I'm a sleep expert – here’s 3 surprising ways we help insomniacs sleep05/15/2022
A SLEEP expert has revealed the worst things you can do when you’ve got insomnia – and the surprising ways it’s really treated.
Sleep physiologist Stephanie Romiszewski revealed the sleep disorder is often tackled in the wrong way.
Around ten per cent fulfil the criteria for insomnia disorder, the National Institute for Health and Care Excellence (NICE) says.
Insomnia can last just a few days (transient), stretch into a few weeks (acute) or become chronic, lasting several months or even years.
How it’s tackled could impact how long it sticks – and it’s largely within your own control, Stephanie, who runs The Sleepyhead Clinic in Exeter, explains.
People try to go to bed earlier, take naps or pop sleeping pills in order to make up for lost hours.
But this may worsen symptoms by confusing the body even more, she says.
Instead, one of the ways experts fix the condition is to restrict bedtime in those with insomnia.
Here's what you need to know…
How NOT to deal with insomnia
Recognising you have insomnia might be frightening.
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Stephanie told The Sun: “Unfortunately, insomnia has that label. And what comes along with that is this real fear and so it makes people do strange things.”
Stephanie says when people are worried they aren’t sleeping well enough, their first reaction is often to “alter their behaviour quite significantly”.
This can often cause more problems.
“Sleep is all about time," says Stephanie.
“If you start mucking about with the goalposts, by changing your wake time, and going to bed early… basically trying to manipulate sleep because you're worried you stopped sleeping, that's actually a way to make the sleep problem worse.”
In a similar vein, Stephanie warns against coping mechanisms that only increase the anxiety in your life.
Things like “sleeping pills, avoiding going to the gym, avoiding seeing your friends, moving away from the life that you want to live”.
“Suddenly you're a complete shell of your former self," she warns.
"Not only do you have a sleep problem, but you've got a huge anxiety problem."
This reaction to short-term insomnia may cement the condition in somebody’s life chronically.
Once you realise insomnia is just a pattern, you have the capacity to change the pattern
"Why hasn't that sleep problem gone away? Well, it's not usually down to the original trigger anymore," says Stephanie.
“Once you've had it for longer than three months, it turns into a habitual problem, which means your brain is starting to see it as a pattern.
“It is actually because you’ve trained the brain into a new pattern with all the behaviour and coping mechanisms you thought were going to help.
“And so actually, once you realise insomnia is just a pattern, you have the capacity to change the pattern.”
What to do instead
Stephanie says one of the first things to understand about insomnia is that it does not mean there is something genetically wrong with you, or there is any kind of chemical imbalance in the brain.
It can be tackled by changing beliefs and behaviours.
Most sleep problems are “entirely normal” and common.
And while the word insomnia may instil fear, meaning “no sleep” in Latin, you don’t need to take it quite so literally.
“If people with insomnia were getting absolutely no sleep, they would be dead,” Stephanie says.
“That is not what is actually happening with insomnia. This is the first point to make because people really get frightened.
“They think something terrible is going to happen. But actually that’s not the case.”
Only one form of insomnia, called fatal familial insomnia, a genetic disorder, has the ability to kill over a few weeks – and it is incredibly rare.
How the experts treat insomnia
Treating insomnia is all about retraining the brain, and re-education on how sleep works, says Stephanie.
Restrict bed time
The first thing insomniacs should do is to stop spending so much time in bed, willing themselves to nod off.
"A lot of people with insomnia will think, ‘I need to increase my time in bed to try to encourage sleep to come’," says Stephanie.
“But that doesn't come from any science that we know. You cannot fall asleep just by spending more time in the place where you used to sleep.
“You've got to actually restrict your bedtime down.”
It sounds counterintuitive, but restricting the amount of time you spend in bed can help improve sleep quality.
Sleep quality is, experts argue, more important than sleep quantity.
It refers to how restful and useful your sleep is, as opposed to how long you spend in slumber.
You cannot fall asleep just by spending more time in the place where you used to sleep
Restricting the time you spend in bed = no daytime napping, and no lie ins. This will help you create a sleep drive (AKA, a strong desire to sleep).
“After a while what you notice is your body actually gives you this wonderful, really good quality sleep. So suddenly you feel in control of your sleep again," says Stephanie.
“Once we've got that good quality, we add time [hours asleep].”
But as a patient with insomnia, you’ll have to drop the idea that eight hours of blissful sleep is either necessary, or achievable.
“We've got to help you understand what good sleep is, and that doesn't mean perfection. Sometimes you're going to have poor sleep,” admits Stephanie.
A therapist can provide cognitive behavioural therapy for insomnia (CBTi), which combines a number of psychological strategies to help reprogram the brain.
“For example, cognitive restructuring can help us notice and change negative thinking patterns," notes Stephanie.
“Another example is fear exposure; when I’m nearing finishing treating a patient, I need to help them understand that they'll have some bad nights but actually, it’s totally normal and it’s not going to end the way it used to, which was in a chronic insomnia condition, because they have much more healthy strategies to deal with it now.
“The more they see it that way, the more anxiety reduces, and the quicker it is to actually get back on track and have normal sleep again.
“We also do Acceptance and Commitment Therapy, which is trying to help you accept and come to terms with the sleep issue and the anxiety issue that can come along with it, as well as the fact there is something we can do about it.
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“We've got to help give you that boost and reassurance that you need in order to effectively go against the status quo – which is what you hear in the general population about sleep and is quite wrong – and actually do something that's going to help you.”
CBTi – “the evidence based, highly scientific way of treating sleep” – is not always available on the NHS, Stephanie says, but it is always worth speaking to your GP if you are concerned about your sleep.
Stephanie was a guest on Holland & Barrett’s The Wellness Edit podcast – listen to the February episode Reset Your Sleep here.
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