how to understand insomnia
Sleep

An expert guide to understanding insomnia and how to deal with it

Struggling with your sleep? Insomnia expert Stephanie Romiszewski tells us everything you could possibly want to know about sleeplessness and how to get a proper night’s shut-eye. 

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Insomnia can be crippling. Writhing around in the dark can feel unnerving and lonely, not to mention exhausting when the morning finally arrives.

When you’re trapped in your own thoughts in the middle of the night sleeplessness can be an isolating experience, but insomnia is actually extremely common. A third of the global population will suffer from sleep problems at some point in their lives, while 10% will be diagnosed with insomnia. During the pandemic, nearly two-thirds of people in a study by King’s College London said their sleep had been worse. 

In response, there’s been a proliferation of apps, gadgets and self-help guides released in recent years all aiming to get us sleeping better, but spending so much time tracking and worrying about our sleep could actually be making it worse.  

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“There’s been a huge focus on sleep hygiene and the idea of ‘clean sleep’,” says Stephanie Romiszewski, a leading sleep physiologist, insomnia and Cognitive Behavioral Therapy for Insomnia (CBTi) expert at the Sleepyhead Clinic in Exeter. The term ‘orthosomnia’ has even been coined to describe our obsession with getting the perfect night’s sleep. “But, just like ‘clean eating’, ‘clean sleep’ doesn’t exist and this focus on sleep actually leads to increased anxiety around it,” Stephanie says.

Stephanie believes we might not have such an insomnia epidemic if we were all properly educated about sleep. Last year, her research found that doctors studying undergraduate medical degrees were only given around an hour and a half of sleep education through out their studies. “Doctors don’t understand sleep well because they don’t get much education on it,” says Stephanie. “This means the general public isn’t educated on what sleep is and how it works, which means we start freaking out when we’ve got a sleep problem.”

Here, Stephanie outlines what we really need to know about sleep and insomnia, including the mistakes we might be making in our daily routines that make it so difficult to drift off.  

What is insomnia?  

The textbook definition of insomnia and the symptoms a doctor will look for to diagnose it usually describe someone who has suffered from sleep disruption for at least three months, struggles with sleep more often than not in their week and whose lack of sleep affects how they function during the day.

However, Stephanie explains that insomnia can embody a whole host of different disrupted sleeping patterns.

Sleep-onset insomnia, for example, is where someone struggles to get to sleep. While sleep-maintenance insomnia is when someone struggles to stay asleep during the night.

“There are many different variations,” says Stephanie. “You might take hours to get to sleep. You might not have any problems getting to sleep, but then you wake in the night several times. Or, you just can’t get back to sleep once you’re awake in the middle of the night. It can even be a mixture of these things.”  

What causes insomnia?  

“It’s very important to understand that to treat insomnia, you don’t need to worry about the triggers,” says Stephanie. “The things that directly cause insomnia are not necessarily the perpetuating factors.”

Insomnia may be a symptom of something else, like stress, anxiety, depression, an illness, or a new medication. Stephanie explains it’s completely normal to experience sleep problems due to these things. “It’s just your body trying to adapt to the new situation,” says Stephanie.

However, when sleeping problems persist, it’s important to look beyond the initial trigger and look more closely at how our behaviour influences our sleep instead.  

The vicious cycle of sleep anxiety

“Sleep is becoming such a zeitgeisty area,” says Stephanie. “We have books, apps and trackers telling us we need to sleep more and that if we don’t bad things will happen to us.” However, this only increases our urgency for sleep and we start to fear not sleeping. “Then suddenly you’ve got anxiety about your sleep, and it’s not just a sleep problem anymore – it’s anxiety as well.”

Stephanie explains it can become an addiction to have a sleep problem: “You become so obsessed with the little coping mechanisms you’re given, like ‘the 20 top tips for insomnia’, and you start obsessing over all these things. The irony is, you end up creating more of a sleep problem than you had before.”

“I see tens of thousands of people in my sleep clinic,” says Stephanie. “Most of them are just very anxious, stressed-out people who are creating the problem themselves. It’s not their fault, it’s the way that our society deals with sleep.”

The ultimate goal is to get to a place where sleep isn’t a concern anymore. “A good sleeper is defined by somebody who doesn’t care about it,” says Stephanie. “They might not sleep perfectly, because nobody sleeps eight hours every night, but they don’t care. That is liberating.”  

Overthinking sleep debt

When it comes to sleep it’s not an eye for an eye, explains Stephanie. “If you lose four hours sleep in a night, it doesn’t mean your body needs to gain four hours sleep.”

When we try to make up for lack of sleep it may lead us to go to bed earlier, lie in for longer or nap to recover the sleep we’ve lost the night before. All this does is disrupt your routine and make you more anxious, warns Stephanie.

“It’s not that sleep debt doesn’t exist,” she says. “But it’s something we don’t have the power to change, so the best thing you can do is use that extra bit of sleep deprivation you’ve incurred to boost your sleep cycle, rather than try to increase your sleep.”  

Stephanie’s expert advice to help improve your sleep 

Stick to a routine

Creating a regulated sleep cycle by waking up at the same time every day is one of the best things you can do. Even if you haven’t got as much sleep as you’d like the night before, getting out of bed at a set time helps build good sleeping habits.

“It might seem counter-intuitive to get out of bed earlier if you’ve had a bad night’s sleep,” says Stephanie, “but if you keep waking up at the same time every day for long enough, I promise you, you will slowly start to become a morning person.”

“You’ll probably notice after several weeks of following that routine you do start going to bed around about the same time and you won’t have to force it.”

Rethink weekend lie-ins

You must factor weekends into your healthy sleep routine. “A lot of people want to lie in on the weekends and not get as much sleep during the week,” says Stephanie. “That is never going to work long term.”

“If you’re going to regulate your sleep so you start to go to bed naturally it’s important to try and wake up at the same time every day.”

Stick to your usual daytime habits

It’s also important not to change your routine during the day. “If you worry about getting extra sleep and let insomnia take over you’ll stop going to the gym, you’ll stop seeing your friends late because you’re worried it’s going to eat into your sleep opportunity. You’ll start obsessing over relaxation,” says Stephanie.

“The irony is, if you had changed nothing, if you kept going to the gym, moving around, seeing your friends and enjoying life, you’d find that your brain will happily start doing the work for you and will naturally make you sleepier.”

Build your sleep drive

When people try to compensate for lack of sleep it can lead them to spend more time in bed to give their bodies more opportunity to sleep. “The issue is when you’ve had sleep problems, you just teach your brain to dilute your sleep by doing this,” says Stephanie.

“If you spend 10 hours in bed your brain thinks it doesn’t need to give you one block of sleep anymore. It thinks it can make you sleep for the first hour, wake up for the next hour and give you a disrupted night’s sleep because you’re in bed for so long. Then your body gets used to coping and compensating for lack of sleep.”

Not forcing yourself to go to bed at a certain time is a good way to combat this. “Allow your body to build a strong sleep drive by only going to bed when you feel really tired,” says Stephanie.

“The longer you stay awake, the stronger your need to sleep is,” says Stephanie. “If you’re not able to sleep that’s totally fine. It just means you need to spend more time awake in order to build that sleep drive.”

Don’t rely on quick fixes

Looking for a quick fix to our sleep problem is often an instantaneous reaction when we start struggling to drift off. “Wouldn’t it be nice if your 20-year sleep problem was fixed by buying a new mattress,” says Stephanie, “but that cannot be.”

You can never change a routine you’ve habitually built, even one that’s not making you feel good, with a quick fix. “You need to unbuild it over time,” says Stephanie.

“Sleep has been affecting us since the moment we were all existing,” says Stephanie. “So, while things like massage, sleeping pills and CBD oil can help with short-term sleep problems, longer-term issues need greater behavioural changes.”

Focus on light

Light is incredibly important for human beings – “we are much more like plants than people realise,” says Stephanie – so it’s important we use light to our advantage to help us wake up and get to sleep.

“You can trick your brain into being really awake in the mornings by  exposing yourself to lots of bright light, even if didn’t get any sleep the night before,” says Stephanie. 

Instead of using coffee to try and stay awake, light is a much healthier alternative – and it’s free!

Light also has the ability to repair your sleep. Using light differently in the evenings, like turning off overhead lights and reducing the brightness on our screens, can help prepare you for sleep. 

“Starting your day off super bright and then, just like the sun going down, reducing the amount of light you’re exposed to in the evening is very powerful,” says Stephanie.   

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  • Stephanie Romiszewski, consultant physiologist and director of Sleepyhead Clinic

    Stephanie Romiszewski sleep expert
    Sleep expert Stephanie Romiszewski

    Stephanie is a sleep physiologist with a BSc in psychology and an MSc in behavioural sleep medicine. She specialises in insomnia and complex sleep disorders founding sleep treatment and education centre, Sleepyhead Clinic. She runs a complex sleep service for the NHS in Devon and is looking at access to sleep education for doctors in their medical training programs as part of a research team at Exeter University.