Sleeping Well: Online Therapy, Counseling and Treatment

What Are Causes?

Many factors can contribute to sleep deprivation or lack of sleep including poor sleep hygiene, lifestyle choices, work responsibilities, sleep disorders, and other medical conditions. Common reasons for lack of sleep include:

• Stress: Stress and worries from work, school, or family may keep the brain active at night, making it difficult to fall asleep. Stressful life events or traumatic experiences also may cause changes in sleep patterns.
• Travel or work schedule: The circadian rhythm acts as the internal clock for our body. It regulates various important bodily functions like metabolism, body temperature, and the sleep-wake cycle. Disruption in the circadian rhythm is often a leading cause of insomnia. The reasons for this interruption can be jet lag due to crossing multiple time zones, late or early shifts, or frequent shift changes.
• Poor sleep habits: These habits include irregular bedtime routine, short sleep/naps, stimulating activities around bedtime, a sleeping environment not suitable for sleep, and using the bed to work or eat. Computers, televisions, video games, smartphones or other screens before bed, using electronic devices close to bedtime or keeping them in the bedroom can disrupt your sleep rhythm,
• Overeating late at night: A little snack before bed is fine. However, overeating can cause physical discomfort while lying down, resulting in poor sleep.
• Sleeping environment: A sleeping environment that is noisy or not the right temperature can cause sleep disruption.
• Age: Aging and sleep are closely related. Insomnia is more common with age. As we age, it can become increasingly difficult to fall or stay asleep, and therefore make it hard to get good quality sleep. Our circadian rhythms or "biological clocks" change and the duration of sleep also decreases with age. Changes in these biological patterns can cause sleep deprivation.

There are various medical conditions that are known to lead to sleeping issues. Some of the health problems that commonly interfere with sleep include:

• Mental health disorders: Anxiety disorders interfere with sleeping, for example, PTSD (post-traumatic stress disorder) Insomnia is often associated with other mental disorders such as depression, bipolar disorder, and also schizophrenia.
• Medical conditions: Examples of conditions associated with insomnia include diabetes, heart disease, asthma, cancer, chronic pain, overactive thyroid, Alzheimer’s disease, narcolepsy, chronic fatigue, and Parkinson’s disease, etc.
• Sleep-related disorders: Common sleep disorders include sleep apnea and restless legs syndrome amongst others. Sleep apnea disrupts breathing frequently at night, causing a disturbance in sleep. Restless legs syndrome can give an overwhelming urge to move the legs, preventing the patient from falling asleep.
• Medications: Certain medications can cause sleep disturbances, such as certain antidepressants, asthma medications, high blood pressure medications, etc. Some medications may contain stimulants like caffeine (certain pain killers, cold/allergy medications, weight loss products, etc.).
• Caffeine, nicotine, and alcohol: Drinks containing caffeine (coffee, cola, tea, and various beverages) act as stimulants. Nicotine is another known stimulant to disturb sleep. Tobacco products are common sources of nicotine. Alcohol can help sleep. However, it prevents falling asleep deeply. It can cause you to wake up in the middle of the night.

Managing Your Sleep Disorders

Sleep disorders interfere with sleep, causing sleep deprivation on a regular basis. If there are symptoms of sleep disorders, it’s important to get diagnosed right away. The earlier the treatment, the easier it is to recover. If left untreated, sleep disorders can lead to other health complications.

Sleeping disorders come in various forms, like insomnia, parasomnias, sleep apnea, narcolepsy, etc. Common obsessions and compulsions can also cause above-average rates of insomnia and even other sleep problems such as delayed sleep phase disorder.

Based on the type of sleeping disorder, one may have difficulty falling asleep and feel excessive tiredness during the day.

Treating these conditions is important as lack of sleep can negatively affect energy, mood, focus, and overall health. Treating sleep disorders requires an understanding of their underlying causes.

It usually involves a combination of medical treatment and lifestyle changes.

Medical treatment: Prescription sleeping pills can help you fall or/and stay asleep. Generally, doctors recommend medications for up to a couple of weeks. However, there are specific medications that are suitable for long-term use. Some of the medical treatments are:

• sleeping pills
• melatonin supplements
• allergy or cold medication
• anti-anxiety or antidepressant
• medications for any underlying health issues
• breathing device or surgery (usually for sleep apnea)

Lifestyle changes: Lifestyle changes can significantly improve the quality of sleep, especially when combined with medical treatments. Some tips include:

• including more vegetables and fish into your diet, and reducing sugar consumption
• drinking less water before going to bed
• limiting your caffeine intake
• decreasing alcohol and tobacco consumption
• eating smaller, low-carb meals before bedtime
• reducing stress and anxiety through exercising and stretching
• creating and following a regular sleeping schedule
• maintaining a healthy weight as recommended by your doctor

Keeping a sleep diary can help you track the amount of sleep you are getting as well as its quality. This can also help you keep track of your progress in managing any concerns.

Mental Health Conditions That Can Cause Sleeping Problems

Just as sleep problems are a symptom of mental disorders, experts say that mental illnesses mutually contribute to sleep problems. The close relationship between sleep and mental health becomes even clearer when we look at what we know about the relationship between sleep and certain mental illnesses. Some common mental illnesses that can cause sleep problems are:

1. Depression: According to an estimate, there are about 300 million people worldwide suffering from depression (a mood disorder with the common characteristics of feeling sad and hopeless). Around 75% of the people who suffer from depression have symptoms of insomnia, and many of them also experience hypersomnia, which is excessive sleeping.
2. Seasonal affective disorder: It’s a subtype of depression. As the name suggests, it generally affects people during a specific time of the year (when there’s less daylight) or a specific time of the day. People affected by seasonal affective disorder generally sleep too much or too little during the time period. It may also alter their sleep cycles.
3. Anxiety disorders: anxiety disorders are highly correlated to sleeping disorders, for example, OCD (obsessive-compulsive disorder), PTSD (post-traumatic stress disorder), social anxiety disorder, and general anxiety disorder, etc.
4. Bipolar disorder: Bipolar disorder is described by episodes of extreme moods (can be manic and depressive). For people with bipolar disorder, their emotional state has a high effect on the change of their sleep pattern. The survey shows that many people with bipolar disorder experience alterations in their sleep patterns before an episode starts.
5. Schizophrenia: Schizophrenia is a mental health disorder defined by difficulty in differentiating between reality and unreality. Schizophrenic people are more likely to experience insomnia and circadian rhythm disorders.
6. Attention deficit hyperactivity disorder (ADHD): Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder that involves reduced attention span and increased impulsiveness. People with ADHD commonly experience sleeping problems. They have difficulty falling asleep, waking up frequently, and being too sleepy during the day. Rates of other sleeping problems, such as restless leg syndrome (RLS) and sleep apnea are also higher in people with ADHD.

Overcoming Sleepless Nights

Your sleep habits and overall attitude and approach toward sleep play a critical and vital role in determining whether you sleep well or poorly most nights. Practicing good sleep hygiene and better sleep habits can help you overcome sleep problems and sleep well at night. Sleep hygiene relates to daily practices that can help to develop better quality and quantity of sleep. Some sleeping hygiene tips include: getting out of bed when you can’t sleep, using the bed only for sleeping, avoiding spending too much time in bed, limiting caffeine & alcohol, exercising regularly, keeping your bedroom cool, quiet, and dark, etc.

When you can’t fall asleep at night, using some of the following approaches may help.

1. Set a consistent bedtime. By regularly going to bed at the same time each night, you can train your body to stay on a competent and predictable cycle. After a while, and with some regularity, you'll find that your body naturally prepares for bedtime.
2. Prepare your bedroom for sleep. Cool, quiet, and dark environments are helpful to fall asleep. Don’t forget to keep electronic devices out of the room as exposure to blue light is known to hamper sleep.
3. If you have trouble falling asleep or if you wake up frequently, stay in bed. Getting out of bed and keeping on mental and/or physical stimulation will make it difficult to fall asleep again.
4. Stop worrying about sleep. Worry means stress which causes trouble sleeping. The stress and worry about not getting enough sleep is often what keeps people from sleeping at night.
5. Keep yourself away from racing thoughts. You may find your brain thinking of life stressors like family, work, or financial issues while lying in bed. Develop your mind to stay away from these thoughts at the time of your sleep. Deep breathing exercises, meditation, and mindfulness exercises can help calm your thoughts down.

Dealing with Sleep Issues Through Therapy

In addition to changing your sleep pattern and treating problems that may be related to insomnia, your doctor may advise you to take medications, therapy, or both to help improve relaxation and sleep. Other therapeutic strategies include psychoeducational relaxation techniques. Training in progressive muscle relaxation techniques, as well as other mindfulness techniques, can help people further reduce stress or other concerning factors that cause their sleep issues. Moreover, Acceptance and Commitment Therapy helps improve sleep quality.

• Psychotherapy: Psychotherapy is the use of psychological methods, especially when based on regular face-to-face interaction, to help a person change their behavior, increase happiness, and overcome their problems. Experts advise psychotherapy as the first-line treatment for insomnia. Psychotherapy can help treat most mental illnesses and thus improve mental sleep problems.
• Cognitive Behaviour Therapy (CBT): CBT aims to treat negative thoughts and behaviors that contribute to sleeping problems. Cognitive-behavioral therapy for insomnia (CBT-I) is a specific form of therapy for those who get insufficient sleep and have a hard time feeling rested and refreshed. As the name suggests, cognitive-behavioral therapy regards two main factors which are addressed through different techniques:

The cognitive part of the therapy aims to teach recognizing and changing negative thoughts and beliefs that discourage sleep. On the other hand, the behavioral part of the therapy aims to teach avoiding behaviors that discourage sleep and involves replacing them with better sleep habits.

• Acceptance & Commitment Therapy (ACT): Acceptance and Commitment Therapy (ACT) offers a unique, gentle, drug-free approach to overcoming chronic insomnia. It aims to make people willing to experience the physiological and psychological ailments normally associated with sleeping problems.

7 Cups offers therapeutic services to help you sleep well after addressing any concerns such as insomnia symptoms or underlying mental health issues. The team at 7 Cups is available globally and once subscribed, you can message your therapist throughout the week regardless of scheduled appointments.