Symptoms of depression include sadness, feelings of guilt, poor attention and concentration, changes in appetite, fatigue, loss of energy, decreased libido, increased crying, lack of desire to do things that are enjoyable, and lack of pleasure when doing things that you used to enjoy. People with depression may have early morning awakenings and spend more time lying in bed than is needed, thus causing a worsening of insomnia.  

If you experience excessive worry, feeling nervous and stressed, difficulty relaxing, feeling scared or fearful, frequent nightmares, obsessive thoughts, or symptoms of panic, then anxiety may be taking a toll on your life. Anxiety may cause trouble falling asleep, especially when it’s difficult for you to relax at night and you experience racing thoughts or worries at bedtime. 

Effective treatment for depression and anxiety include cognitive behavioral therapy, which focuses on the behaviors and thought processes that are worsening your symptoms.

Insomnia is a common problem in the United States and other industrialised nations around the world.

It is estimated that up to one-third of the United States population has insomnia.

So what is insomnia, exactly? 

Insomnia is typically defined as difficulty either falling asleep, staying asleep, or both.

It can also involve early morning awakenings with trouble falling back to sleep.

It can be caused by stress, anxiety, depression, poor sleep hygiene, environmental factors, certain medical illnesses and medications, or other sleep disorders such as restless legs syndrome, periodic limb movements, sleep apnea, circadian rhythm disorders, shift work disorder, or narcolepsy.

To help you figure out if you have insomnia, read through the following descriptions and see if they apply to you.

Transient insomnia is short-term in nature. It is often due to stressful situations in your life, such as a new job, break-up in a relationship, or the death of a loved one. It can also be caused by illnesses, certain medications, and environmental circumstances. Short-term, or transient, insomnia typically lasts between a few days and a few weeks, but it can still be a time of frustration. It is common to experience transient insomnia at some point in your life and it doesn’t mean that it’s going to last forever. The important thing is not to let it turn into a chronic problem.

Psychophysiological or conditioned insomnia is a learned-type of insomnia that lasts more than a month. People with conditioned insomnia often describe feeling “wide awake” when they get into bed at night, even though they were tired beforehand. You may feel like your mind just “won’t shut off” when you get into bed, and so as a result, you spend a lot of time lying in bed each night but not sleeping. This type of insomnia is reinforced by both your behaviours and thoughts, both of which may be making your sleep problem worse. Poor sleep can then affect your mood, daily functioning, and overall health.

Insomnia Treatment:

Cognitive-behavioral therapy for insomnia (CBT-I) has been shown to be an effective way of overcoming your insomnia, and it doesn’t involve taking any sleep medications. CBT-I teaches you how to change the thoughts and behaviours that are keeping you up at night so that you can get more refreshing, restorative sleep.

There are over 80 different sleep disorders. Some of the most common include:

Sleep Apnea

• The Greek work apnea means “without breath”.  When a person has sleep apnea, they stop breathing or have reduced breathing repeatedly and frequently during sleep.  This disruption of sleep can cause a person to feel sleepy during the day.  Obstructive sleep apnea is the most common type of apnea and occurs when there is a collapse in the upper airway.  In other words, the muscles in the back of the throat don’t keep the airway open, which results in stopping or decreased breathing. Central sleep apnea occurs when the brain fails to send signals to the muscles that control breathing.  This is typically due to an underlying medical condition.  Mixed sleep apnea is a combination of obstructive and central apnea.

• Common symptoms of obstructive sleep apnea include snoring, waking up gasping for air, difficulty breathing at night, choking sensation while sleeping, frequent awakenings from sleep, dry mouth upon awakening, morning headaches, and excessive daytime sleepiness. 

• • When left untreated, the combination of sleep apnea and low blood oxygen levels can lead to high blood pressure, heart disease, diabetes, stroke, automobile accidents due to drowsy driving, mood and memory problems.
  • Over 18 million adult Americans have sleep apnea.
  • Risk factors for sleep apnea include being overweight, smoking and alcohol use, having a small upper airway or enlarged tongue, tonsils, or uvula.
  • Diagnosis of sleep apnea requires an overnight sleep study, called a nocturnal polysomnogram.  Both in-lab and home sleep studies are used to diagnose sleep apnea.

Restless Legs Syndrome

• Restless Legs Syndrome (RLS) is a creepy crawly sensation in the legs at nighttime. It often feels like an uncomfortable tingling sensation. RLS causes a strong urge to move the legs, and the discomfort typically goes away when the person massages the legs or gets up and moves around.

• • • RLS symptoms begin or get worse when inactive or resting, often when sitting in the evenings or when lying down to go to sleep.
    • RLS symptoms typically get better or go away when moving and stretching.
    • Nonpharmacological treatment for RLS includes moderate daily exercise emphasizing the legs, decrease or elimination of caffeine, decrease or elimination of nicotine, and taking a hot bath approximately one hour before bedtime.
    • It is important to rule out an underlying medical cause to RLS symptoms. 

• Due to significant discomfort when lying down at night, RLS can cause Sleep Onset Insomnia.

Periodic Limb Movement Disorder

• An abnormal amount of limb movements during sleep. They can appear like brief muscle twitches, jerking movements, or upward flexing of the feet. These may or may not be associated with EEG arousals. 

• Many people are unaware that they have PLMs, but they may experience excessive daytime sleepiness and fatigue due to frequent arousals at night. 

• PLMs may cause awakenings during the night and therefore contribute to symptoms of insomnia. 

• Treatment is only necessary if it is causing daytime symptoms like sleepiness or fatigue, or if it is worsening insomnia. 

• There are some underlying medical conditions that can cause PLMs, so it is important to discuss this with your doctor. 

REM Sleep Behavior Disorder (RBD)

• REM Sleep Behavior Disorder is a parasomnia that occurs when a person “acts out” his or her dreams. It is due to a disinhibition or loss of muscle atonia that normally occurs during Stage REM sleep. 

• REM sleep-associated muscle atonia means that the body does not move during Stage REM sleep. This is a normal survival mechanism so that we do not “act out” our dreams. However, in persons with RBD, the muscle atonia is intermittently lost.

• Symptoms of RBD include movements during sleep, associated with dream content. Often these dreams are vivid in nature and involve fighting, running, chasing, or struggling.

• RBD is more common in men who are over 55-years-old.

• • RBD is common in persons with Parkinson’s disease and other neurodegenerative diseases.
  • Treatment of RBD typically involves medication and counseling, in addition to bedroom safety precautions to avoid injury during episodes of RBD.

Narcolepsy

• A disorder characterized by excessive daytime sleepiness that is often associated with cataplexy (loss of muscle tone provoked by strong emotion), sleep paralysis, and hypnagogic or hypnopompic hallucinations (vivid perceptual experiences that occur when falling asleep or upon waking up).

• • • Daytime sleepiness can feel like a “sleep attack” where a person may fall asleep during activities that require alertness, like while eating, driving, or talking to someone else.

• Nighttime sleep is often disrupted with frequent awakenings and difficulty staying asleep at night.

Advanced Sleep-Wake Phase Disorder (aka Advanced Sleep Phase Syndrome)

• A circadian rhythm disorder where there is a complaint of an inability to stay awake until the desired bedtime or an inability to remain asleep until the desired wake time. In other words, a person with this disorder falls asleep earlier in the evening than he/she would like to and wakes up earlier in the morning than he/she prefers. For example, someone who falls asleep at 8 PM each evening and wakes up at 4 AM.

• This syndrome is more common in the elderly, but may occur at any age.

• • People with advanced sleep phase syndrome have an “early bird” circadian rhythm.
  • Behavioral modifications are an effective form of treatment.

Delayed Sleep-Wake Phase Disorder (aka Delayed Sleep Phase Syndrome)

• A circadian rhythm disorder in which there is a complaint of difficulty falling asleep until very late and subsequent difficulty waking up at the desired time in the morning. A typical complaint is Sleep Onset Insomnia, with extreme difficulty waking up in the morning at a desired time. There is typically no reported problem maintaining sleep once sleep has begun.

• • • The delay in bedtime/sleepiness occurs due to one’s internal sleep clock being shifted later compared to societal norms. 
    • People with delayed sleep phase syndrome have a “night owl” circadian rhythm.

• This syndrome is more common in adolescence and college students, but may occur at any age.

Since many sleep disorders have similar symptoms (e.g. excessive daytime sleepiness, difficulty falling asleep at night, frequent awakenings from sleep, etc.), it is highly recommended that persons seeking consultation and treatment for a sleeping difficulty see a Board Certified Sleep Specialist.

For more information on sleep disorders, check out these resources:

Sleep Apnea:

https://www.sleepapnea.org/

https://www.sleepfoundation.org/sleep-apnea 

https://browardsleepdisorders.com/index.html

Restless Legs Syndrome

https://www.rls.org/

https://www.sleepfoundation.org/sleep-disorders/restless-legs-syndrome-rls

Periodic Limb Movements

https://www.sleepfoundation.org/articles/periodic-limb-movements-disorder

https://www.webmd.com/sleep-disorders/periodic-limb-movement-disorder

REM Sleep Behaviour Disorder

https://www.sleepfoundation.org/articles/rem-sleep-behavior-disorder

http://sleepeducation.org/sleep-disorders-by-category/parasomnias/rem-sleep-behavior-disorder/overview-facts

https://www.webmd.com/sleep-disorders/rem-sleep-behavior-disorder

Narcolepsy

https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/fact-sheets/narcolepsy-fact-sheet

https://www.sleepfoundation.org/articles/narcolepsy

http://sleepeducation.org/essentials-in-sleep/narcolepsy/overview-facts

Advanced Sleep-Wake Phase Disorder (aka Advanced Sleep Phase Syndrome)

http://sleepeducation.org/sleep-disorders-by-category/circadian-rhythm-disorders/advanced-sleep-wake-phase

https://stanfordhealthcare.org/medical-conditions/sleep/advanced-sleep-phase-syndrome.html

Delayed Sleep-Wake Phase Disorder (aka Delayed Sleep Phase Syndrome)

http://sleepeducation.org/sleep-disorders-by-category/circadian-rhythm-disorders/delayed-sleep-wake-phase/overview-and-risk-factors

https://www.sleepfoundation.org/articles/what-circadian-rhythm

Cognitive Behavioral Therapy (CBT)

Dr. Silberman specializes in Cognitive Behavioral Therapy (CBT) for the treatment of psychological and sleep disorders, including depression, panic disorder, generalised anxiety disorder, obsessive-compulsive disorder, post-traumatic stress disorder, insomnia, and other difficulties. Dr. Silberman works with couples having relationship problems, families who aren’t communicating well together, and persons coping with chronic medical illnesses. She also helps those who feel “stuck” in their careers or those who aren’t sure what career path to take by helping them focus on their true interests combined with their skills and abilities. In addition, Dr. Silberman uses CBT for persons wanting to lose weight or quit smoking.

In Cognitive Behavioral Therapy, there is an emphasis on identifying “cognitive distortions”, “automatic thoughts”, and underlying assumptions that lead to an individual having symptoms of depression, anxiety, insomnia, overwhelming stress, marital discord, or other issues. In addition, we work to identify what behaviours are maintaining, or reinforcing, the symptoms. With a CBT approach, the patient and psychologist work together to modify maladaptive thoughts and change problematic behaviours. This leads to a decrease in distressful symptoms, improved coping skills, and improved mental and physical health.

Cognitive Behavioral Therapy for Insomnia (CBT-I)

As a board certified sleep medicine specialist, Dr. Silberman specializes in the evaluation and treatment of sleep disorders. For insomnia, the treatment approach used is called CBT-I. Like CBT for other disorders, Cognitive Behavioral Therapy for Insomnia (CBT-I) is an evidence-based approach focused on changing the maladaptive thoughts and behaviours that maintain chronic insomnia. CBT-I can improve one’s mood as well, since there is a significant connection between sleep quality and quantity and an individual’s daytime functioning, mood, and overall well-being.

Research shows that CBT-I is the first line treatment for insomnia and that it is highly effective. Treatment is typically short-term in nature. Through CBT-I, people learn that by changing the behaviours, thoughts, and maladaptive patterns that contribute to poor sleep, they can take control of their symptoms and sleep better without sedative hypnotics. CBT-I is an individualised treatment approach with focus on finding the right sleep-wake schedule to optimize your chances of sleeping, decreasing behaviours that keep you up at night, and learning ways to decrease anxiety and worry during the day and especially at nighttime. CBT-I is a collaborative, active, hands-on approach to insomnia with the goal of improving sleep quality.