Insomnia, causes and solutions

The most common sleep disorder is chronic insomnia. People with a so-called insomnia disorder have problems falling or staying asleep at least three times a week for three months. As a result, they are so tired that they experience difficulties in their daily activities.

People who struggle with insomnia are tired, irritable, gloomy, or drowsy during the day and have difficulty concentrating and remembering. Insomnia affects more women than men and is more common in older people. One in three people in the Netherlands sleeps poorly, but only 1 in 10 people has an insomnia disorder.

A sleep disorder increases the risk of physical and mental problems and conditions. Untreated long-term insomnia is a risk factor for developing cardiovascular diseases, an anxiety disorder, or depression. Additionally, sleep problems can increase the likelihood of someone becoming suicidal.

Insomnia is therefore not something to take lightly. And not only does the prolonged poor sleep cause problems for the individual.

Long-term insomnia generates high societal costs. People with insomnia complaints make greater use of healthcare. This is because they visit a doctor more often or use medication. However, the right treatment is not always provided. Currently, only a small portion of all insomnia patients receive the necessary care as described; a short-term cognitive behavioral therapy.

But what are the underlying factors that can cause someone to experience long-term sleep problems?

There are three factors that define the basis of insomnia: the predisposing, triggering, and maintaining factors.

For predisposing factors, we think of genetic and personality traits that may cause poor sleep. For example, think of perfectionism.

Triggering factors involve a stressful life event, such as a divorce or job loss, a mental disorder, or a medical problem. These can acutely lead to insomnia. Often, the insomnia goes away when the triggering factor disappears.

Maintaining factors are factors that trigger insomnia. Examples of these are: lying in bed for a long time, frequent daytime sleeping, and worrying. For example, it may be possible to sleep on the couch, but once in bed, sleep disappears. By continuing to take naps during the day, the insomnia will persist at night. This is also called the vicious circle of insomnia. In the vicious circle of insomnia, sleep-inhibiting thoughts, wrong sleep habits, and physiological and emotional overactivity reinforce each other.

There are various solutions for sleep disorders. Some are more effective than others.

1. Do not sleep during the day, or limit the afternoon nap to half an hour.
2. Do not drink coffee, cola, and alcohol 4 to 6 hours before going to sleep.
3. Never go to bed feeling hungry or with a full stomach.
4. Keep the bedroom only for sleeping. No reading, no laptop, smartphone, or watching TV.
5. Create a dark, quiet, and calm sleep environment.
6. Pay attention to the room temperature: ideal is between 16 and 20°C.
7. Ensure good ventilation in the bedroom.
8. Try to go to bed and wake up at the same time.
9. Sleep as many hours as you need to feel fit and rested the next day. For most people, this is about 7 to 8 hours.
10. Try to get some physical activity during the day, but avoid heavy exertion right before bedtime.
11. Use a weighted blanket to calm down

When the above tips do not help, it may be beneficial to visit your general practitioner. After the diagnosis, your doctor, together with you and the other doctors on the team, will choose the best solution.

Opt for cognitive behavioral therapy instead of sleeping pills

Sleep medications are still prescribed by doctors today for patients with insomnia complaints. However, research has shown that it is better to follow cognitive behavioral therapy for insomnia (CBTi). This type of therapy is, like sleep medications, also effective in the short term. Moreover, it is even more effective and less harmful in the long term.

Almost half of insomnia patients fully recover, and another thirty to forty percent significantly improve their sleep through cognitive behavioral therapy for insomnia. Additionally, cognitive behavioral therapy also leads to a positive mood and improvement in quality of life.

What is the goal of cognitive behavioral therapy for insomnia?