I can't sleep: what causes insomnia and what can help?

Have you heard “Insomnia” by Faithless? You probably have; it’s had a fair bit of airtime over the years. Pretty relatable too, eh? Most of us struggle with sleep from time to time, whether that’s difficulty falling asleep or staying asleep.

In its Sleep Manifesto, The Sleep Charity estimates that 37% of UK adults experience symptoms of insomnia. Research reported by the Mental Health Foundation also suggests that the average UK adult gets good-quality sleep on only three nights a week.

Poor sleep has a financial as well as an emotional cost. Research by RAND Europe estimated that sleep deprivation costs the UK economy up to £40 billion per year through reduced productivity, absence from work and premature mortality (Hafner et al., 2016).

However, there is a difference between occasionally sleeping poorly and meeting the criteria for chronic insomnia disorder. This involves one or more of the following:

1. Difficulty falling asleep.

2. Difficulty staying asleep.

3. Waking earlier than intended and being unable to return to sleep.

   
   

These difficulties must occur despite having a suitable opportunity and environment for sleep, and they must cause significant distress or disruption to daytime functioning. For chronic insomnia, they must generally occur at least three nights a week and continue for three months or longer.

Insomnia can coexist with other difficulties, such as chronic pain or mental health conditions, although another condition or sleep disorder should not better explain the problem.

What causes insomnia?

Like many difficulties, insomnia rarely has a single cause. It can be triggered by psychological, physical or practical factors and is often maintained by a combination of them.

For someone with PTSD, vivid and frightening nightmares may create anxiety around going to sleep.

With generalised anxiety, persistent worry can make it difficult for the mind and body to settle. This often includes worrying about sleep itself: What if I can’t sleep tonight? How will I cope tomorrow?

Depression can also disrupt sleep. Rumination may keep the mind active at night, while reduced activity and sleeping during the day can weaken the natural drive to sleep at bedtime.

What can help?

There are specific treatments for insomnia, including CBT for insomnia (CBT-I) and medication. However, these approaches are not for everyone. Some people may find the behavioural changes involved in CBT-I difficult to maintain. Some medications can also have drawbacks, such as dependence and next-day drowsiness.

However, there are practical steps you can take to improve your sleep.

Sleep hygiene

Diet can aggravate sleep difficulties. Research has associated diets high in saturated fat and sugar with lighter, less restorative and more disrupted sleep. Conversely, greater fibre intake has been associated with more deep, slow-wave sleep (St-Onge et al., 2016).

A varied diet containing whole foods, fibre and essential nutrients may therefore support healthy sleep, although no particular food can guarantee it.

The timing of meals can also have an impact. Eating a large, fatty or spicy meal shortly before bed may cause indigestion or acid reflux, making it more difficult to fall asleep or remain asleep.

A lack of activity during the day can also affect sleep. Spending long periods physically inactive while remaining mentally stimulated, such as playing video games for several hours, may leave you feeling tired but wired and unable to settle.

The same may be true of highly stimulating activities just before bed, such as watching sport, reading something thrilling or becoming absorbed in online content. This will vary from person to person, so it can be helpful to notice what affects you rather than following a rigid set of rules.

Psychological factors

This may seem like a mixed message after discussing sleep hygiene, but becoming preoccupied with sleep and making endless changes can also maintain the problem.

Sleep is a natural process. The more we try to force it, the more elusive it can become.

Think about walking upstairs. Normally, you don’t plan it; you simply do it. Now imagine concentrating intensely on every step, anticipating that you might trip and planning each movement in advance. You look behind and in front of you, gripping the handrail as though your life depends on it. How much harder would climbing the stairs become?

Sleep can work in much the same way. Imagine that you had never experienced a sleep problem and someone offered you £1 million if you could fall asleep within the next half-hour. The pressure to succeed would probably make sleep considerably less likely.

Focusing heavily on the importance of sleep can also lead us to underestimate how much sleep we are getting and overestimate how much we need in order to function well. Have you ever been told by a loved one that you were snoring when you were convinced you had been awake? We do not always realise when we have slept, and this can reinforce the belief that we have a more severe sleep problem than we actually do.

Finding a balance

Everyone’s experience of sleep is different, but looking after yourself through a balanced diet and regular activity is a sensible place to start. It is also worth understanding your own vulnerabilities. Some people can drink coffee at bedtime and fall asleep straight away, but most people cannot.

Many of the choices that support healthy sleep are also beneficial for our mental health more generally.

At the same time, try to become less preoccupied with sleep. You might yawn because you are tired, but you can also yawn because you are bored or because you have seen someone else do it. If you attribute every dip in energy or sign of tiredness to the previous night’s poor sleep, you may unintentionally prime yourself to struggle again that night.

A poor night’s sleep is not ideal, but it is usually something you can get through. Taking away some of its power and importance may make it easier for sleep to happen naturally.

If you would like to book an assessment to discuss sleep or other difficulties then please click here.

Russell Wharton is a BABCP accredited CBT Therapist, RMN and EMDR Consultant.