• Sleep-onset insomnia is when it takes longer than thirty minutes to fall asleep.
• Sleep-maintenance insomnia is the sleeping pattern of waking often during the night. This may be due to sleep apnoea (a breathing disorder), habit, shiftwork, stress or drug use.
• Early-morning awakening insomnia is often related to depression and can be due to alcohol use, habit, shiftwork, jet lag and going to bed too early.

Insomnia can be a short-term or chronic problem. Insomnia is not a disease, it is a symptom of other problems.

There is a lot you can do to improve your sleep but first you need to find out what is causing the problem.

Causes:

Many of us have experienced some sort of sleep problems at some time in our lives. Some of the things that may affect a good night’s sleep are:

PERSONAL FACTORS:

Medical Conditions: Asthma, Coronary heart disease, depression, chronic fatigue syndrome, chronic pain and tinnitus may affect sleep.

Sleep disorders: Restless leg syndrome, narcolepsy, snoring and sleep apnoea can affect sleep.

Parasomnias: Some specific conditions can interfere and disrupt the sleep process. Examples include sleep talking and walking, night terrors, nightmares, bedwetting and grinding of teeth.

Grief: Grief can be experienced from losses such as breaking up with a partner, the death of a close friend or family member and can cause intense emotional and psychological distress.

Grieving may lead to a range of sleep disturbances.

Talking to someone about the loss may help make the feelings more bearable. Someone experiencing prolonged or very strong grief reactions may require specialized assistance.

Stress: Stress is the body’s response to anything that is threatening. Experts suggest that 60-80% of sleep problems may be due to stress and worry.

LIFESTYLE FACTORS:

Circadian rhythms sleep disorders: Going to sleep late at night, going to sleep too early at night, having an irregular sleep-wake cycle, jet lag and shift work may interfere with sleep.

Physical Activity: It reduces the time taken to fall asleep and increases the length and amount of deep sleep leading to a more refreshing sleep.

Physical activity during the afternoon will improve sleep, but it can make getting to sleep difficult if too close to bedtime.

Nutrition: Eating late at night or going to bed hungry tends to keep you awake. Maintaining a well-balanced healthy diet is one way of improving your sleep.

Alcohol and other drugs: Drugs such as the caffeine in tea, coffee, cola drinks, cocoa and chocolate, nicotine in cigarettes, alcohol and the side-effects of medications, may interfere with sleep.

Alcohol may help people to fall asleep but may not lead to deep refreshing sleep. Drug use may cause decreased quality of sleep, insomnia, daytime sleepiness and more frequent walking.

Shift work: It can be difficult to sleep well when working shifts because people are working when they would normally be sleeping.

The internal body clock of shift workers is often affected and may result in a lack of sleep. This can cause sleepiness and difficulty in keeping awake, affecting the ability to function and causing safety issues at work, irritability, depression and family problems. Long-term shift workers can suffer from chronic sleep disturbances.

Some strategies that may help shift workers improve their sleep include:

• Having a sleep environment which is dark, quiet and not too warm
• Eating a carbohydrate-rich meal before sleeping
• Carrying out physical activity during the night shift. This may help the circadian rhythm of night shift workers adapt more quickly to sleeping during the day
• Eating food containing protein during work time may help keep the shift worker more alert.

Jet Lag: Travelling across time zones can make it difficult to fall asleep at the appropriate time in a new location. The symptoms that result are called jet lag. These symptoms include:

• Daytime sleepiness
• Insomnia
• Poor concentration
• Disorientation
• Slower reaction time
• Gastrointestinal problems
• Irritability
• Depression
• Alternations to the menstrual cycle
• A tendency to catch colds.

Strategies to overcome jet lag include:

• Drinking water and avoiding alcohol during the flight
• Going to sleep at the normal time for the country you are in, rather than sleeping during the day
• Doing less activity for the first two days after changing time zones

Environmental factors: Noise, excess light, a lumpy pillow or mattress or a stuffy atmosphere can contribute to sleep problems.

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