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The World Health Organization (WHO) defines insomnia as a sleep disorder in which you have trouble falling and/or staying asleep. The condition can be short-term (acute) or can last a long time (chronic). It may also come and go. Acute insomnia lasts from 1 night to a few weeks. Insomnia is chronic when it happens at least 3 nights a week for 3 months or more. Clients report of unsatisfactory quality or quantity of sleep-in terms of difficulty in falling asleep and staying asleep, or early final awakening (also known as initial, middle, and late insomnia.

Sleep is a complex system of physiological (the body) and psychological (the mind), both of which go to rest for a period of time. Sleep regulation has two components, the build-up of homeostatic sleep drive and our circadian rhythms.

These two components interact to determine the time when we go to sleep and the time when we wake up. For sleep to occur the balance between sleep-promoting factors and alertness factors needs to be in favour of the former. When alertness-promoting factors such as light, stress and stimulants are more dominant, then insomnia can start and maladaptive thinking, behaviours and reactions to insomnia can maintain the condition.

Client’s report, or the clients’ parents can observe, some of the following effects of insomnia:

  • Fatigue/malaise, attention, concentration, or memory impairment,

  • Impaired social, family, occupational, or academic performance along with mood disturbance/irritability

  • Behavioural problems such as hyperactivity, impulsivity, and aggression

  • Daytime sleepiness, leading to reduced motivation/energy/initiative

  • And the safety concern of proneness to errors and or accidents

Some of the common causes of insomnia are stress and anxiety activating the bodies fight or flight system. Have you woken up between 2-3 am, and been unable to get back to sleep?  Cortisol, the stress hormone, naturally increases around this time, helping in managing our 4 sleep stages of NREM (1-2-3) and REM (4). If we take unresolved stress or anxiety to bed with us, then more cortisol is added waking us up and keeping us awake! Classic or Pavlovian conditioning can trigger, outside of our awareness, that the bed-bedroom-bedtime becomes a cue for emotional arousal interfering with sleep.

Irregular sleep patterns, as experienced with shift workers affecting their circadian rhythms, cause a higher prevalence of insomnia and mental health disorders . There is a bidirectional relationship between mental health disorders such as depression and anxiety and our quality of sleep. Insomnia can be a contributing factor to the onset of mental health problems. So, improving sleep can be of direct benefit to prevent or aid in the treatment of mental health conditions.

To help us determine what factors are causing insomnia we assess the Predisposing factors such as genetic, some people are inherently poor sleepers. Personality traits and temperament and also chronic job stress or other chronic related stress factors.

In helping to determine Precipitating factors, we assess medical disorders, medication and substance misuse, life struggles and interpersonal conflicts, poor coping, and maladaptive thoughts.

Perpetuating factors can include chronic physical illness, work/life schedule rigidity, financial obligations, social support, and avoidance behaviours.

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