Severe emotional distress, such as bereavement, job loss or serious illness in those near and dear may require appropriate counselling prior to any specific sleep promoting therapy. Equally PTSD, may be managed appropriately prior to CBT-I.

Severe emotional distress, such as bereavement, job loss or serious illness in those near and dear may require appropriate counselling prior to any specific sleep promoting therapy. Equally PTSD, may be managed appropriately prior to CBT-I.

In some respects, it is unfortunate that emotional aspects such as these should be addressed first because good quality sleep generally helps these issues too, but common sense dictates that safety should come first.

Heavy or regular consumption of alcohol may also raise issues. Many people consider having a drink (night-cap) a good start to sleep. Alcohol is a soporific (sleep promoting), it has muscle relaxing properties. This is the main reason that snoring worsens after a drink or two. It is also a CNS (Central Nervous System) depressant, hence not drinking and driving. Unfortunately, alcohol, despite its appearance, does not promote good quality sleep. It disrupts sleep staging and normal sleep cycles, consequently it’s far from the ideal sleep medication!

Furthermore, excessive alcohol use (abuse) brings its own set of problems, as does the use of recreational or street drugs. Not only do they add chemical issues but they reduce compliance with plans that you put in place for yourself. Assistance is available and access is prudent for health maintenance. Smoking equally so, although smoking in itself has not been shown to adversely affect sleep improvement through CBT-I, smoking is clearly not in anyone’s best interest (except for the cigarette manufacturers and the government).

So, what about smoking – it can relax me, right?

Nicotine disrupts sleep and despite the general belief (like alcohol) use before bedtime disrupts sleep. Smoking can also increase the risk of developing sleep conditions like sleep apnea alone. However, since nicotine is a stimulant, smoking can mask tiredness. This is why for smokers; a cigarette can get you “up and going” for the day. Therefore, smoking disguises, the harm, it does.

Yes, coffee is a stimulant and excessive use may be used to counteract the problem of poor quality or deficient amounts of sleep. With a little insight we start to see just how bad the problem of poor sleep actually is! So, you want to be part of the solution, not part of the problem – good for you!

Both smoking and vaping expose your body to the addictive stimulant nicotine. Research shows that nicotine disrupts sleep several ways:

It suppresses REM (rapid eye movement) sleep, that is restorative sleep. Research indicates that most smokers feel less rested than non-smokers because they spend more time in the earlier stages of sleep (Stages 1-3).

Nicotine also causes withdrawal symptoms during the night that can disturb the Circadian Rhythm too. Smokers are also more prone to OSA in the night and experience more apneic events than non-smokers. Nicotine may impair the signaling system between the brain and breathing.

Inhaling nicotine-infused smoke or vapor can lead to inflammation in the nose and throat and can narrow the bronchial tubes of the lungs, all of which can aggravate nighttime breathing. Smoking and vaping may trigger obstructive sleep apnea or make existing OSA worse.

Daily inflammation of your lungs can lead to long-term breathing problems like asthma and COPD, or acute or chronic respiratory illnesses like bronchitis or a nagging cough. These coughing fits, combined with not getting enough oxygen when you breath, can disrupt your sleep further and contribute to many other health problems.

So, as you guessed smoking’s not great. Don’t try and give up smoking at the same time as CBT-I. It’s a lot to deal with all at once!

There are other issues that can disrupt sleep and your attempts to overcome them, on the way to a better sleep. You have to remember that sleep is natural. I would imagine that given a perfectly smooth path in life, most of us would not have any difficulty in sleeping. Let’s face it, life (for most of us) isn’t that way. I’d go so far as to say that given the frequency it occurs, there must be something going on!

As Insomnia is defined as a complaint of difficulty falling or staying asleep, associated with significant distress or impairment in daytime function and occurring despite an adequate opportunity for sleep – it has an approximate general population point prevalence of 10%. This relates to significant ongoing insomnia and the number is likely greater if other factors are considered.

Life isn’t easy generally and can occasionally be really quite difficult. For instance, if you feel that you’re under a lot of pressure right now (and with COVID-19 many are) your first step may be to seek support from some counselling sessions. Before you wonder why you would do this, remember; qualified counsellors are made to retain counsellors for themselves!

In the case of work or domestic disputes, tension or troubles, your body is potentially giving more than it can. It’s like having a bank account, but always withdrawing!

Let’s have a quick look at stress, what it is and how it can affect us.

I mentioned that Sleep Disordered Breathing (SDB) , which Includes Obstructive Sleep Apnea (OSA) is a common sleep complaint too. Insomnia and OSA have a strong association and it is wise to arrange a “sleep test” if you’re undergoing care for insomnia to rule out SDM. Anything that fragments sleep will make you feel dragged out and often lacking energy, sometimes with Excessive Daytime Sleepiness (EDS) too.

Insomnia

SDB is a disorder where there is limitation of airflow at night while you’re asleep and unable to protect your airway yourself. Snoring is a type of SDB and can cause the sufferer fragmented sleep. Often times it is their bedpartner who suffers insomnia! However, many studies have shown that heavy snoring can be the cause of cardio-vascular disease, especially heart attack and stroke. Alas, as medical awareness is poor, many snorers are not treated and their disorder goes on to cause a catastrophic even which is then blamed on to something else.

SDB comprises snoring, OSA and a disorder called Upper Airway Resistance Syndrome (UARS). OSA is a disorder where there can be complete blockage of the airway (called an apnea) as well as a partial blockage which as it allows some passage of air, cases snoring. Snoring and OSA often appear together but can exist separately, hence the value of a sleep test. A sleep test can often be performed at home (home test) although admittedly they tend not to promote sleep themselves – still diagnostically, they can be worth their weight in gold!

UARS is an interesting disorder because it occurs (not infrequently) in people you wouldn’t expect to have OSA. Therein lies the problem. One tends to assume that someone suffering from OSA will be male, middle aged and overweight. Because of this most of the screening tools used are for that stereotype, so UARS may get missed on the radar!

Only a decade or so ago, Upper Airway Resistance Syndrome was not on the radar and only a few years ago, I’ve heard physicians arguing against its existence! Still, I’ve also heard a physician claim that she “didn’t believe in OSA” although exactly what she meant by that I’m still not sure. There is still much misunderstanding out there and so it pays for you to find out what issues may be affecting you, if you want a better sleep.

UARS can be seen in the young, the slim, the fit and the healthy. Young women may also be affected yet everyone assumes that they can’t have OSA because they’re not middle-aged men, yet they do have it. Their breathing problem is more due to airway collapsibility than the blockage (usually the tongue and pharyngeal tissues) found in OSA.

UARS is also not so easily diagnosed as standard garden variety OSA which can also pose a problem. Sometimes a little common-sense may be required.

So, are there other problems we should know about before we look at insomnia?

Insomnia

Are you just about all in? Are you close to your wits end in not being able to get a decent night’s sleep? You’ve tried just about everything, from reading, to music and even herbal teas! May be there’s something you missed, but what is it? You’d buy it if you thought it would work! Hang in there, there’s light at the end of the tunnel, there’s hope for even the worst sleepers out there, let alone you! Continue reading “Insomnia”

Restless Legs Syndrome (RLS), or  Willis‐Ekbom Disease is a strange phenomenon, almost like a short-term craving or compulsion to move your legs.

Continue reading “Does Restless Legs Syndrome (RLS) cause Insomnia?”