Question 1

Why can't I sleep?

Accepted Answer

We refer to this as ‘Sleep-Onset-Latency’ (SOL), the time it takes from intending to fall asleep to sleep onset. Normal mean adult sleep latency is between 10-20 minutes.

A common factor of sleep latency greater than 20 minutes is anxiety. Studies have shown up to 90% of anxious or depressed people have some form of sleep disorder such as SOL. The famous author Charlotte Bronte relates a “ruffled mind makes for a restless pillow”. We work to reduce an overactive mind to a relaxed mind ready for sleep in CBT-I.

Question 2

Why do I keep waking up during the night?

Accepted Answer

This is called "wake after sleep onset" (WASO). It is normal for us to wake up during the night, most of us do experience ‘mini awakenings’, but as we fall back to sleep relatively quickly we don’t form a memory of waking up. When we experience difficulty falling back to sleep we need to assess what factors are keeping us awake. 
Some common factors are:
 • Work and family stress
 • The use of certain substances
 • Sleep disorders such as insomnia
 • Obstructive sleep apnoea (OSA) 
 • Periodic limb movement disorder (PLMD) which is repetitive cramping or jerking of the legs during sleep
 • Circadian rhythm disorders.

Question 3

Why do I fall asleep during the day?

Accepted Answer

Some common causes of excessive daytime sleepiness are factors such as sleep deprivation, medications that have a sedating effect, obstructive sleep apnoea (OSA), sleep disorders such as narcolepsy and psychiatric conditions such as depression (OSA and depression are closely linked to each other).

Excessive daytime sleepiness can be measured using the Epworth Sleepiness Scale (ESS). This is an assessment to learn more about the symptom of daytime sleepiness and if it interferes with your ability to do routine tasks.

Question 4

What are sleep disorders?

Accepted Answer

Sleep disorders can be characterised by the timing, quality, and the actual amount of sleep a person gets. To become a disorder daytime functioning is impaired which can cause distress. There are over 80 different types of sleep disorders, some of the most common we see are:

• Chronic Insomnia, is when you have trouble falling asleep and maintaining sleep more than three times a week for at least three months.

• Obstructive Sleep Apnoea is a disorder that causes you to stop breathing while asleep. Your brain tries to protect you by waking you up enough to breathe, but this prevents restful, healthy sleep. Over time, this condition can cause serious health complications. Thankfully this condition is often manageable.

• Shift Work Sleep Disorder (SWSD), a circadian sleep disorder due to your work schedule. SWSD causes difficulties adjusting to a different sleep/wake schedule, which results in significant issues with, sleeping when you want, staying asleep and unwanted sleepiness.

• REM Sleep Behaviour Disorder (RBD) is a parasomnia due to the loss of REM sleep atonia (sleep muscle paralysis). RBD dream enactment can range in severity from gentle hand movements to extreme limb movements such as punching and kicking.

• Parasomnias are unusual behaviour during sleep, such that the person is on a boarder between sleep and awake.  Sleepwalking, as an example, occurs during deep sleep, Non-REM sleep or N3 stage sleep. sleepwalking is classified as an NREM disorder of arousal. Other parasomnias are sleep talking, confusional arousal and night terrors.

• Narcolepsy is when you are unable to regulate when to fall asleep or how long to stay awake.

Question 5

What is a sleep diary?

Accepted Answer

A sleep diary is an essential tool we use in CBT-I to help identify current unhelpful sleep patterns and where best to focus our interventions for the optimum sleep schedule for the client. The sleep diary enables us to measure and track improvements as therapy progresses.

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