Having trouble sleeping? A primer on insomnia and how to sleep better

Written by Greg Potter, PhD

Sept. 3, 2019

Having trouble sleeping?

Rest assured, you aren’t alone: 50 million to 70 million adults in the US alone have sleep disorders, among which insomnia is the most prevalent. At a given time, short-term insomnia erodes the lives of about 30% of US adults. Chronic insomnia afflicts about 10% more.

That’s a lot of people.

We’re therefore going to focus on how to overcome insomnia in this blog series. However, regardless of your sleep problems, I’m going to try to help you identify and address the key contributors to your sleep problems.

We’ll begin by briefly reviewing what insomnia is. In subsequent blogs, we’ll turn our attention to two subtypes of insomnia: sleep-maintenance insomnia (difficulty sleeping through the night) and sleep-onset insomnia (difficulty falling asleep). As an NBT reader, you’re probably unusually fond of testing the limits of your physical performance, so we’ll end with a discussion of the complex relationship between exercise and sleep, as well as some of the particular challenges that athletes face.

Throughout the series, I’ll give you some practical tips you can use to enhance your sleep, building on multiple podcasts (such as this one) and a comprehensive previous blog that Megan wrote. To supplement these blogs, Chris and I will also record a podcast.

Let’s get to it!

What is insomnia, anyway?

If you have difficulty falling asleep, staying asleep, getting enough sleep, and/or getting high-quality sleep, you may have insomnia. To be diagnosed with insomnia, you must experience daytime impairment too, which often entails struggling to concentrate at work or living amidst an unwelcome cloud of anxiety. There are actually numerous sub-categories of insomnia, but we’ll divide them into two:

Acute insomnia: Also known as adjustment insomnia, this is the type of transient difficulty sleeping that most of us experience now and then. It can result from extrinsic stimuli, as occurs during jetlag and/or use of certain medications. It can also result from intrinsic stimuli, including spikes in pain, psychological distress, or anticipation ahead of important events. Short-term insomnia generally resolves when the disruptive stimuli subside.

Chronic insomnia: Lots of factors can lead to chronic insomnia, including:

Other sleep disorders (such as sleep apnea)
Psychiatric disorders (including depression)
Consumption of medications (such as some antidepressants)
Drug abuse (this includes alcohol)
Medical disorders (such as arthritis, asthma, gastroesophageal reflux disease, heart failure, hyperthyroidism, kidney disorders, neurodegenerative diseases, prostate hypertrophy, and rhinitis)
Poor sleep hygiene
Most of these factors are beyond the scope of this series, but we will review some core tenets of good sleep hygiene.

Most of these factors are beyond the scope of this series, but we will review some core tenets of good sleep hygiene.

Insomnia diagnosis

At minimum, insomnia is best identified by a detailed medical, sleep, and sleepiness history carried out by a qualified sleep medicine specialist. If you think you might have a sleep disorder, you should visit a sleep facility accredited by the American Academy of Sleep Medicine (see this for more).

This said, don’t worry, I’m not going to leave you empty-handed. While the goals and nature of treating insomnia depend on differences between people, all people having trouble sleeping should ensure that they are engaging in key sleep-health-promoting behaviors. I’m going to address these behaviours in a sequence that I think is logical.

Having trouble sleeping? Track your sleep!

First, if you want to sleep better, you should track your sleep. You can start this today. Tracking might be obvious, but it’s a potent strategy - as Simon Marshall has discussed on the NBT podcast before, self-monitoring might be the most effective behavior change tool there is, at least for some health behaviors.

Two ways of tracking sleep are:

Using devices: There’s now a panoply of sleep-tracking devices out there, the most common of which are finger- or wrist-worn. While I can’t claim this confidently when manufacturers are continually updating their devices, there simply doesn’t seem to be a big difference in the accuracy of most of these devices. So, if you buy a wearable, pick one made by a reputable manufacturer that has the functionality you’re after. At the time of writing, I wouldn’t pay attention to things like sleep stages or sleep “scores” - just focus on the sleep timing and duration data.
Using a diary: If I had to pick either a wearable or a sleep diary, I’d probably pick a sleep diary. In addition to quantitative measures, how well you feel you slept is important, and an advantage of sleep diaries is that you can record various factors that might affect your sleep. You’d probably prefer to keep a digital diary, so you could try one such as this.

To establish your baseline sleep, track it every morning for two weeks. To ingrain this tracking habit, pair it with a routine activity, such as waiting for the kettle to boil. As your habits largely determine whether your health improves or deteriorates, you will surely benefit from learning more about how to shape your habits for the better. For more on this, check out the SEEDS journal.

Having trouble sleeping? Your bed is the most important item of furniture you own

Consider this:

You will spend about a third of your life asleep...

… so you should make sure you’re sleeping on a good mattress!

While you’re tracking your baseline sleep, you might want to buy a new mattress. Three key variables to consider when buying a mattress are comfort, durability, and support.

In recent years, “bed in a box” mattresses have dramatically increased in popularity. To be foldable, these are made of foam. The problem with this is that foam tends to absorb heat, and you won’t sleep well if you get too hot. Some manufacturers use cooling gels to attempt to overcome this limitation, but it’s unclear how long the gels last. As spring mattresses dissipate heat more efficiently, they’re probably better than foam mattresses for most people.

Another key consideration is mattress firmness. Heavier people tend to benefit from firmer mattresses. If you sleep with a bed partner, the two of you may prefer different mattress firmnesses. Fortunately, some mattresses are made to have different firmnesses on either side.

Next, when it comes to mattresses, you generally get what you pay for. So, if you can afford a good mattress, buying a mattress is not the time to be thrifty. You should pick a mattress that you have tried before buying, and if you buy one from a shop then lie down on potential options for at least 10 minutes each.

If you have lots of disposable income, you could try a water-cooled mattress pad to help you more closely control your bed temperature. Perhaps the best-known of these are the ChiliPAD and OOLER. Cooler still (forgive me), we’re now at the cusp of the emergence of “smart” beds such as this one, which apparently uses AI to optimise in-bed conditions. I anticipate that smart beds may be very useful for those who can afford them, we just don’t know much about how well this technology works yet.

Finally, as per your mattress, ensure that your pillows, blankets and sheets are breathable and effectively dissipate heat too. This may seem odd to some, but one strategy I have always found useful is keeping a duvet cover without any duvet in it handy. That way you can use the cover alone if you get too hot at night. Or you can use the duvet and the separate cover concurrently - for example, you might cover your lower body with your duvet but your torso with a duvet cover alone.

Having trouble sleeping? Make your bedroom relaxing!

Finally, you should like your bedroom and do what you can to make it relaxing. This means getting rid of all unnecessary items and anything that clutters your mind.

Summary

Most of us have difficulty sleeping now and then. If you do too, begin by tracking your sleep and ensuring your bedroom is comfortable and uncluttered.

These are just some of the things that we all should implement to sleep better. However, different strategies are suited to overcoming different sleep problems, and an array of different behaviors interact to affect how well we sleep. So, if you think you are doing everything right and are still having trouble sleeping, why not book a free starter session with NBT?

You can schedule one by clicking this link.

In the next blog we’ll explore more strategies you can use to sleep better… stay tuned!

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