The types of insomnia we see
Insomnia is a real diagnosis — defined by the International Classification of Disease (ICD-10) with specific subtypes. The common types we see are "primary insomnia" — people who've always been light sleepers — and "adjustment insomnia" — people who've had something tough happen and the worry and anxiety surrounding the events are disrupting sleep.
Some people have developed a pattern of being awake in bed reading, using a screen, watching TV, worrying about issues, and finally worrying about not being able to fall asleep. This is a problem with what is called "sleep hygiene."
Many things affect the sleep cycle and the quality of sleep — changes in job schedules, alcohol at night, late night studying or partying, and perhaps most of all, anxiety. Research as much as 50 years ago, replicated in the last 10 years, confirms that people who sleep poorly are more anxious and more physiologically activated during the daytime as well as at night.
Understanding your sleep cycle
The pattern of arousal happens on about a 90-minute cycle all night every night. When you fall asleep you go down into a very relaxed state. The brainwaves get very slow and large — that's called "slow wave sleep," when you store new memories of important events of the day, when your brain automatically cleans itself out, and when you make some important hormones like human growth hormone. You need that to repair and restore your body, even when you're done growing.
After about 90 minutes you come back up into a state much closer to being awake — you may dream in what's called "rapid eye movement" (REM) sleep. Then you go back down again. As the night goes on, the deepest sleep decreases and the REM periods get longer.
Sleep hygiene for sleep onset insomnia
The key concept is setting a regular wake-up time and not doing anything in bed except falling asleep.
- Get up at the same time every day, including weekends — if you're trying to fix an insomnia problem this is really important.
- Cut out caffeine entirely, or at least don't use it after noon — it has a really long effect.
- Cut the stimulation from light, movies, etc. a couple of hours before you want to sleep.
- Make your bedroom cool and very dark.
- Don't stare at the clock, but if you're not asleep in about 20 minutes, you're not sleepy enough — so get out of bed, go sit and read in low light, listen to music, practice meditation, or do some other quiet activity.
- If you're worrying about things in bed, get out of bed, write it down and decide if you need to make a plan to deal with it — tomorrow, not tonight.
Anxiety and tension during the day carries into the night
When you are physically tense, worried and emotionally upset - anxious, angry, or agitated - these physiological states don't go away when you fall asleep. In fact, they get incorporated into your sleep patterns and produce non-restorative sleep. So, it is a good idea to practice some kind of relaxation method in the day and evening. Look at our page on how we help with anxiety to learn more. Also, it is a good idea in the evening to write down anything that's on your mind and decide if that's something that needs to be addressed, or not. If it is, make a plan to address it - but not at bedtime! Making a note about it in writing gets it out of your mind a bit - it will be there tomorrow when you are fresher. Also a great idea is to deliberately think about something you enjoyed during the day. This could be some accomplishment, large or small, some kindness you showed to someone, something you did that you were satisfied with. Getting some pleasant thoughts and feelings on your mind right before you want to sleep gives the automatic, unconscious brain some much needed soothing.