insomnia and poor sleep

Insomnia and poor sleep

Dr Phillippa LawsonConsultant sleep physician

East Anglia

About me• Live in Saffron Walden• Consultant in sleep, respiratory and general

medicine at West Suffolk Hospital• Founder of the good sleep programme• Mother to two professors!

Outline• What is it?• Who does it affect?• How is it diagnosed?• What can be done?

What is insomnia?• Difficulty falling asleep• Difficulty staying asleep• Early morning wakening• Non-refreshing or non-restorative sleep

plus• Daytime symptoms• Prolonged

Who does it affect?• Anyone!• Prevalence 10 – 48 % depending on study methods• UK study§ found incidence to be 15 %, prevalence 37%• More common in females (55 %)• Median age 50 years (18 – 98)• Persistence of insomnia associated with increasing age• Associated with mental health problems• Associated with physical health problems• Associated with other sleep disorders

§Morphy et al SLEEP 30 (3) 2007

What causes insomnia?

Predisposing factors• Genetics• Hyperarousal• Depression• Tendency to worry and ruminate

Precipitating factors• Acute stress• Illness (physical or mental)• Medications• Worry and rumination

Perpetuating factors• Dysfunctional attitudes about sleep• Staying awake in bed• Increased time in bed• Worry and rumination about

insomnia

How do we diagnose it?

• Who? Self-diagnoseGPSpecialist in sleep medicine

• How? ‘Sleep history’QuestionnairesSleep diaryActigraphyPolysomnogram

Sleep diary example

How do we diagnose it?

• Who? Self-diagnoseGPSpecialist in sleep medicine

• How? ‘Sleep history’QuestionnairesSleep diaryActigraphyPolysomnogram

What can be done?Set your goalsGeneral wellbeing

• Nutrition and fluid intake• Alcohol intake• Caffeine intake• Nicotine• Exercise• Sun light• Incorporating rest times• Positive attitude

What can be done?Preparing the sleep environment

• Temperature• Bed and bedding• Light• Calm, uncluttered environment• Clocks and technology!

‘Sleep hygiene’• Regular bed/rise times• Avoiding napping• ‘Wind down’ routine

What can be done?Stimulus control

• Get out of bed when can’t sleep• Stop all sleep-incompatible activities• Strengthen the bed-sleep association

Sleep restriction• Reduce time in bed to actual sleep time• Shorten time in bed• Improves sleep efficiency and strengthens bed-sleep

association• Avoids disrupted and fragmented sleep

Sleep efficiencyTotal sleep time

(time from falling asleep to time you woke for final time minus estimated time spent awake during night)

÷Total time in bed

(time from lights out to time you finally got up)

X 100

Sleep diary example

What can be done?Stimulus control

• Get out of bed when can’t sleep• Stop all sleep-incompatible activities• Strengthen the bed-sleep association

Sleep restriction• Reduce time in bed to actual sleep time• Improves sleep efficiency and strengthens bed-sleep

association• Avoids disrupted and fragmented sleep

What can be done?Relaxation

• Progressive muscle relaxation/yoga/Alexander technique• Breathing exercises• Mindfulness• Imagery

Cognitive techniques• Thought blocking• Listing the positives• Turning the tables• Trying to stay awake• Alternative thinking techniques• Carefree attitude towards sleep• Test the hypothesis• Consider cognitive behavioural therapy and related techniques

Alternative thinking example

A carefree attitude towards sleep!

What can be done?Relaxation

• Progressive muscle relaxation/yoga/Alexander technique• Breathing exercises• Mindfulness• Imagery

Cognitive techniques• Thought blocking• Listing the positives• Turning the tables• Trying to stay awake• Alternative thinking techniques• Carefree attitude towards sleep• Test the hypothesis• Consider cognitive behavioural therapy and related techniques

But what about medication?

• Many on the market• Frequently employed• Intended as short term aid but often become long

term crutch• Daytime side effects• Treating a symptom, not the cause• Perhaps more useful as an ad hoc adjunct, for

acute problems

Conclusion• Insomnia is not a life sentence• Seeking help is the first step towards moving

forward• The ability to succeed comes from within but

gaining support will increase your chances of doing so

• Positive thinking is key• Believe!

"If you think you'll lose, you're lost,For out in the world we find

Success begins with a fellow's will;It's all in the state of mind.

Life's battles don't always goTo the strongest or fastest man;

But soon or late the man who winsIs the man who thinks he can."

Walter D. Wintle

thegoodsleepprogrammetake charge, move forward, live life