Insomnia: What causes it and how to treat it
It happens every few months for Claire, and she describes it as "hell in a handbag".
She struggles to function day-to-day and loses tolerance with her kids, her husband, her parents, her in-laws and her colleagues. Her thinking is impaired, concentration is terrible and she makes poor decisions on all fronts. Some days she feels like she's less use at work than someone who turned up rolling drunk. Welcome to the world of the insomnia sufferer.
Researchers at Massey University's Sleep/Wake Research Centre define insomnia as having difficulty initiating or maintaining sleep, or non-restorative sleep together with impaired waking function that has been present for at least one month. These complaints occur despite having adequate time and opportunity for sleep.
Dr Lora Wu, a clinical psychologist who specialises in insomnia at the centre, says sometimes people go through periods of sleep loss, but if they've tried all the common solutions like having a regular sleep pattern; avoiding television, computer and phone screens in the hour before bed; not exercising too late in the evening; making sure their bed is comfortable, the room dark and the right temperature; avoiding alcohol, caffeine and cigarettes; not having daytime naps and taking clocks out of the room at night, it's probably time to seek professional help.
"Sleep issues are very common, and usually people don't bring it up. It's often not top of the list when you go to your GP so it's under diagnosed and under-reported. Sometimes people have had insomnia for years or decades and they've not sought treatment for it for a number of different reasons," says Dr Wu.
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Why does insomnia happen?
It's hard to put it down to a neat group of causes, but Dr Wu says with chronic insomnia there can often be an initial stressor (that starts the sleepless nights) but the disturbance can continue well after the gravity and impact of that event has declined.
"Sleep disturbance in response to stress is a very normal reaction. It's when that carries on, it becomes insomnia."
Family history is definitely a factor, too. "We've known for a while from population and twin studies that insomnia runs in families," tells Dr Wu. "Not always, but often, when you ask people with insomnia about how others in their family slept, they recall parents or siblings' sleep problems."
Your own behaviours can add another layer. Dr Wu says while there may be a predisposition to sleeping problems, current behaviours can make it worse.
"Things like how you treat sleep, sleeplessness, and feeling fatigued. Little things like clock watching and big things like trying to sleep in after a bad night.
"These behaviours are logical but in the long term they can contribute to insomnia. And of course the insomnia itself can become a stressor too. It's a vicious cycle because it makes you less likely to be able to handle small daily problems you would typically be able to handle with sufficient sleep. That can stress you out more, and then make it harder to sleep because you have more to think about at night."
The cost of insomnia to society
The mental cost of insomnia is high, as sufferers find their lives affected in so many ways – day and night. But it's not just affecting individuals.
Research carried out in Australia for the Sleep Health Foundation by Deloitte Access Economics 2017 estimates that inadequate sleep cost a total of $72.3 billion in 2016-2017. This includes $28.6 billion in financial costs and $43.7 billion in the loss of wellbeing.
It costs the health system, it costs businesses productivity, and it can even cost people their lives when accidents and mistakes are made due to lack of sleep. This means that if you suffer from insomnia, it is particularly important to look after your mental health throughout the busy festive season, and throughout the rest of year during the day, too.
So what’s the cure to insomnia?
What can sufferers do? "The most common solution is sleeping pills because that's the only funded treatment, but I have seen a pretty high success rate with cognitive behavioural therapy – that's what people with chronic insomnia should absolutely be getting before moving on to other treatments," says Dr Wu.
"It's basically a suite of tools we use to help people change how they think about sleep but also change their behaviour around sleep, because when you have insomnia for a long time you start acting differently about sleep. Sometimes people with insomnia, understandably, become hypersensitive around the issue, and they get up and start assessing how the night went, and before they go to bed they worry about how it's going to go. We try to teach them to see sleep and sleeplessness differently, and make sure what they're doing to try and improve their sleep, isn't in fact making it worse."
Many people report success with natural remedies too and one of the best known here is SleepDrops. Founder Kirsten Taylor is a naturopath and still gets daily emails from people who have suffered for years and found the combination of minerals, vitamins, essences and herbs she has formulated was exactly what they needed. When Kirsten works with people with serious insomnia, she believes the key is addressing both the day and night situation. Like Dr Wu, she recognises that the problem can become cyclic – the day affecting the night and the night affecting the day.
"Sleep might be an eight-hour block but it's part of a 24-hour circadian rhythm, so you can't just treat insomnia at night if you want to bring the person into balance quickly," explains Kirsten. "If you're getting out of whack during the day it's only going to exacerbate the night time and vice versa. Not sleeping at night is having an effect on 711 genes in your body during the day."
She gives chronic insomniacs night drops to calm the nervous system and get them to fall asleep. The drops contain a combination of herbs (such as chamomile, passionflower, Californian poppy, lavender and zizyphus) homeo-pathic components and flower essences – all widely known for their sleep-enhancing qualities. On top of that, she has developed a day formula to address the issues outside of sleep, including fixing factors that contribute to bloating and forgetfulness.
"When you're tired, your digestion doesn't work well – same with liver and thyroid for metabolism and energy. And then the nervous system is frazzled and overloaded and that needs to be energised, but at the same time it needs to be calmed. We put chronic insomniacs on a day formula to calm them down but also lift them up and give them energy – not like a Red Bull drink, more like a 'Thank god, I feel better' energy and that helps with their concentration so they're less likely to have accidents or get in trouble at work, or forget things."
Kirsten and her team completed a trial with Auckland City Rail Link as an initiative through their HR department.
"It was a 30-day Sleep Better Challenge using Sleep Hygiene, The US Sleep Foundation Sleep Health Wellness Survey – the internationally recognised survey for measuring sleep – and our products. One hundred per cent of participants experienced an improvement in their sleep and 71 per cent of people who were previously waking on average three times per night are now sleeping eight hours straight."
Words by Alexia Santamaria
This article orginally featured in NEXT magazine