask ourselves why do more women than men suffer from anxiety and depression, ideas?
True - As people get older, sleep changes, about 15% of an elderly persons sleep is so called light sleep, it is said that older people are more sensitive to surrounding factors ( noise, light etc ), they are also prone to certain medical problems such as heart conditions, urination problems, athritis, gastrointestinal problems, which can cause night time distress, different hormonal shifts maybe relevant too. This is very generic, but older people tend to lead a more sendentary life than younger people another reason why it maybe a problem.
90% - Most people complain of pressures on relationships, work problems, difficulty to pay attention to day-to-day events and the loss of friends,just some examples. What seems significant with this? – to me it seems that if 90% of people recognise that it’s a problem a good number of people can move towards some support and help to start combatting it, but it might mean addressing the source and root of the problem too.
Spidergraph – What are the causes?. Psychological - Anxiety , a condition in which individuals feel increased tension, apprehension, and feelings of helplessness, fear, worry, and uncertainty. This may be due to the effects that other people at work have on us, financial worries, concerns over relationships outside work or numerous other causes. Stress , much more diffuse, anxiety and stress go hand in hand of course, sometimes we don’t deal effectively in coping with emotional, physical, social, economic, or other factor that requires a response or change. Depression , a mood disturbance characterized by feelings of sadness and despair, though can range right through to low mood and irritability to clinical and severe depression, again co-morbid with anxiety and stress is integral. Of course its important to note that other factors can cause insomnia and as a consequence can affect or mental health….creating a vicious circle Physica l – Melatonin – Link. By age 60, the body produces very little melatonin. LINK Medical conditions. These include allergies, arthritis, asthma, heart disease, high blood pressure, thyroid problems and Parkinson's disease. Pain. Pain and discomfort from a medical illness or injury often interfere with sleep. Genetics – Is it genetic? - It is difficult to say conclusively although studies have shown that in roughly a third of all insomnia cases the sufferer has had one parent who has suffered from the condition themselves. It usually transpires that the sufferer’s mother has been the insomniac. Studies in the United States show that many twins suffer from Insomnia and this may well be a genetic link which has yet to be accurately pinpointed. Other sleep disorders. But lets just acknowledge this for now, we will cover the other issues. Adjustment. This form of sleeplessness is a reaction to change or stress. It may be caused by a traumatic event such as an illness or loss of a loved one, or a minor event such as a change in the weather or an argument with someone. Jet lag. Air travel across time zones often causes brief bouts of insomnia. Shiftwork:Working the night shift or long shifts. Individuals who work at night and those who work long shifts may have trouble adjusting their sleep habits. Medications. Insomnia can be a side effect of various medications, both prescription and over-the-counter . LIST Overuse of caffeine and alcohol. Caffeine most commonly disrupts sleep. While a drink or two before bed may help a person relax, more than that can lead to fragmented sleep and wakefulness a few hours later. Environment - Environmental noise, extreme temperatures, or a change in a person's surrounding environment.
Co-morbid - Co-morbid insomnia involves sleep problems that are associated with other medical problems, and is the most common. More than eight out of ten people who suffer with insomnia are believed to have this type. Examples of medical problems that are commonly associated with insomnia are: physical health problems – athritis, heart problems, mental health – stress, anxiety and depression, another sleep disorder – we’ll pick up on this in a few mins, plus poor sleep environment and sleep routine. Transient – This is a disturbed sleeping pattern or the inability to sleep well and feel refreshed next day over a period of a few days up to 4 weeks. Almost everybody has had this experience before important events or changes of the daily routine, examples? from going on holiday, taking an exam, or after an argument with a close friend or relative. Usually linked to stress levels and anxiety. Studies show that extreme physical and mental activity can cause transient. Most people tend to cope, usually no treatment is necessary or recommended, it also worth saying that its better to identify the sources of stress or worry and to find a better way to relax in the evening than seek out a medication remedy. Short Term - Short-term insomnia lasts for a period of four weeks to six months. It often results from more prolonged stress or worries, such as financial troubles, the death of a loved one, a job change, or a divorce. If not addressed, short-term insomnia may escalate into a chronic problem. Chronic - Chronic insomnia can occur every night, most nights, or several nights each month. Chronic insomnia is often caused by a medical problem; treating the underlying problem may alleviate the insomnia. Chronic sleeplessness may also be caused by bad sleep habits and intense stress and anxiety. The causes tend to be the same, mental and physical strain, but the severity determines the type experienced.
Here are 5 descriptions of some other sleep disorders ( on flipchart ) all you have to do is match up each description with its title / name. Sleep Apnea – Risk factors include, overweight, age..its more prevalent over 65, smoking, thick neck, receding chin, nasal congestion and blockage – can be cured – exercise, diet and lifetsyle changes. Narcolepsy – Causes are difficult to pin down, maybe environmental and health triggers, such as a virus, might also be something to do with a brain chemical called hypocretin, too little of this may cause the problem, has been proved to be genetically inherited, can be overcome by dealing with emotional and behavorial factors, some stimulants and and depressants. There are many others, from a seemingly endless list, restless legs syndrome and periodic limb movement disorder, sleep paralysis , adjustment sleep disorder,
Insomnia won’t kill you but some of it consequences might be fatal - what are the consequences – whole group / flip Driving – Accidents, falling asleep at the wheel, concentration problems, inability to make quick descisions might prove fatal. Problems in the workplace – Tiredness, lack of attention to detail, mistakes, accidents, poor decision making, struggle with workload, conflict with colleagues due to irritability and fatigue, increased absence, ironically of course work could be the catalyst for the stress or anxiety which causes the insomnia which then in turn affects performance of work, so a vicious cycle tends to appear. Note: Under the Disability Discrimination Act, an employer has to make reasonable adjustments for employees who have been diagnosed with chronic health problems, including insomnia. Even without a diagnosis, you may find that your employer is keen to discuss possible changes in order to retain you as a member of staff. Stress and depression – As we have said it can cause insomnia but lack of sleep can also cause stress and depression, it’s a bit of a chicken and egg scenario, suffice to say a lack of sleep and poor sleep patterns undoubtedly have a significant effect on our mood and well being. Sleep deprived brains are not producing enough of the chemical (serotonin) that helps to regulate mood, appetite and memory. At the extreme end of the scale, increased paranoia, aggression or anti-social behaviour can result. Memory Loss - Getting good sleep helps your memory, while sleep deprivation damages it. It is said that sleep protects memories from interference Intellectual impairment - insomnia or lack of sleep can impair IQ and cognitive development in children. Lower grades and poor peer relations could also result from sleep deprivation. Getting good sleep increases cognitive ability. Decline in physical health - The body may experience fatigue, pale skin, nausea, tremors, weight fluctuations, and an ineffective immune system. The eyes may be affected by blurred vision, dark circles, twitching muscles, and even color blindness. Chronic insomnia can also affect the brain, causing dizzy spells, fainting, headaches, irritability, and slurred speech.
exercise Poor sleep habits are among the most common problems encountered in our society. We stay up too late and get up too early. We interrupt our sleep and we overstimulate ourselves with late-night activities such as television etc. So how do we develop better sleep hygiene. Here are some headings, work in groups to describe some ideas about how someone might develop better sleep habits, strategies etc. Personal Habits – Fix a bedtime and an awakening time . The body "gets used" to falling asleep at a certain time, but only if this is relatively fixed. Even more important for people who are retired or not working, this is an essential component of good sleeping habits. Avoid napping during the day. If you nap throughout the day, you will not be able to sleep at night. Somepeople will take a nap during the late afternoon. This is generally not a bad thing to do, provided you limit the nap to 30-45 minutes and can sleep well at night. Avoid alcohol 4-6 hours before bedtime. How hard is that!!???. Many people believe that alcohol helps them sleep. While alcohol has an immediate sleep-inducing effect, a few hours later as the alcohol levels in your blood start to fall, there is a stimulant or wake-up effect. Avoid caffeine 4-6 hours before bedtime. This includes caffeinated beverages such as coffee, tea and many fizzy drinks, as well as chocolate, so be careful. Avoid heavy, spicy, or sugary foods 4-6 hours before bedtime. These can affect your ability to stay asleep. Exercise regularly, but not right before bed. Regular exercise, particularly in the afternoon, can help deepen sleep. Strenuous exercise within the 2 hours before bedtime, however, can decrease your ability to fall asleep. Swimming example – risk of oversleep!!!. Sleeping environment - Use comfortable bedding. Uncomfortable bedding can prevent good sleep. make appropriate changes. Find a comfortable temperature setting for sleeping and keep the room well ventilated. Is it too cold or too hot, does it keep you awake. A cool (not cold) bedroom is often the most conducive to sleep. Block out all distracting noise , and eliminate as much light as possible. Reserve the bed for sleep and sex. Don't use the bed as an office, workroom or recreation room. Let your body "know" that the bed is associated with sleeping. Sleep Restriction - Restricting your time in bed only to sleep may improve your quality of sleep. This therapy is called sleep restriction. It is achieved by averaging the time in bed that the patient spends only sleeping. Rigid bedtime and rise time are set, a person can force themselves to get up at the rising time even if they feel sleepy. This may help the person to sleep better the next night because of the sleep deprivation from the previous night. Sounds like it is not Getting ready for bed - Try a light snack before bed. Warm milk and foods high in the amino acid tryptophan, such as bananas, may help you to sleep. Practice relaxation techniques before bed. Relaxation techniques such as yoga, deep breathing and others may help relieve anxiety and reduce muscle tension. Don't take your worries to bed. Leave your worries about job, school, daily life, etc., behind when you go to bed. Assign a "worry period" during the evening or late afternoon to deal with these issues. Establish a pre-sleep ritual. Pre-sleep rituals, such as a warm bath or a few minutes of reading, can help you sleep. Get into your favorite sleeping position. If you don't fall asleep within 15-30 minutes, get up, go into another room, and read until sleepy.
For many poor sleepers learning how to relax is easier than getting to sleep. Learning relaxation techniques can help in falling asleep. It also helps relax the body easing muscle tension and calming the mind. Relaxation can be learnt and many people find yoga, tai chi, meditation, relaxation classes and CDs helpful. Relaxation can be done anywhere and requires little more than a quiet space. Your aim is to relax and calm the mind, which will help you learn how to let go and relax when you do go to bed. Breathing Exercise / if time: Imagery
Sometimes its what we eat and drink which has a bearing on our ability to sleep well. There a number of foods that keep us awake at night. Is your brain revved up or is it relaxed? Tryptophan is a precursor of sleep inducing substances such as serotonin and melatonin, a lot of foods have high amounts of tryptophan, therefore eaten over an extended period of time can help you relax and feel calmer, there is much more information available about this on the internet, have a look at MH Foundation they produce a fantastic guide but lets keep it simple, heres a list of the best ‘snooze foods’. HANDOUT Bad foods – Anything with caffiene in it will serve to keep you awake, a single cup of coffee can increase the heart rate, breathing, speed up the urinary output, it’s the reverse of what you would want if you need to get to sleep!, they say 2 and a half cups of coffee a day is sufficient. Of course its not just coffee, its tea also, fizzy drinks ( coca cola ). Chocolate is not high in caffiene, ironically some chocolate based biscuits and cakes are reasonably high in tryptophan!. Exercise - People who regularly engage in exercise have fewer episodes of sleeplessness. Exercise promotes improved sleep quality by allowing smoother and more regular transition between the cycles and phases of sleep. Moderate exercises lasting 20 to 30 minutes three or four times a week will help you sleep better and give you more energy. Exercise in the morning or afternoon, not close to bedtime. For some people, exercise alone is sufficient to overcome their sleep problems. Benefits – A whole host, but here are some: reduces the boredom, worry, and tension, strengthens and stimulates the heart and lungs, eases the muscular tension that can build up, stimulates the release of epinephrine, a hormone that creates a sense of happiness and excitement, increases the body's production of endorphins. Endorphin creates a sense of well-being and increases the body's resistance to pain. Best exercise? – what do you think? – I can give you a clue its not snooker or darts – Cycling, Swimming, Jogging, walking and dancing , so not a years subscription at the gym, if you have a bike and a few quid a week to go swimming then that’s it, jogging, walking and dancing you can do for nothing.
It’s also helpful to challenge the negative attitudes about sleep and your insomnia problem that you’ve developed over time. The key is to recognize self-defeating thoughts and replace them with more realistic ones. Its like dealing with the internal voice. Exercise
What is it? - Emotional intelligence is the ability to identify, use, understand, and manage your emotions in positive and constructive ways. It's about recognizing your own emotional state and the emotional states of others. Emotional intelligence is also about engaging with others in ways that draw people to you. Read Goleman 1995, further reading. 4 areas - Self-awareness – The ability to recognize your own emotions and how they affect your thoughts and behavior, know your strengths and weaknesses, and have self-confidence. Self-management – The ability to control impulsive feelings and behaviors, manage your emotions in healthy ways, take initiative, follow through on commitments, and adapt to changing circumstances. FOUR A’s – Avoid, alter, adapt or accept. Social awareness – The ability to understand the emotions, needs, and concerns of other people, pick up on emotional cues, feel comfortable socially, and recognize the power dynamics in a group or organization. Relationship management – The ability to develop and maintain good relationships, communicate clearly, inspire and influence others, work well in a team, and manage conflict. It seems obvious in a way, I suppose to sum it up if we build some of this into our lives, we are less likely to be stressed, anxious and suffering from low mood which ultimatelly might increase our happiness Example relating to stress: Realize when you’re stressed – The first step to reducing stress is recognizing what stress feels like. Many of us spend so much time in an unbalanced state that we’ve forgotten what it feels like to be calm and relaxed. Identify your stress response – Everyone reacts differently to stress. Do you tend to space out and get depressed? Become angry and agitated? Freeze with anxiety? The best way to quickly calm yourself depends on your specific stress response. Discover the stress relief techniques that work for you – The best way to reduce stress quickly is through the senses: through sight, sound, smell, taste, and touch. But each person responds differently to sensory input, so you need to find things that are soothing to you.
The general rule here is that its best for people to try some different strategies, look at the sleep hygiene issues, the self defeating thoughts, the lifestyle changes. If the symptoms are so severe and debiltating then some more professional advice might be sought. Counselling – The sleep hygiene, relaxation therapy, stimulus control, and sleep restriction ideas and suggestions we have highlighted today are pretty much what CBT counsellors and other counsellors would look towards doing.My own opinion is that you help and support yourself to do these things, but when its not possible a point in the right direction by an objective voice can be the catalyst in turnign things around. Medication – Can’t be ruled altogether but shouldn’t be a starting point or at least should be inconjunction with some of the strategy based ideas. Most common? – Benzodiazepines – which drugs fall under this grouping? – Diazepam, Lorazapam etc. Some anti depressants, used for the treatment of insomnia in patients with co-existing depression because of some sedative properties. OTC - Antihistamines with sedative properties E.G. BenadryL have also been used in treating insomnia as they may induce drowsiness, but they do not improve sleep and should not be used to treat chronic insomnia. Melatonin: Melatonin supplements may be beneficial in patients with circadian rhythm problems. Herbal - St. Johns Wort and chamomile have not shown any real benefit in treating insomnia, although there is some evidence to say low mood can be helped by taking these.