It's not uncommon for individuals, after a night observed in the sleep lab, to think they've had only a few minutes' sleep across the whole night.
So it could be that, in patients with paradoxical insomnia, some area of the brain responsible for awareness is not 'switching off' to the same extent as the rest of the brain, so they feel they were awake all night.But one relatively safe, temporary option to deal with insomnia is melatonin, a man-made version of the 'sleepy' hormone that occurs naturally in the brain to help control sleep patterns.So it's only people whose sleep is truly curtailed who'll experience the physical consequences of poor sleep, with their nervous system on high alert, flooding their systems with hormones and chemical messengers.While almost all insomniacs will have an over-active mind at night and experience the emotional consequences of poor sleep – which can include low mood, anxiety and irritability – most won't experience any of these markers of physiological stress.Even the daytime cognitive performance of people with 'normal' insomnia is more like that of people who say they have no trouble sleeping than those with short-sleep duration insomnia.But one relatively safe, temporary option is melatonin, a man-made version of the 'sleepy' hormone that occurs naturally in the brain to help control sleep patterns.The side effects may include nausea, headache and night sweats – but it doesn't lead to the dependence and other serious issues seen with some other sleeping pills.But the primary aim should always be re-establishing healthy sleep patterns, not staying on drugs long-term.This uses behavioural techniques to reprogramme the brains of people with insomnia.If you have no problems with sleep, you associate your bedroom with that comforting sensation of putting your head on the pillow and drifting off.
This is done using a number of strategies – stimulus control, sleep restriction, relaxation training and the cognitive therapy after which it is named.
We begin by doing things during the day that facilitate sleep later, including setting regular wake and sleep times, restricting light exposure in the evening and not eating late at night or consuming caffeine.And you mustn't nap during the day as this could diminish your body's desire for sleep at night.
At night, if you haven't drifted off within 15 minutes, you must get out of bed and go to a different room, only returning when you feel sleepy.However, many people with insomnia spend more time in bed to compensate for their poor sleep, to give themselves more 'chance' to fall asleep.By limiting time in bed to about five hours a night (the amount depends on the individual) for a couple of weeks during CBTi, the theory is that we end up strengthening the brain's drive to sleep while in the bed.Patients are asked to spend no longer than five hours in bed the night before going to a sleep laboratory for a 24-hour treatmentThey are permitted to try to fall asleep at night, every 30 minutes, with electrodes attached to their scalp
This technique is not yet used routinely in clinical practice and is not appropriate for everyone but it shows that retraining the brain to associate bed with sleep is fundamental to dealing with insomnia