Insomnia is now recognised as a significant public health issue and recent estimates suggest that one in three UK adults find it difficult to fall asleep or to stay asleep, whilst around half of these cases sleep so badly that they experience problems functioning the next day. Commonly prescribed medications for sleep disorders (benzodiazepines, nonbenzodiazepine sedatives and melatonin) provide relief from symptoms but are commonly associated with negative side effects including cognitive impairment, dependence and abuse. As a result many of those who suffer from sleep disorders are turning to alternative treatment therapies that do not carry these associated risks. There are now numerous means of treating insomnia without having to rely on prescription drugs and there is a growing body of evidence to support the effective role of these therapies in sleep medicine.
Behavioural Therapy is conducted by a qualified psychotherapist and involves the use of a number of techniques including sleep hygiene education, stimulus control, relaxation, sleep restriction therapy, cognitive therapy and cognitive behavioural therapy to address sleep issues. There is an overwhelming body of evidence to suggest that behavioural therapy, in particular cognitive behavioural therapy for insomnia is as effective as sedative hypnotics during acute treatment and is more effective in the long term i.e. following treatment.
The Craniosacral System which comprises the cranium, spine and sacrum is the home of the nervous system which has a constant and very subtle rhythmic motion in all of its bones, tissues and fluids; this motion is fundamental to life and directly affects the health of each individual. When the body is shocked, following either physical injury or emotional stress it contracts, if the shock is severe or chronic, over a long period of time the tissues and nervous system may remain contracted, holding onto the force of the shock. These stresses, strains, tensions or traumas can be stored in the body, restricting its proper function, resulting in lack of space and ability to deeply relax. Craniosacral therapists are trained to work with your system to facilitate the release of any inertia, freeing the body from both physical and emotional restrictive patterns by offering the compressed areas space to release. As the spine and nervous system release a sense of incredibly deep relaxation is instilled which, with successive treatments can be extended into everyday life.
Acupuncture is widely used for the treatment of insomnia and whilst the mechanism of action is not fully understood, it presents a viable and effective treatment strategy. It is thought to possibly work in a number of ways which include:
• Stimulation of the opiodergic neurones, resulting in increased concentration of beta-endorphin, an opiod peptide neurotransmitter which has been associated with sleep promotion.
• Stimulation of increased melatonin production which is associated with improved sleep patterns.
• Stimulation of certain acupoints is found to increase the concentration of nitric oxide in the brain and blood which is associated with improved sleep outcomes clinically.
• Modulation of the autonomic nervous system, affecting both sympathetic and parasympathetic activities which may be associated with a sleep promoting effect.
Meditation has been associated with improved clinical sleep outcomes. In their book Meditation as Medicine, Dharma Singh Khalsa M.D. and Cameron Stauth report that 75% of insomniacs can address their sleep issues through regular meditation. Once again the exact way in which meditation confers benefit is unknown. However there is a small base of evidence to suggest that meditation results in:
• A reduction of lactate, a marker of stress and anxiety.
• Increased production of 'calming' hormones melatonin and serotonin.
• Decreased production of the stress hormone cortisol.
Mindfulness based stress reduction has been associated with clinically significant improvements in sleep in insomniacs; this method is often used alongside meditation. According to visiting practitioner at Grace, Padma Coram who is a meditation specialist and holistic lifestyle and wellness mentor, meditation and mindfulness untangle mental knots and help us to ease gently into restful sleep. Meanwhile medication in Padma's opinion merely puts a blanket over the mental knots and provides only a temporary solution; meditation and mindfulness she believes present a long-term, permanent solution.
Hypnosis is a widespread technique in psychotherapy and is applicable in various psychiatric and psychosomatic disorders. Although there is little research on the use of hypnosis for sleep disorders, there is a building body of evidence to demonstrate that hypnosis is effective in their treatment. Ana Isobel, hypnotherapist at Grace Belgravia believes that where insomnia is caused by stress, "hypnotherapy helps individuals to deal with this stress more calmly and with greater resilience."
Exercise is often included in an integrated approach to sleep disorders and there is evidence to suggest that improvements in insomnia following exercise are comparable to those experienced by patients on sleep medication. A number of theories have arisen to explain the positive effects of exercise on a good night's sleep:
• Sleep onset is thought to be triggered by a decline in body temperature in the evening. It is thought that the increase in core temperature caused by exercising stimulates the initiation of sleep via activation of heat dissipation mechanisms. However, heat dissipation characteristically occurs over a period of four- five hours. Exercise should therefore be done well in advance of bedtime. This theory has been termed the Thermogenic Effect.
• Whilst exercise is associated with increased serotonin production it has been suggested that insomnia may be caused by reduced serotonin activity. Therefore it has been suggested that the serotonin produced during exercise may be effective in normalising sleep patterns.
• Insomnia is classically associated with anxiety and anxiety disorders. Meanwhile exercise is associated with anxiety relief. In this way exercise may help to eliminate one of the key causes of insomnia.
Diet is an under-recognised cause of sleep disturbance. Stimulants such as caffeinated drinks as well as alcoholic drinks can disturb the normal sleep pattern but also may act as a diuretic causing frequency of urination through the night. Furthermore it is thought that the consumption of refined carbohydrates and alcohol can trigger an insulin peak resulting in hypoglycaemia during the long overnight fast. As a steady supply of glucose is crucial to the brain during sleep, this drop in blood sugar results in the secretion of stress hormones and neurotransmitters such as adrenaline which mobilise glucose from the body's sugar stores. In turn people can wake up as a result of this adrenaline surge with a racing heart and racing thoughts which will keep them awake for a while. Finally, poor digestion and acid reflux due to imbalances in the gut flora and undiagnosed food intolerances are also found to cause sleep issues. Having a nutritional assessment may help to rule these causes out.
The integrated approach to healthcare, where the best principles of conventional Western and Eastern medicine are combined to provide a rounded, 360-degree solution to health and disease, is fast becoming recognised as the gold standard in modern medical care. This approach not only embraces the principle of prevention but it encourages the individual to approach their healthcare with an open mind. An integrated approach to sleep disorders is at the heart of Grace Belgravia's Integrated Sleep Therapy Programme.
Grace Belgravia is a wellbeing and lifestyle member's club in London that is founded upon these principles looking at the mind, body and soul. The team of Grace experts recognise that sleep problems classically respond well to a multi-disciplinary approach because the cause is often multi-factorial. The development of good sleep habits requires input from any number of consultants, all of which can be accessed at Grace Medical.