The National Council of Psychotherapists
Insomnia and Stress
Michael O'Sullivan FNCP
If you are a practising therapist, you will know that one of the most common presenting symptoms of stress is insomnia, especially in cases where people are suffering from stress. It may, however, surprise you to know exactly how common it is: an estimated one third of the population will suffer from insomnia at some stage in their lives. This is not to say that all these people will be suffering from stress – although I would point out that a recent survey indicated that one in five people suffer from stress generated by their work or workplace – but the fact remains that insomnia is a massive problem, and that a high proportion of these incidences may be caused by stress inducing situations.
Let us go back to those statistics. One in three of us will suffer from insomnia. One in five may suffer from work-related stress of which insomnia is a common symptom. This means there are a lot of people out there who cannot get to sleep, stay asleep or have an uninterrupted sleep. On the face of it, this can sound quite trivial.
Think of it this way, however. In the UK, if someone has little or no sleep for more than a week it is called insomnia. In other parts of the world, if this situation is brought about by artificial means, it is called torture. The results are the same – disorientation, deprivation of REM sleep and, over the longer term, loss of contact with reality. Lack of sleep can also cause digestive problems, muscle pain and even depression where chronic insomnia sets in. Lack of sleep over an extended period can have serious consequences and referral to a specialist sleep clinic might well be in order.
Types of insomnia
There are two main types of insomnia – the inability to fall sleep in the first place and the inability to sleep through the night, even though sleep is achieved. There is no reliable research to link either with any particular cause, ie; the type of sleep disruption is not directly attributable in all cases to any particular event or cause.
Short term and long term insomnia
An overwhelming majority of the population will suffer from short-term insomnia at some stage in their lives. This is caused primarily by stress and/or by disruption of sleep patterns.
One of the most common manifestations of stress is disruption of or inability to sleep. The mind might be overactive, running through possible scenarios and attempting to find solutions or replaying stressful incidents over and over again in a never-ending worry cycle.
The other reason for insomnia is disruption of sleep patterns. This is commonly caused by either shift working or by children, especially new babies. Indeed, one school of thought attributes post-partum blues (postnatal depression) at least partly to lack of proper sleep. It can also be caused by noisy neighbours, road works or excitement over an upcoming life event.
As you will realise, the number of people potentially affected is huge. The message is, though, that even short-term insomnia has a cause: one does not break the pattern of a lifetime without a reason. The reasons for short-term insomnia, however, are normally capable of being dealt with by the person affected themselves, albeit sometimes with a little help from a therapist.
Long term insomnia, we suggest, is where the sufferer has experienced continuously broken sleep patterns for more than four weeks, and can be a symptom of something far more serious – clinical depression being one. Where long term insomnia is a presenting symptom we suggest that a referral to the client’s GP is essential in order to eliminate possible pathology as a cause for the insomnia.
As you will have seen from the above paragraphs, there is more than one type of insomnia and no one specific cause. To some therapists, this might seem daunting. In fact, it provides an interesting challenge and the opportunity to exercise some imagination as to both preventative and management measures.
First of all, however short the period of sleep deprivation; one should look at the possibility of stress as a factor. It may be that any causative stress is discharged by the client having the opportunity to talk about the events or factors which are disturbing them: equally, it might be that a programme of stress management needs to be discussed. Either way, if the client is suffering from stress, the situation can only be made worse by sleeplessness and the symptoms which ensue.
Secondly, one needs to look at diet. Caffeine is a major culprit and clients should remember that not only does coffee contain caffeine but so does tea, chocolate and a variety of fizzy drinks. Avoidance of these may well reduce or help to begin to eliminate the problem. One might also look at the whole issue of food and environmental allergies, which can produce a variety of unpleasant symptoms. Allergy testing is cheap and easy, whether it is through blood samples or kinesiology. The results of a client avoiding known allergens can be dramatic. It should also be pointed out to a client that nicotine can be a contributing cause of sleep disturbance. If a client cannot give up smoking, at least he or she should avoid cigarettes in the hours immediately before bedtime.
Thirdly, rituals can be useful. These can take any form, from a long, hot bath with aromatherapy oils and candles to putting ones feet up for a half an hour read prior to going to bed. These are simply ways of relaxing the body and informing the mind that it is time to sleep. They interrupt the mind’s involvement with the day to day problems which are leading to sleeplessness.
Fourthly, relaxation tapes, exercises and hypnosis may well bring about the desired effect. A large part of the problem is that when someone experiences sleeplessness, they then start to anticipate further sleeplessness, thus adding to the problem. One good night’s sleep will demonstrate to them that they can indeed sleep and at the very least, prevent the problem from escalating. Experience and research shows that insomnia is generally a result of emotional pressure rather than organic illness and thus any treatments must begin at this level – however this is not to suggest that a client should be discouraged from seeking medical advice.
If emotional problems are eliminated or worked through so that they become less upsetting, and there is no amelioration it is suggested that the existence of an allergic reaction be explored.
To sum up, insomnia is never to be taken lightly. Ironically it is one of the few conditions that patients are allowed to self-diagnose, so common is it. There is much which can be done to alleviate it, but this will involve a detailed exploration of the client’s emotional state and lifestyle. Many insomniac clients over the years have complained of not being taken seriously enough although recently this is changing for the better as the concept of holism spreads.
Action Against Allergy - PO Box 278, Twickenham, Middlesex TW1 4QQ
Association for Allergic Disorders - 24 Chiltern Road, Ramsbottom, Bury BB11 9LF 01706 828256
British Allergy Foundation - St. Bartholomew’s Hospital, London EC1A 7BE 0207 600 6166 or try 0208 303 8525
Food & Chemical Allergy Association - 27 Ferringham Lane, Farring, West Sussex -01903 241178 or 020 76287774
Institute Of Allergy Therapists - Llangwyryfon, Aberystwyth SY23 4EY - 01974 241376
Association for Systematic Kinesiology - 39 Browns Road, Surbiton, Surrey KT5 8ST - 020 8399 3215
Suggested Reading: Sleep Talking, science, needs & misconceptions - by Yvonne Harrison, published by Blandford Cassell plc. - ISBN: 0-7137-2748-9 (RRP £12.99)