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I have spent more than 30 years trying to understand and find the best solution to the phenomenon of insomnia. Having spoken to countless thousands of patients and research participants, I know that not being able to sleep when you need it and when you want it is one of the most frustrating human experiences that is.
So, three key questions. What is insomnia? How's it going? Can it be treated? Whether you use the term insomnia or not, I guess you know what I mean. Insomnia is a difficulty in falling asleep and / or staying asleep, occurring three or more nights a week for at least three months. In fact, in my clinics, the average duration of insomnia is closer to five to ten years.
Insomnia is not only a nighttime problem, but it also causes significant daytime deficits. According to the definition of insomniac disorder, poor sleep results in energy depletion, mood alteration, or poor concentration during the day. Everything seems more difficult … and our friends and family members, perhaps our co-workers, can often see these effects. The consequences of insomnia drive people to seek help because waking up after a bad night is often followed by a bad day.
Indeed, my patients feel that their lives have been taken away from them. They often feel that their problem is not well understood, or even that it is questioned, including by health professionals. So, they just have to learn how to live with it. Historically, it's as if this has not been considered a suitable illness.
Well, nothing is further from the truth and I am happy to say that the wind is turning. Science has discovered that people with insomnia are twice as likely to develop depression and that they are increasingly vulnerable to type 2 diabetes and hypertension. Persistent insomnia is not a trivial matter.
Insomnia is not simply a consequence of "something else"; it is also a causative factor of the disease. As far as I know, it only takes four things to sustain life: air, water, food and sleep. This is true for almost all species. Can you imagine having a supply of oxygen, water or food that is inadequate or of poor quality? Would not it cause serious health problems?
We should not trivialize sleep as if it were just a lifestyle choice or something to do if we had time in our busy schedules. No, sleep is a life force. and lack of sleep, whether neglecting to give enough room for sleep in our lives, or a sleep disorder, is extremely important.
How does insomnia occur?
This is a complex issue and a lot of research is going on in this area. Let me illustrate some of the things we have discovered.
Having a bad night's sleep is not uncommon. Indeed, it is a beautiful universal experience; especially in times of stress. But sleep is also a healer. Sleep helps us regulate our emotions, strengthen our learning, develop our immune responses, and physically recover. So for most people, short-term insomnia is just that; temporary. Of course, it can be difficult to have a newborn at home, to deal with health problems, to mourn or to change your personal, financial or professional situation. But sleep is there to help us cope, as well as sometimes to be a victim of pressure. How many times have people told me, "If only I could sleep, I think I could manage."
The insomnia disorder can result from short-term insomnia. A stressor can be a starting point, but people usually find normal sleep after a period. Stress is not the cause of chronic insomnia. On the contrary, a vicious circle develops where sleep itself becomes the focal point of attention. We go to bed wondering if we are going to sleep; fearing we could not. We are awake thinking we are awake and trying to fall asleep. We calculate the remaining hours and minutes if we do not sleep soon. We worry about the consequences of not sleeping … and all this becomes a self-fulfilling prophecy. Sounds familiar?
Importantly, good sleepers have no idea how they do it. They never had to learn. They sleep as they breathe – without ever really thinking about it. They simply follow their biology: they fall asleep and stay asleep when they are asleep. It is important. People who have developed chronic insomnia have become like tightrope walkers. Trying to handle the challenges of sleep and wakefulness constantly vulnerable to imminent wavering.
People suffering from insomnia become hyper excited in their bed and their bedroom because they try to walk. For the good sleepers, there is nothing further in their minds. They are not Make no matter what. They allow sleep to be king.
Once insomnia becomes chronic, the only effective treatment is cognitive behavioral therapy (CBT). .
All international authorities and clinical guidelines agree. Sleeping pills are not recommended for use for more than a few nights and do not have a factual basis for long-term use. Although some people make judicious use of these pills (called hypnotics) for long periods, the mere fact that they do so shows that they rarely solve insomnia. In addition, doctors are actively discouraged from giving more than one prescription because, according to the guidelines, this would be pointless and could cause harm, such as side effects or addiction.
So what is CBT? The best way to explain this is to say that CBT is the antidote to the problem that I have previously described. CBT helps establish a rhythm of biological sleep – the right amount of sleep for you at the right time. The behavioral elements of CBT help you establish a new model of healthy sleep; help you discover how much sleep you need and rely on sleep even when you try to stay awake. A bit like the good sleeper, actually. The bed becomes connected again to sleep well.
The C in CBT refers to cognitive; it's the mentality. These parts of CBT help you get rid of the racing spirit that is the enemy of sleep; help you stop trying to sleep like it 's been a performance; help you rest the day long before going to bed; and help you use relaxation and imagery to divert unhealthy attention from sleep itself.
As you can see, CBT is not a single treatment, but a set of treatments; and finding the right elements of CBT that work best for you is part of the therapy. Above all, I want to emphasize that CBT is not just a set of "sleep tips". If someone had a depressive state, we would not say: here are some tips to help you be more positive. We would take depression seriously and provide evidence-based treatment. People suffering from insomnia deserve nothing less.
• Colin Espie is a professor of sleep medicine at the University of Oxford. He is one of the world's leading experts in insomnia and Chief Medical Officer of Big Health, the company that created the Digital CBT Program (Web / Mobile) sleepio.com/nhs
Snooze button: Digital TCC approved by the NHS
Sleepio.com/nhs This is an online tool designed to help improve adult sleep through a cognitive-behavioral therapy approach. It has been evaluated by the National Institute for Health and Care Excellence and approved by the NHS. Users pbad a simple test and Sleepio then suggests techniques that can help. A comprehensive program based on CBT is available for the poorest sleepers, tailored to the needs of each individual.
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