Cameron Ivchenko

Insomnia is the most commonly reported sleep disorder.  At any given time between 30-50% of the population will be experiencing acute episodes of insomnia (< 3 months), and 10-15% meet criteria for chronic insomnia (> 3 months.)

Insomnia can present as difficulty in initiating sleep (Sleep onset Insomnia), difficulty maintaining sleep (Sleep maintenance Insomnia) and/or waking too early on more than three nights per week.

Insomnia has been associated with poorer mental health, reduced quality of life and an increased risk of developing psychiatric conditions.

Most insomnia begins as a response to a stressor, such as financial or relationship issues, or can be a consequence of jet lag.  If symptoms persist after the original stressor has resolved, or continue for greater than two weeks, then the insomnia can become the primary issue.

People often feel unrefreshed upon waking and fatigued during the day. This is distinguished from sleep disordered breathing conditions such as sleep apnoea wherein sufferers will feel sleepy and crave sleep during the day.

For initial presentation insomnia (<2 weeks duration) sleeping medication can be an option.  However there is a risk of addiction, therefore weaning strategies should be discussed with your GP.

Good sleep hygiene will also optimise the chances of returning to a regular sleep cycle:

  1. It is important to maintain a regular wake time, regardless of how well you sleep and whether it is a weekday or weekend.
  2. Try and address concerns or worries before bedtime, or make an interim plan to address these issues at a specific time during daylight or wakeful hours.
  3. Avoid going to bed until you are drowsy and ready to sleep. Going to bed early when not particularly tired increases the total time you are in bed whilst not sleeping, and reduces the psychological association between bed and sleep.
  4. Try not to force sleep, and if you find it hard to initiate sleep within 30 minutes of going to bed, get up and do something else which is calming such as reading on the couch.
  5. Avoid napping during the day, especially naps longer than 20-30 minutes, and in particular in the afternoon or early evening. Napping saps your sleep drive and makes it more difficult to have a complete sleep over night.
  6. Reserve the bedroom for intimacy and sleep. Reduce bright lights and decrease stimulation by turning off televisions and screens.
  7. If you have an alarm clock, face it away from you so it is unable to be seen overnight.
  8. Allow enough time in bed to get sufficient sleep. For those experiencing daytime somnolence/lethargy aim for a minimum of seven hours total sleep time per night.
  9. Avoid caffeine after lunch. Restrict caffeinated drinks to not more than two per day. Avoid coffee, tea, cola or energy drinks in the afternoon.
  10. Avoid or minimise alcohol consumption in the late afternoon and evening.
  11. Avoid large meals prior to going to bed.
  12. Avoid smoking or other nicotine products in the afternoon and evening.
  13. Remove pets from the bedroom while attempting sleep.
  14. Exercise regularly for 20 minutes each day but not closer than one to two hours before bedtime.
  15. Create a pre bed routine which is relaxing and regular such as having a bath and reading.
  16. Keep the sleeping environment cool.

If these sleep hygiene tips are adhered to and sleep is still difficult to attain or maintain then referral to a sleep psychologist and/or a GP who may use cognitive behavioural  therapy (specific to insomnia) can be helpful.

Melatonin supplementation can also be effective in entraining circadian rhythms (sleep wake patterns) however it is not available without prescription for those under the age of 55 . It should only be taken under the guidance of a medical practitioner and as an adjunct to other sleep behavioural treatments.

Often insomnia can be a symptom of another underlying condition such as sleep disordered breathing, restless legs syndrome and or conditions which cause significant night pain and so have the potential to disrupt sleep. A thorough assessment by a medical doctor is recommended to clarify this.

Cameron Ivchenko is a Physiotherapist with an interest in sleep.  He has completed a Master of Sleep Medicine and a post graduate diploma in Psychology. Cameron consults as a physiotherapist and sleep therapist and can conduct Physician reported sleep investigations through Springs Medical in Daylesford. A GP referral may be required.