Insomnia, causes and remedies

The most common sleep disorder is long-lasting sleeplessness. People with so-called insomnia disorder have trouble falling asleep 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 struggling 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 among 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 chance of physical and mental problems and ailments. Untreated long-lasting sleeplessness is a risk factor for developing heart and blood vessel diseases, an anxiety disorder, or a depression. In addition, sleep problems can increase the chance that someone becomes suicidal.

Sleeplessness is therefore not something to take lightly. And the long-term poor night's rest causes problems not only for the person themselves.

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

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

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

Predisposing factors include genetic and personality traits that can cause poor sleep. Think, for example, of perfectionism.

Triggering factors involve a stressful life event, such as a divorce or dismissal, a mental disorder, or a medical problem. These can acutely lead to sleeplessness. In such cases, the sleeplessness often disappears when the triggering factor goes away.

Maintaining factors are factors that provoke sleeplessness. Examples include: 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 is gone. By continuing to take naps during the day, the sleeplessness at night will persist. This is also called the vicious circle of sleeplessness. In the vicious circle of sleeplessness, 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 nap to half an hour.
2. Do not drink coffee, cola, or alcohol 4 to 6 hours before going to sleep.
3. Never go to bed hungry or with an overly full stomach.
4. Keep the bedroom only for sleeping. No reading, no laptop, smartphone, or watching TV.
5. Create a dark, quiet, and calm sleeping 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 sleep and get up at a fixed time.
9. Sleep as many hours as you need to be fit and rested the next day. For most people, this is about 7 to 8 hours.
10. Try to do physical exercise during the day, but avoid heavy exertion just before bedtime.
11. Use a weighted blanket to relax.

When the above tips do not help, it may be beneficial to visit the family doctor. After diagnosis, your doctor, together with you and the other doctors of the team, chooses the best solution.

Choose behavioural therapy instead of sleeping pills

Doctors still prescribe sleeping pills today for patients with insomnia complaints. However, research has shown that it is better to follow cognitive behavioural therapy for insomnia (CBTi). This type of therapy is, like sleeping pills, also effective in the short term. Moreover, it is even more effective and less harmful in the long term.

Almost half of the insomnia patients fully recover, and in another thirty to forty percent, sleep improves significantly through cognitive behavioural therapy for insomnia. In addition, behavioural therapy also leads to a positive mood and improvement in quality of life.

What is the goal of behavioural therapy for sleeplessness?