What to do about insomnia? Understanding seven tips for better sleep from a mental health perspective!

2024-10-07

8 Mins Read

The definition and symptoms of insomnia | Psychological causes of insomnia
Physiological causes of insomnia | Psychological treatments for insomnia
Seven tips for improving sleep quality | AXA BetterMe Weekend 2024

After a long and hectic day, you finally make it to bed, only to find yourself wide awake, unable to sleep. This situation can be incredibly frustrating, leaving you anxious about how the lack of rest might affect your performance the next day.

Insomnia has become a widespread issue in modern society. According to the World Health Organization (WHO), about one-third of adults globally experience insomnia at least once a week. In Hong Kong, a survey conducted by the Chinese University of Hong Kong revealed that nearly 70% of HongKongers have experienced insomnia in the past six months. In this article, we will examine the psychological causes of insomnia and provide practical tips to help improve sleep quality.

The definition and symptoms of insomnia

Insomnia is a common sleep disorder characterised by difficulty falling asleep, staying asleep, or waking up too early and being unable to get back to sleep. These issues often affect overall sleep quality and duration, impacting daily performance, such as fatigue, poor concentration, and mood swings. The symptoms of insomnia manifest both during sleep and in daily life, and common signs include:

1. Difficulty falling asleep

Spending a long time in bed without being able to fall asleep.
Feeling like your heart is racing or your thoughts are overwhelming, making it hard to relax.

2. Difficulty staying asleep

Waking up frequently during the night and struggling to fall back asleep.
Waking up too early in the morning and being unable to go back to sleep.

3. Poor sleep quality

Despite getting enough sleep, you still feel unrefreshed and tired.
Waking up in the morning feeling unrested, or lacking energy throughout the day.

4. Impact on daily life

Losing interest in daily activities or feeling down because of sleep problems.
Declining quality of life, affecting relationships and work performance.

Duration of insomnia:

Acute insomnia (Short-term insomnia): This type of insomnia lasts for less than three months and is often triggered by short-term stress, anxiety, or changes in the environment. For example, work-related stress or jet lag can cause temporary sleep issues.
Chronic insomnia (Long-term insomnia): This type lasts for three months or more and is often linked to persistent mental health issues such as anxiety or depression, or other underlying health conditions. Chronic insomnia can have a more significant impact on quality of life and often requires professional treatment.

Psychological causes of insomnia

Insomnia's psychological causes are influenced by a range of complex emotional and mental factors. The most common include:

1. Anxiety

Generalised anxiety disorder: Persistent and excessive worry, whether about work, family, or financial issues, can disrupt sleep. Anxiety keeps the brain active at night, making it difficult to relax and fall asleep.
Social anxiety: Excessive worry about social situations or interactions with others can prevent calmness at night, thus affecting sleep quality.

2. Depression

Depressive disorder: Those suffering from depression often experience sleep difficulties, including trouble falling asleep, early waking, or oversleeping. Depression can cause emotional lows and a loss of interest in life, which disturbs normal sleep patterns.
Negative thoughts: Persistent self-criticism and negative thinking increase psychological stress, making it hard to relax before sleep. These negative thoughts contribute to anxiety and tension, hindering the ability to fall asleep.

3. Stress

Acute stress: Short-term stressors, such as tight work deadlines, family arguments, or major life changes (e.g., moving house, job loss), can lead to temporary sleep difficulties. These stressors keep the brain in a heightened state, making sleep elusive.
Chronic stress: Ongoing stress from work, financial pressure, or relationship problems can cause long-term insomnia. Chronic stress disrupts the body's physiological and psychological balance, affecting normal sleep cycles.

4. Post-traumatic stress disorder (PTSD)

Traumatic experiences: Those who have endured traumatic events (such as violence, accidents, or serious illness) may struggle with sleep due to trauma-related memories, fear, or anxiety. They may experience nighttime awakenings or nightmares.

5. Lifestyle and behavioural factors

Irregular sleep schedule: A habit of going to bed late and waking early disrupts the body's natural circadian rhythm, leading to sleep problems. Psychologically, this irregularity can also increase anxiety and stress.
Excessive use of electronic devices: Overuse of devices such as smartphones or computers, especially those with blue-light screens, at night disrupts the normal sleep cycle, making it difficult to fall asleep.

6. Self-perception and expectations

Worry about sleep: Anxiety about not getting enough sleep can exacerbate insomnia. This worry makes it harder to relax and fall asleep at night.
High expectations: Unrealistic expectations of perfect sleep quality can lead to anxiety and pressure, further hindering the ability to fall asleep.

Physiological causes of insomnia

The physiological causes of insomnia involve various disruptions in the body’s functions and processes. These include:

1. Sleep disorders

Sleep apnoea: This condition causes pauses in breathing during sleep, leading to frequent nighttime awakenings and poor sleep quality.
Restless legs syndrome: Discomfort in the legs (such as tingling or cramps) makes falling asleep and staying asleep difficult.

2. Circadian rhythm disorders

Jet lag: Travelling across time zones or having an irregular sleep schedule can disrupt the body’s internal clock, making it hard to fall asleep.
Shift work: Regularly working night shifts or rotating shifts disrupts the natural circadian rhythm, leading to insomnia.

3. Hormonal imbalance

Thyroid issues: Overactive or underactive thyroid glands can affect sleep. Hyperthyroidism causes anxiety, while hypothyroidism leads to excessive fatigue.
Hormonal changes in women: Fluctuations in hormones during the menstrual cycle, pregnancy, or menopause can affect sleep patterns.

4. Neurological issues

Brain disorders: Conditions such as Alzheimer’s or Parkinson’s disease can affect the regulation and quality of sleep.
Nervous system disorders: An overactive sympathetic nervous system can keep the body in a heightened state of alertness, preventing sleep.

5. Medication and substance use

Medication side effects: Stimulants, antidepressants, or steroids can interfere with sleep.
Caffeine and alcohol: Caffeine stimulates the brain, and alcohol disrupts the sleep cycle.

6. Physical health conditions:

Chronic pain: Conditions such as arthritis or back pain can disrupt sleep due to discomfort.
Digestive issues: Problems like gastroesophageal reflux disease (GERD) or other digestive conditions can cause discomfort at night, affecting sleep quality.

How insomnia is diagnosed

Diagnosing insomnia typically involves a comprehensive evaluation of sleep patterns, overall health, and psychological state. The common diagnostic steps include:

1. Clinical assessment

Medical history review: Doctors will ask about the patient’s sleep habits, specific symptoms of sleep difficulties (such as trouble falling asleep, staying asleep, or waking up too early), and how insomnia is affecting their daily life.
Duration of symptoms: The duration of the symptoms is assessed. Generally, if insomnia persists for more than three months, it may be diagnosed as chronic insomnia.
Mental health evaluation: The patient is asked whether they have any issues such as anxiety or depression, as these factors can also affect sleep.

2. Sleep diary

Recording sleep patterns: Patients may be asked to keep a daily sleep diary, noting the time they go to bed, how long it takes to fall asleep, how many times they wake up, what time they get up, and their level of fatigue during the day. This helps doctors gain insights into sleep quality and patterns.

3. Questionnaires and assessment tools

Sleep questionnaires: Standardised questionnaires, such as the Pittsburgh Sleep Quality Index (PSQI) or the Epworth Sleepiness Scale (ESS), are often used to evaluate the quality of sleep, the severity of sleep problems, and their impact on daily life.

4. Medical examinations

Physical exam: A physical examination may be conducted to check for any underlying health conditions (such as thyroid issues or chronic pain) that could be affecting sleep.
Laboratory tests: Blood tests or other investigations may be carried out to rule out physiological causes, such as hormone imbalances.

5. Sleep studies

Polysomnography: This comprehensive sleep study is conducted in a sleep centre and measures brain waves, eye movements, muscle activity, heart rate, and breathing patterns. It is used to diagnose sleep disorders like sleep apnoea.
Home monitoring: In some cases, doctors may recommend patients use home sleep monitoring devices to measure basic sleep parameters.

6. Exclusion of other causes

Differential diagnosis: Other potential causes of sleep issues, such as schizophrenia, medication side effects, or other sleep disorders, must be ruled out before a diagnosis of insomnia is confirmed.

Psychological treatments for insomnia

Psychological insomnia often stems from emotional and cognitive disturbances. Treating these issues requires addressing and improving the psychological factors contributing to insomnia. Common treatment approaches include:

1. Cognitive behavioural therapy for insomnia (CBT-I): This is a specialised form of psychological treatment designed to address insomnia by altering negative thinking patterns and behaviours that contribute to sleep problems. It includes the following components:

Cognitive restructuring: Patients learn to identify and challenge negative thoughts that lead to insomnia, such as worries about sleep or false beliefs, replacing them with more positive and realistic thinking.
Behavioural changes: This involves modifying unhealthy sleep habits, such as limiting time spent in bed and establishing a regular sleep schedule.
Relaxation techniques: Patients are taught relaxation techniques such as deep breathing, progressive muscle relaxation, or meditation to help reduce anxiety and stress before sleep.

2. Emotional management and psychological counselling

Counselling: Talking therapies with a psychologist or counsellor can help individuals explore and address emotional issues such as anxiety, depression, or stress that may be causing insomnia.
Emotion regulation techniques: Learning how to manage and regulate emotions effectively can improve sleep. Techniques such as journaling, mindfulness, or emotional regulation strategies can help reduce the impact of negative emotions on sleep.

3. Medication (When necessary)

In some cases, doctors may recommend short-term use of sleeping pills or other medications to help improve sleep. However, medication is generally not advised as a long-term solution and should only be used under the guidance of a healthcare professional.

Seven tips for improving sleep quality

In addition to systematic insomnia treatments, certain lifestyle changes can help alleviate insomnia and improve sleep quality. Here are seven practical tips:

1. Establish a regular sleep routine

Maintain a consistent schedule: Try to go to bed and wake up at the same time every day, whenever it's a weekday or a weekend. This helps stabilise your body’s internal clock, promoting deeper sleep.

2. Create an ideal sleep environment

Control light: Keep your bedroom dark to avoid disrupting your sleep. Use blackout curtains or an eye mask to block out unwanted light.
Minimise noise: Use earplugs, a white noise machine, or other methods to drown out disruptive sounds. If you can’t eliminate noise, soothing music or nature sounds may help you fall asleep.
Adjust the room temperature: Ensure your bedroom is at a comfortable temperature, ideally between 18°C and 22°C. An overly hot or cold environment can negatively impact sleep quality.

3. Avoid using electronic devices before bed

The Impact of blue light: The blue light emitted by electronic devices such as phones, tablets, and TVs suppresses melatonin production, making it harder to fall asleep. It’s recommended to switch off electronic devices at least 30 minutes to an hour before bed.
Opt for reading or meditation: Engage in relaxing activities such as reading a light book or meditating before bed to calm your mind and prepare for sleep.

4. Develop a relaxing bedtime routine

Relax before bed: Establish a calming pre-sleep routine to signal your brain that it’s time to rest. Relaxation techniques include deep breathing, progressive muscle relaxation, or taking a warm bath.
Avoid stimulating activities: Steer clear of intense physical exercise, thrilling TV shows, or stressful work tasks before bed, as these can overstimulate your brain and make it harder to sleep.

5. Manage caffeine and alcohol intake

Limit Caffeine: Caffeine is a potent stimulant that can interfere with sleep. Avoid consuming caffeinated beverages like coffee, tea, or energy drinks in the afternoon or evening, as they can delay sleep onset and reduce sleep quality.
Drink alcohol in moderation: While alcohol may help you fall asleep initially, it can disrupt the sleep cycle, leading to shallow sleep and nighttime awakenings. Avoid excessive drinking before bed.

6. Limit napping time

Avoid long naps: Long naps or napping late in the afternoon can affect your ability to fall asleep at night. Try to keep naps to 20 to 30 minutes.
Short power naps: If you feel tired, a brief 10 to 15-minute nap can help restore energy without affecting your night-time sleep.

7. Maintain a balanced exercise routine

Exercise regularly: Moderate exercise can promote deeper sleep at night. Aim for 20 to 30 minutes of daily exercise, such as walking, yoga, or light strength training.
Choose the right time to exercise: Avoid vigorous workouts close to bedtime, as they can over-stimulate you and make it harder to fall asleep. Morning or afternoon exercise is best.

The close relationship between insomnia and mental health cannot be overlooked. Psychological factors such as anxiety, stress, and negative thought patterns often keep the brain in a heightened state of alertness, which interferes with falling asleep and reduces sleep quality. When emotions become unstable, worries intensify, or psychological stress increases, these issues can quickly develop into insomnia, affecting daily life and overall health.Fortunately, there are ways to relieve these problems, with the most important step being knowing when to seek support.

1. Buysse, D.J., 2020. Insomnia. The New England Journal of Medicine, 383(5), pp.459-470.
2. Roth, T., 2021. Insomnia: Diagnosis, Evaluation, and Treatment. American Family Physician, 104(2), pp.139-146.
3. Grandner, M.A., 2020. Sleep, Health, and Society. Sleep Medicine Clinics, 15(1), pp.1-10.
4. Morin, C.M., et al., 2021. Cognitive Behavioral Therapy for Insomnia: A Systematic Review and Meta-Analysis. Journal of Clinical Sleep Medicine, 17(5), pp.969-979.
5. Koffel, E., et al., 2022. Psychological Treatments for Insomnia: A Review of Meta-Analyses. Sleep Medicine Reviews, 61, p.101568.
6. Javaheri, S., et al., 2020. Sleep and Cardiovascular Disease. Journal of the American College of Cardiology, 75(19), pp.2285-2294.
7. Wu, J., et al., 2023. Association Between Insomnia and Depression: A Meta-Analysis. Psychiatry Research, 312, p.114452.
8. Pigeon, W.R., 2020. Sleep and Depression: A Review of Recent Literature. Current Psychiatry Reports, 22(10), pp.57-65.
9. van Straten, A., et al., 2021. Treatments for Insomnia: A Systematic Review and Network Meta-Analysis. Sleep Medicine Reviews, 56, p.101394.
10. Minde, K., et al., 2022. The Impact of Anxiety on Sleep Quality: A Review. Clinical Psychology Review, 85, p.102060.
11. Morin, C.M., et al., 2022. The Efficacy of Digital CBT-I for Insomnia: A Review. Sleep Medicine Reviews, 56, p.101393.
12. Walsh, J.K., 2021. The Role of Sleep in Physical and Mental Health. Journal of Clinical Psychiatry, 82(3), pp.1-8.
13. Lee, S.A., et al., 2023. The Relationship Between Stress and Sleep: A Meta-Analysis. Sleep Medicine Reviews, 60, p.101569.
14. Riemann, D., et al., 2022. Insomnia Disorder and Its Management. The Lancet Psychiatry, 9(1), pp.33-42.
15. Hertenstein, E., et al., 2023. Effectiveness of Mindfulness-Based Interventions for Insomnia: A Meta-Analysis. Sleep Medicine Reviews, 61, p.101576.
16. Koltai, M., et al., 2020. Understanding the Sleep-Stress Connection. Sleep Medicine Reviews, 51, pp.101-107.
17. Baert, S., et al., 2021. Impact of Sleep Disorders on Mental Health: Evidence from Recent Research. Journal of Affective Disorders, 295, pp.789-798.
18. Chang, P.P., et al., 2022. Sleep Disturbances and Psychological Stress: A Review. Current Sleep Medicine Reports, 8(1), pp.1-9.
19. Thomsen, A.B., et al., 2023. Long-Term Effects of Sleep Disruption on Mental Health: A Longitudinal Study. Sleep Medicine, 103, pp.27-34.
20. Dzierzewski, J.M., et al., 2020. Sleep Quality and Cognitive Functioning: A Review of Recent Findings. Sleep Medicine Reviews, 51, pp.101-107.

You may also be interested in

AXA BetterMe Weekend 2024

With World Mental Health Day happening in October, AXA seeks to inspire action to promote physical and mental wellness and environmental protection, encouraging everyone to live healthily and become a BetterMe.

This year, the AXA BetterMe Weekend will be held at AXA X WONDERLAND, WestK again. The specially designed BetterMe City is full of fun activities for all ages, focusing on learning more about the enviromental and society. It also includes photo spots, large-scale facilities and various thematic booths. Come and join us on 19th and 20th October!

Share This Article: