The most useful and efficient way of starting one’s sleep program is by understanding their current sleep–wake patterns. The standard measurement tool for insomnia is the “sleep diary”. Sleep diaries are not really diaries, but simple logs, based on one’s recollection of their last night’s sleep. Because they are the expert on their insomnia, they are the best person to report on each night’s sleep in order to measure their sleep problem. In fact, people with insomnia who go to sleep labs usually have trouble sleeping in the lab, which simply confirms their insomnia. Although the sleep information obtained from consumer wearable devices is appealing, at the time of writing this, these trackers are not yet ready for use in Sleep Therapy. This chapter provides a note about personal electronic sleep trackers and discusses logging your sleep with a sleep diary.
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After Week 4 of Sleep Therapy, it is recommended that one should check to see if they are now free from insomnia. One can do this by looking at the same things in their current sleep diary, before they started Sleep Therapy. This chapter provides suggestions to find out the experiences of initial insomnia, multiple awakenings, middle insomnia, and terminal insomnia. If a person takes longer than 30 minutes to fall asleep, he/she is experiencing “initial insomnia”. If a person has more than 3 awakenings per night, he/she can describe it as having “multiple awakenings”. If a person awakes each night, (3 nights or more) for greater than 30 minutes, he/she is experiencing “middle insomnia”. If a person wakes up for more than 30 minutes too early on at least 3 mornings, then he/she has “terminal” or “end-of-night” insomnia.
Women are more likely than men to have insomnia. A family history of insomnia increases the likelihood of developing insomnia, especially if one’s mother had sleep difficulty. Some girls and women experience worse sleep in the 3–4 days before their menstrual period than at other times in their cycle. This is especially likely if they have premenstrual symptoms like depressed mood, irritability, appetite changes, and feeling tense. Pregnancy increases the risk of developing some other sleep disorders. Childbirth is a time when your sleep is bound to be totally disrupted. Women who develop persistent insomnia sometimes identify childbirth as the starting point of their poor sleep. Effective treatments are available for most sleep disorders. For insomnia, women make up the majority of volunteer participants in treatment studies. Cognitive behavioral therapy for insomnia works to reverse insomnia during most stages of life including young adulthood, midlife, and old age.
One’s sleep diary provides good information about their sleep timing, quality, and quantity, and is the best way to measure sleep if a person has insomnia. For more in-depth examination of sleep by scientists, or sleep medicine clinicians, special equipment is used to track sleep stages and cycles through the night. To determine sleep stages, three main measurements are used: brain waves, eye movements, and muscle tone. These are measured using electrodes that are attached to the scalp, the face near the eyes, and under the chin, respectively. Polysomnography is measurement of sleep overnight in the sleep lab, with electrodes that are attached to the scalp, face, and chin, to determine sleep stages. Actigraphy is another way that sleep can be measured, but only roughly.
Sadness and anxiety are normal human emotions and stress is a normal occurrence in our lives. When we’re feeling somewhat down, anxious or stressed, we can benefit from exercise, relaxation, recreation, eating nutritious foods, allowing time for sleep, and talking to a friend. Clinical depression and anxiety are very common conditions. This chapter looks at what they are, what happens to sleep, and what helps recovery of mood and sleep. It outlines what is known about treating insomnia in three forms of clinical depression: major depression, Seasonal Affective Disorder, and Bipolar Disorder. Research on how people respond to natural disasters has told us that within the first months of disaster, many people develop signs of anxiety, depression and posttraumatic stress. With respect to sleep, people with posttraumatic stress disorder tend to get somewhat less deep sleep, longer periods of being awake during the night, and an overall shorter sleep duration.
Although women tend to report insomnia in greater numbers, men have their share of sleep problems. Testosterone, a hormone that occurs in much higher levels in men than in women, influences the development and maintenance of male sexual characteristics, including reproductive organs, body structure, beard growth, strength, sex drive, aggression, and mood. There are important connections between testosterone and sleep. Research shows that the more the father is involved in caring for the infant—both during the day and at night—the better the mother’s sleep and the fewer times the infant wakes at night. There are two sleep disorders that occur more frequently in men than in women. These are “sleep related breathing disorders” and “
REMsleep behavior disorder”. This chapter outlines both. With age, men’s sleep, like women’s, becomes shorter and more broken up by awakenings. As with women, men experiencing stress at work are at high risk of insomnia.
As insomnia develops, one may start to worry about not sleeping. One of author’s friends had a stressful management position over which she started to lose sleep. She then feared that the lack of sleep would negatively affect her work performance. This made it even more difficult for her to sleep because the thought of underperforming increased her anxiety. One can see how this can become a cycle of worry and sleeplessness. This chapter discusses some of the common worries that are linked to insomnia. By examining these topics in the light of day, rather than ruminating during a sleepless night, we achieve a more balanced view of our sleep problem and its effects. Stressful thoughts at night have a way of expanding to fill the dark spaces around us. The chapter provides information that will help to bring one’s sleep-related worries down to earth.
Insomnia is a complaint of difficulty falling asleep or staying asleep that impairs the functioning or causes distress. So, compared to a bout of poor sleep, insomnia is a sleep problem that takes on a life of its own. Basically, it is persistent, unsatisfactory sleep that has daytime consequences. When insomnia occurs at least three nights per week and lasts for three months or longer, it is technically called “chronic” insomnia. People with insomnia report low mood, irritability, poor concentration and memory, reduced physical well-being, and some difficulties interacting with other people. They also report having more fatigue-related car crashes than people without insomnia. People with insomnia seem to be able to perform mundane tasks of daily living but they tend to have less enjoyment of their activities and show less “cognitive flexibility”—they tend to think more narrowly and less creatively—than people who sleep well.
Surveys from all over the world show that people who have medical conditions are especially likely to have sleep problems. A medical condition can lead to a sleep problem, and a sleep problem can lead to a medical condition. Each can exacerbate the other. There is a particularly strong link between chronic pain and sleep difficulty. Most people with chronic pain have insomnia. Research shows that cognitive behavioral therapy for insomnia improves the sleep of people who have heart disease and insomnia. People with lung cancer and women with breast cancer are especially likely to experience sleep difficulty. People who experience seasonal allergies are more likely than other people to have insomnia, to snore and to have sleep related breathing problems. The chapter also summarizes some of the findings about sleep when a person has Alzheimer’s disease, Parkinson’s disease, or multiple sclerosis.
Often people who are starting to improve their sleep worry that their progress is only temporary and that poor sleep will return. If a person had insomnia for several years, he/she may be especially prone to this fear of relapse. Maintenance starts with reminding oneself that they have acquired new knowledge about their sleep and mastered the strategies that improve it. This is very important to remember; it means that one will never be back at square one. This chapter provides some very practical steps to anticipate what could happen. Once a person knows the strategies for improving sleep he/she can use them as needed.