By Dr Leanne Fleming, Lecturer in psychology, University of Strathclyde
INSOMNIA is the most commonly reported mental health complaint in the UK. Around a quarter of the population regularly experience insufficient or poor quality sleep and approximately one in 10 meet diagnostic criteria for insomnia disorder. Insomnia disorder is defined as a combination of both sleep dissatisfaction and compromised daytime functioning. The negative impacts on daytime functioning can be far-reaching and include significant fatigue, poor concentration and low mood.
Previously, insomnia was thought to be merely a symptom or secondary consequence of poor mental health. Fortunately, the importance of treating insomnia as a condition in its own right is now recognised, regardless of other medical or psychiatric problems that may be present. Studies have shown that improving sleep has important benefits for other, related conditions such as anxiety and depression. These findings have led sleep researchers to believe that poor sleep is more than just a by-product of poor mental health. It is, in fact, a primary contributor to mental illness. So, whilst mental health influences insomnia, insomnia can also lead to other mental health problems.
However, unlike other mental health complaints, sleep may be in a unique position to act as a non-stigmatising gateway to psychological care. Evidence shows that many people with mental health problems do not seek the support they need. According to the Mental Health Foundation, the social stigma attached to mental ill health exacerbates the problem and makes recovery more challenging. Sleep problems do not seem to suffer from the same level of stigma and therefore, may provide a useful entry point to support and treatment for mental health problems in general.
Insomnia responds very well to a psychological treatment called Cognitive Behavioural Therapy (CBT). CBT techniques have been shown, in numerous clinical trials, to improve sleep in the long term. This is because CBT addresses the underlying factors that contribute to insomnia development and helps the individual to overcome the worry that accompanies the experience of being unable to sleep. In this regard, CBT is a superior treatment for insomnia than sleeping medication. Indeed, UK and US advisory boards advocate CBT as the preferred treatment for persistent poor sleep. Despite this, accessing a CBT-based programme for insomnia in Scotland is difficult.
The Psychological Interventions Team, established in 2010 by the Scottish Government’s Mental Health Directorate & NHS Education Scotland, aims to increase access to evidence-based mental health provision. However CBT for insomnia remains largely unavailable due to a lack of appropriately trained specialists. This means that poor sleepers are often left untreated or when treatment is provided, it is most often in the form of sleeping medication.
In light of this service-delivery dilemma, digital forms of CBT for insomnia, that require no therapist to be present, have emerged as a scalable solution with beneficial outcomes for both sleep and other aspects of mental health. In a recent study published in the Lancet Psychiatry, digital CBT resulted in improved sleep, improvements in depression and anxiety and reduced psychotic experiences. So, insomnia-focused CBT programmes could do much more than improve sleep – they seem to provide additional benefits to other aspects of mental health.
There are some self-management strategies, based on CBT principles that can often be a useful first approach to improving sleep. The Mental Health Foundation has today, on World Sleep Day, published a guide on good sleep. This advice includes having a “tech free bedtime” by stopping the use of computers, phones and so on at least two hours before bed. Today is a good opportunity to reflect on our sleep and take action to improve our wellbeing.
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