It is estimated that some form of sleep disturbance will affect approximately 90 per cent of people at some point in their lives. In most cases the disturbance is temporary and will resolve, but for some people sleep problems persist. This fact sheet outlines some of the common causes of poor sleep and offers some simple tips to help improve sleep.

What is insomnia?

Insomnia is the name given to the inability to go to sleep or to stay asleep. Insomnia is more common in older people and twice as many women experience insomnia than men. There are several types of insomnia.

Primary insomnia

Most adults need about seven and a half to eight hours of sleep each night, however some people need less sleep. About two per cent of the population needs less than five hours a night. These people can still be highly productive and quite happy although not everyone in this group wants to live this way. Many would rather go to bed at the same time as their partner or simply don’t want to lie awake until 1:30 in the morning. These people may seek help and say, “Oh, I’ve never been a good sleeper”, but they still manage to function well and are generally not tired when awake.

It’s interesting to note that other family members will often have the same complaints. This type of insomnia can be difficult to treat as it may be very resistant to non-drug strategies. Basically, it is recommended these people go to bed for fewer hours, while listening to their own body clock for clues. Some simple lifestyle changes may also have an impact. See tips to improve your sleep.

Insomnia stimulated by an incident

Sometimes people who have not experienced sleep problems before can begin to experience insomnia because something has triggered a change in their sleep patterns. Often the trigger is a period of emotional trauma, or perhaps because work shifts have been altered or a baby has been born. Habits persist beyond the trigger period because the body learns that this is the norm. Patients with insomnia can feel frustrated and anxious and feeling this way can often make the problem worse.

For this group a range of psychological techniques aimed at ‘unlearning’ the conditioned sleep pattern may be useful. Strategies to overcome anxiety or frustration and changing lifestyle habits can help See tips to improve your sleep.

Disorders of the body clock

Some people have problems with their timing rather than quality or duration of sleep. This is very common in adolescents and young adults. These problems are not classified as being true insomnia. Usually people with disorders of the body clock have trouble getting to sleep and are then unable to get up in the morning. This can pose a real problem for those who have to get up early. When a person’s body clock is disrupted they generally feel sleepy during the day and crave recovery sleep on the weekend.

The body clock can be manipulated with carefully timed exposure to bright light. In the same way that body clocks adjust to differing time zones when travelling, body clocks can be shifted with light exposure. The timing of light exposure and the form of light used (outside light or bright light boxes is important and is best managed with a sleep specialist or sleep psychologist. Speak to your general practitioner (GP) for more information. Melatonin, a hormone secreted by the brain that regulates the body clock is now available in prescription form (Circadin). Melatonin capsules may assist in adjusting the body clock. However, light is substantially more potent than capsule forms of melatonin.

Some other causes of sleep disturbance

If any of the following are causing sleep disturbance, speak to your GP, who may refer you to a specialist if necessary.

• menopause – menopause symptoms, particularly hot flushes and night sweats, can disturb sleep
• sleep apnoea – is a repetitive process whereby the airways block, causing airflow and breathing to stop for a short time during sleep
• depression and anxiety – can affect sleep or be caused by lack of sleep, counselling may be helpful
• shift work – working when your body thinks you should be sleeping can impair sleep and lead to chronic sleep disturbance
• pain – pre-existing and chronic conditions can impair sleep, addressing the pain may help

Tips to improve your sleep

The following may help you get a good night's sleep, sometimes a change in routine is all it takes.

• Reduce your caffeine intake – to two a day preferably before lunch, including cola, tea, coffee and chocolate.
• Limit your alcohol consumption – to one to two standard drinks a day, as too much alcohol reduces sleep quality. Alcohol is also a sedative and can shorten sleep onset, however people tend to wake later in the night.
• Be physically active –A falling body temperature may reinforce sleep onset and maintain continual sleeping. This can be accentuated if you can increase your temperature by exercising and then allowing time to cool down. Note, don't be physically active in the four hours before going to bed as exercise is stimulating.
• Maintain regular timing of bed and awake time – by trying to get out of bed at the same time each day and don't sleep in, including on weekends. This is important for those with body clock disorders.
• Restrict time in bed – for sex and sleep, not eating, reading or watching TV, so as to train yourself to sleep when you get there.
• If not sleeping, get out of bed – and do a quiet, relaxing task in another room, as frustration at your inability to sleep can make the problem worse.
• Hide the clock – turn any clocks away from view so as to not clock gaze during the night, as this accentuates the sense of frustration.
• Try relaxation – or meditation as it can help some people to relax and get to sleep.

Medications for sleep disturbance

Sleep medications (e.g. benzodiazepines, stilnox) may be prescribed for short-term use, however these medications may cause dependence and should be taken with care. Speak to your GP or health practitioner for more information

Where can I get more information?

www.jeanhailes.org.au 

www.healthforwomen.org.au 

www.sleephealthfoundation.org.au – Sleep Health Foundation

www.sleepaus.on.net – Australasian Sleep Association

www.sleepoz.org.au – Sleep Disorders Australia

Content updated November 2011