Sleep Problems

If you have problems sleeping you may be experiencing Insomnia, which is difficulty getting to sleep or staying asleep for long enough to feel refreshed the next morning. It's a common problem believed to regularly affect around 1 in every 3 people in the UK. Insomnia can be short-term or chronic (ongoing).

Short-term insomnia is common. Causes may include stress, anxiety or depression, the environment (i.e. noise, comfort, temperature), shift work and/or recreational drugs like cocaine or ecstasy. Short-term insomnia usually lasts for days or weeks. Chronic insomnia lasts for a month or longer. Most cases of chronic insomnia are because of other problems, such as mental health conditions, medical conditions, medication, other sleep disorders such as sleep apnoea, restless leg syndrome and/or substances (i.e. caffeine, alcohol, nicotine). 

If you suffer from problems sleeping regularly you can work through these sections to help identify the causes and find new ways to improve your sleep.

Short-Term Insomnia

Also known as acute insomnia or adjustment insomnia, this is a brief episode of difficulty sleeping. Short-term insomnia due to a stressful life event, such as the loss of a loved one, a disconcerting medical diagnosis, a pandemic, rebounding misuse, or a major job or relationship change. This insomnia lasts for less than three months, and symptoms may fade on their own as time passes.

Chronic Insomnia

Chronic insomnia is a long-term pattern of difficulty sleeping. Insomnia is considered chronic if a person has trouble falling asleep or staying asleep at least three nights per week for three months or longer. Some people with chronic insomnia have a long history of difficulty sleeping. Inability to get the sleep they need may be persistent or go away and recur with months-long episodes at a time.

Other Descriptions of Insomnia

Sleep Onset Insomnia describes difficulty falling asleep at the beginning of the night, or in the case of shift workers, whenever they attempt to initiate sleep. It is associated with the idea of tossing and turning without actually being able to get to sleep. The inability to fall asleep means that a person with insomnia of this nature has reduced total sleep time and can feel the effects of that lack of sleep the next day.

Sleep Maintenance Insomnia

Sleep maintenance insomnia describes an inability to stay asleep through the night. Most often, this means waking up at least once during the night and struggling to get back to sleep for at least 20-30 minutes. The fragmented sleep associated with poor sleep maintenance means a decrease in both sleep quantity and quality, creating higher chances of daytime sleepiness or sluggishness.

Early Morning Awakening Insomnia

Early morning awakening insomnia involves waking up well before a person wants or plans to in the morning. Some experts view this as a component of sleep maintenance while others consider it separately. Inability to get their desired amount of sleep can impair a person’s physical and mental function the next day.

If you have sleep problems you may be able to relate to the following:

• Difficulty falling asleep at night
• Waking up during the night
• Waking up too early and unable to fall back asleep
• Not feeling well-rested after a night's sleep
• Daytime tiredness or sleepiness
• Irritability, depression or anxiety
• Difficulty paying attention, focusing on tasks or remembering
• Increased errors or accidents
• Ongoing worries about sleep

Short-term insomnia may come and go without causing any serious problems, but for some people this can become chronic and last for months or even years at a time. This persistent insomnia can have a significant impact on your quality of life. It can limit what you're able to do during the day, affect your mood, lead to relationship problems and as a result you may find it difficult to boost your self-confidence.

We know that poor sleep can be caused by a number of factors. It could be caused by something environmental, physiological, psychological or a combination of these factors. It could be as simple as your room being too hot at night, drinking too much caffeine or more complex factors such as illness, medication, anxiety or depression. Sometimes it's not possible to identify a clear cause.

ENVIRONMENTAL FACTORS

You may struggle to get a good night's sleep if you go to bed at inconsistent times, nap during the day, or don't "wind down" before going to bed. A poor sleeping environment does contribute to insomnia – for instance, an uncomfortable bed or a bedroom that's too bright, noisy, hot or cold.

Changes to your sleeping patterns can also contribute to insomnia – for example, because of shift work or changing time zones after a long-haul flight (jet lag).

PHYSIOLOGICAL FACTORS

Drinking alcohol before going to bed and taking certain recreational drugs can affect your sleep, as can stimulants such as nicotine and caffeine. These should be avoided as they can delay sleep initiation and reduce sleep intensity, particularly when consumed in the evening.

Of all medical conditions, pain is the number one cause of insomnia. For people with chronic pain, trouble falling asleep is one of the most prevalent types of sleep disruption, but waking up during the night and waking earlier than desired are also frequent problems.

Medical conditions can affect your sleep, such as:

• heart conditions – such as angina or heart failure
• respiratory conditions – such as chronic obstructive pulmonary disease (COPD) or asthma
• neurological conditions – such as Alzheimer's disease or Parkinson's disease
• hormonal problems – such as an overactive thyroid
• joint or muscle problems – such as arthritis
• problems with the genital or urinary organs – such as urinary incontinence or an enlarged prostate
• sleep disorders – such as snoring and sleep apnoea, restless legs syndrome, narcolepsy, night terrors and sleepwalking
• long-term pain

Some prescriptions or over-the-counter medications can cause insomnia as a side effect:

• certain antidepressants
• epilepsy medicines
• medicines for high blood pressure, such as beta-blockers
• steroid medication
• non-steroidal anti-inflammatory drugs (NSAIDs)
• stimulant medicines used to treat attention deficit hyperactivity disorder (ADHD) or narcolepsy
• some medicines used to treat asthma, such as salbutamol, salmeterol and theophylline

Check the leaflet that comes with any medication you're taking to see if insomnia or sleeping difficulties are listed as a possible side effect.

PSYCHOLOGICAL FACTORS

Underlying mental health problems can often affect a person's sleeping patterns.

Depression

An inability to sleep is one of the key signs of depression. Another sign of depression is sleeping too much or oversleeping. Lack of sleep or personal problems can make depression worse.

Stress

High levels of stress impair sleep by prolonging how long it takes to fall asleep and fragmenting sleep. Sleep loss triggers our body's stress response system, leading to an elevation in stress hormones, namely cortisol, which further disrupts sleep.

Anxiety

Anxiety is frequently connected to sleeping problems. Excess worry and fear make it harder to fall asleep and stay asleep through the night. Sleep deprivation can worsen anxiety, spurring a negative cycle involving insomnia and anxiety disorders.

Taking care of yourself is an important step for managing poor sleep. Insomnia can often be improved by changing your daytime and bedtime habits or by improving your bedroom environment. Making small changes may help you to get a good night's sleep. Try some of the methods below for a few weeks to see if they help. 

Daytime Habits

• Set a specific time for getting up each day. Try to stick to this time, seven days a week, even if you feel you haven't had enough sleep. This should help you sleep better at night.
• Don't take a nap during the day.
• Take daily exercise, such as 30 minutes walking or cycling. But don't exercise for at least four hours before going to bed, because this may make it more difficult to fall asleep.

Bedtime Habits

• Stop drinking tea and coffee for a few hours before bedtime.
• Avoid drinking alcohol and smoking, particularly shortly before going to bed. 
• Don't eat a big meal just before bedtime.
• Only go to bed when you're feeling tired. If necessary, go to bed later than usual if it means you might be able to fall asleep more quickly.
• Don't use back-lit devices shortly before going to bed, including televisions, phones, tablets and computers.
• Try to create a relaxing bedtime routine, such as taking a bath, listening to soft music, and drinking a warm, milky drink every night. These activities will be associated with sleep and will cause drowsiness.
• Don't lie in bed feeling anxious about lack of sleep. Instead, get up, go to another room for about 20 minutes and do something else, such as reading or listening to soft music, before trying again.
• Avoid watching the clock because it will only make you anxious about how long it's taking you to fall asleep.
• Write a list of your worries and any ideas to solve them before going to bed. This may help you forget about them until the morning.

Bedroom Environment

• Use thick blinds or curtains or wear an eye mask if the early morning sunlight or bright street lamps affect your sleep.
• Make sure your bedroom is at a comfortable temperature for sleeping.
• Wear ear plugs if noise is a problem.
• Don't use your bedroom for anything other than sleeping or sex. Avoid watching television, making phone calls, eating or working while you're in bed.
• Make sure your mattress is comfortable and that you have a pillow you like, as well as adequate bedding for the time of year.

Living with insomnia can be very difficult, but there are steps you can take that might help. These self-help guides, websites and apps may be helpful as you work towards improving your sleep. Like any new skill, it may take a bit of time and practice before you notice any changes.

We recommend you engage with Sleepio in the first instance. This is a free 6 week online program designed by sleep experts and based on cognitive and behavioural techniques. Click here to access the Sleep Improvement Programme.

Self-help Guides 

NHS Inform Sleep Self-Help Guide

NHS Inform Breathing and Relaxation

Wellbeing Glasgow Trouble Sleeping Self-Help Guide

Wellbeing Glasgow Guided Imagery / Progressive Muscle Relaxation Guides

Websites

Sleepio is a sleep improvement program based on CBT. Over the course of six sessions, a virtual sleep expert will teach you evidence-based cognitive and behavioural skills to tackle even the most stubborn of sleep problems.

Wellbeing Glasgow offer information to support you to manage how you feel, change the way that you think about some things and improve your problem-solving skills and confidence

• Better Sleep Self-Help
• Top Tips
• Relaxation Resources
• Learn about CBT

NHS Every Mind Matters offers a free Wellbeing Plan. Just answer 5 questions to get your free plan with tips to help you deal with stress and anxiety, improve your sleep, boost your mood and feel more in control.

Citizens Advice Scotland offer advice about benefits, debt problems, legal issues and local services. The Citizens Advice Bureau website has a directory listing its local offices.

Get Active is a great place to start if you are looking to become more active or increase your physical activity. They have a list of options to help you identify classes and activities offered throughout Greater Glasgow and Clyde.

Mind 2 Mind shares other peoples stories with managing sleep problems.

Free Courses

Lifelink offer a variety of free online courses such as ‘Re-Assess your Stress’, ‘Art of Relaxation’ and ‘Coping with Change’. Each 2-hour class is delivered experienced facilitators. Participants with a Glasgow postcode can attend as many classes as they like. You can register directly for these classes without the need for any pre-assessment.

Living Life to the Full offer a course to help you learn new skills and tackle problems in your life that may be causing you to feel low worried or hopeless.

SilverCloud is a website with courses you can do to improve your mental wellbeing. You can learn new ways to deal with the challenges you’re facing. It’s designed by clinical experts, and supported by the NHS and Scottish Government.

SilverCloud is:

• secure
• supportive
• free from stigma
• flexible so you can do a course at your own pace

SilverCloud is free, use the code Scotland2020 and an email address to sign up. 

SilverCloud courses relevant to Sleep Problems include:

Space for Sleep - This program will teach you the skills for overcoming your sleep difficulties, allowing you to achieve better quality sleep and wake up feeling refreshed. You will learn the causes of poor sleep, track your current sleeping habits and learn techniques to maintain a healthy sleep cycle.

Self-Management Toolkit - This programme is designed to help you to become an optimal self-manager. It teaches you important skills and tools that you will need during periods of change and uncertainty, including problem-solving and goal setting.

Apps

Sleepio 

Get Support Now 

Some people find that talking with friends and family about their feelings can be a real source of support for coping with distress or suicidal thoughts. It might be helpful for them to map their support network and think about people they could call if their feeling suicidal. Other people may prefer to seek more professional support or call a helpline such as Breathing Space, Samaritans or Shout.

• Breathing Space: Call 0800 83 85 87
• Samaritans: Call 116 123
• SHOUT Crisis Text service also available 24/7 Text SHOUT to 85258

For some people they may be finding it difficult to cope and may think of ending their life, if you are concerned about your mental health and wellbeing, you can contact your G.P. within opening hours. If you feel you are in immediate danger, please call 999 for assistance.