Insomnia usually refers to difficulty trying to get to sleep, staying asleep and/or waking up early. 

Insomnia is a common problem in NZ.  In fact, at any one point in time about 25% of New Zealanders struggle with chronic long-term insomnia.   But don't feel discouraged by this.  It can be treated.

It is important to rule out any physical causes for sleep difficulties such as restless leg syndrome or sleep apnea which may require a visit to your G.P or a sleep specialist who would then recommend appropriate treatments.  For example, iron supplements might be recommended for restless leg syndrome or physical devices to help manage sleep apnea. 

Other causes for insomina that need to be ruled out include disturbances in the circadian rhythm.  There are two types of circadian disturbances. The first is called Delayed Sleep Phase Disorder and the other is called Advanced Sleep Phase disorder.  Treatments for circadian rhythm problems may include melatonin prescribed by a G.P or psychiatrist and/or use of a bright light box.  

If ins0mina is thought to be maintained in large by psychological factors then CBT is highly recommended. The good news is that CBT can be very effective for clients who follow the program.  

The main components of CBT for insomnia (CBT-i) include:

1) An individualised conceptulisation of what might be maintaining the sleep problem

2) Education about sleep (e.g., as we age we need less sleep & most people manage to perform well enough even after a poor nights sleep)

3) Handouts on sleep hygiene (note: handouts & discussion on healthy sleep patterns is not enough on its own to treat chronic insomnia)

4) Stimulus control.  This involves making sure that the bed and bedroom are only associated with sleep (e.g., do not watch movies in bed or lie in bed feeling angry or you will associate the bed with being awake and/or feeling emotionally aroused which is incompatiable with sleep).

5) Sleep restriction.  This involves limiting the time a person is allowed to sleep. The goal behind this approach is to increase sleep efficiency so that the time a person spends in bed is roughly the same time that the person is asleep. Most people with insomnia spend a huge amount of time in bed being 'awake' rather than asleep which means they are accidentally associating their bed with being awake rather than asleep.  

6) Identify and evaluate unhelpful beliefs about sleep and fatigue (e.g., I must get 8 hours sleep or I cannot function, I will look a wreck tomorrow and everyone will notice, it's not fair that I have this problem and that other people can sleep so easily).  

7) Helping a person reduce focus of attention on how sleepy or awake they are (e.g., during the day asking themselves how tired they feel, or at night focusing on how their body feels).

8) Recognise and drop safety behaviours designed to help sleep, but which actually keep insomina going in the long term (e.g., clock watching at night, drinking alcohol)

Treatment is usually carried out over 4 to 10 sessions and has considerable scientic support to show its effectiveness in helping insomina. 

For those of you who are interested in research on CBT for insomnia (CBT-i) you may like to look at the research by Allison Harvey on insomnia.