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  • Writer's pictureV. Romanov

Hypnotherapy for Insomnia. Part I: Describing the problem

Sleep is something that connects us all. Almost all known creatures need sleep to survive, although this state of rest looks and works differently from creature to creature. But what is sleep? Sleep is a natural state of rest characterised by reduced activity of the nervous system and reduced awareness of the environment. During sleep, the body alters various bodily functions such as heart rate, breathing, metabolism, temperature and hormone secretion. Sleep is one of the most important factors in regulating energy balance, mood and cognitive ability. Regular and healthy sleep is essential for our physical and mental health, as lack of sleep can have serious consequences for our physiological, cognitive and emotional state.

Controlled scientific experiments have shown that sleep deprivation, depending on how long it lasts, can cause various physical and mental impairments, including death. Even short-term sleep deprivation can cause symptoms such as drowsiness, difficulty concentrating, irritability and reduced cognitive ability. Prolonged sleep deprivation of up to 48 hours increases pre-existing symptoms of fatigue and may be accompanied by loss of appetite, headache, nausea and mood swings. Psychotic symptoms such as paranoia and hallucinations can occur after just 48 to 72 hours of sleep deprivation. Prolonged sleep deprivation can affect the cardiovascular system, cause cardiac arrhythmias, weaken the immune system, cause depression and anxiety, and even lead to death. Exactly when symptoms occur depends on individual characteristics, health status and genetic predisposition. However, it is clear that complete sleep deprivation quickly and severely impairs a person's mental and physical performance.

The same is true of chronic sleep deficit, which has been linked to an increased risk of heart disease, diabetes, obesity, depression and anxiety, among other conditions. Yet, the importance of sleep is often underestimated. The causes of chronic sleep deprivation are many: shift work, constant stress, poor sleep hygiene, alcohol or drug abuse, and organic and psychological sleep disorders. While some causes of sleep deprivation are relatively easy to address, others require professional therapeutic intervention.

Sleep disorders can occur at any age and have many causes. According to the International Classification of Diseases (ICD-10), a basic distinction is made between organic and non-organic sleep disorders, i.e. those that have a more physical cause and those that are due to psychological or other unspecified factors. Sleep disorders can certainly occur as a side effect or symptom of other physical or mental illnesses.

Organic sleep disorders include restless legs syndrome, obstructive sleep apnoea and the rare sleep disorder narcolepsy. For the sleep disorders mentioned, specific organic causes are either known or at least suspected but not proven, as is still the case with narcolepsy. Restless legs syndrome, as the name suggests, usually causes painful sensations in the legs that can be relieved by movement. In sleep apnoea, the muscles of the upper airway relax, causing the airway to become blocked and leading to sudden, brief awakenings. Narcolepsy is also called sleep addiction because, unlike the disorders mentioned above, it causes people to fall into a deep sleep at any time of the day. This can happen at the most inconvenient times and is understandably very distressing.

Non-organic sleep disorders can be divided into non-organic insomnia, non-organic hypersomnia, non-organic sleep-wake rhythm disorders and parasomnias such as sleepwalking or nightmares. Non-organic insomnia is one of the most common sleep disorders. Depending on the classification system, this disorder can be defined in different ways. Basically, it is characterised by difficulty falling asleep and staying asleep, or non-restorative sleep, and resulting impairment of daytime well-being, lasting for more than 4 weeks. The following symptoms may be associated with this disorder:

  • Difficulty falling asleep

  • Early morning waking

  • Frequent waking during the night

  • Restless, non-restorative sleep

  • Daytime sleepiness and drowsiness

  • Irritability and mood swings

  • Poor concentration and memory

  • Impaired ability to work and perform

  • Social isolation and reduced quality of life

  • Distress caused by symptoms associated with the sleep disorder

If the sleep disorder lasts longer than three months, it is called chronic insomnia. If it occurs repeatedly and lasts less than three months each time, it is called episodic insomnia.

Many studies use insomnia as a synonym for sleep disorders. Epidemiological studies have shown that about 8 million Germans suffer from insomnia and sleeplessness. Prevalence rates of around 20% are reported for Western Europe and the USA. Worldwide, the figures vary between 10% and 48%. This discrepancy is mainly due to different diagnostic criteria, but also to the fact that people may not seek help for many years. Less than half of people who have had symptoms for more than 2 years consult a doctor. The average duration of the disorder is 12-14 years. These results also apply to children and adolescents. This is probably because people tend to accept and cope with the disorder, especially if the symptoms are episodic. Sleep onset and sleep maintenance disorders are more common in women than in men and generally increase with age.

The main difficulty is distinguishing between the causes of the disorder: Is it due to one or more physical factors, or is it emotional? Is it symptomatic of another mental or physical illness from which the patient is suffering? What are the exact reasons why the patient cannot fall asleep or sleep through the night? When presenting to a doctor or therapist, the causes of the sleep disorder should be clarified before starting therapy, especially to rule out physical causes. For example, a suspected sleep-related breathing disorder may be confirmed by a diagnostic test such as polysomnography. This is usually done as an inpatient in a sleep laboratory, where various bodily functions are measured and recorded throughout the night. In the case of psychological sleep disorders, there is usually no need for a machine to diagnose the problem. Instead, keeping a sleep diary has proved effective. The diary consists of a morning and an evening section and records the time it takes to fall asleep, the frequency and duration of night waking and the time it takes to get up. It can also be used to document everyday problems and alcohol and coffee consumption. Sleep disorders are often associated with a misperception of sleep duration and time. A sleep diary can provide a reliable and objective insight into the specifics of each patient's disorder.

Sleep disorders are often directly related to stressful situations, but disappear after the stressful period. However, they can occur not only in the context of major life events, but also as a result of minor everyday stressors. The danger is that the transition from minor episodes of night waking to chronic insomnia is gradual. Chronic insomnia increases the risk of later mental health problems such as anxiety, depression and alcohol dependence through self-medication. Childhood sleep problems are particularly worrying and should be identified and treated early. Problems with falling asleep and staying asleep in children are associated with reduced learning performance, tend to become chronic and can thus promote the development of suicidal thoughts and emotional crises in adolescence.

The development and chronicity of psychologically induced sleep disorders require a multifaceted approach to explain the complexity of the disorder and its mechanisms. Approximately 75% of insomniacs associate the onset of the sleep disorder with critical life events such as death, separation from a partner or loss of a job. However, these one-time events, which may have long-term effects, are not enough to explain the chronicity or regularity of sleep problems. It has been shown that coping with so-called "daily hassles", everyday problems and stress, contributes significantly to the chronicity of the disorder. Studies have shown that insomniacs tend to have poor problem-solving strategies for dealing with stress. They are less aggressive in conflict situations, more likely to blame themselves and less likely to attribute bad intentions to those around them. The behaviours mentioned here usually have a positive social connotation and are generally considered desirable and appropriate. However, from the perspective of the development and chronification of sleep disorders, these behaviours appear to be rather unfavourable. These aspects of coping style are further emphasised by the tendency to internalise conflicts, to exaggerate problems and to inhibit the expression of feelings - both positive and negative.

But what are the specific behaviours and thoughts that cause us to have trouble falling asleep, and what treatments are there to help us get back to sleep? Find out in the second part of this article.

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