Psychosomatics of insomnia
Doctors call it insomnia when you have trouble falling asleep, wake up in the night or too early in the morning, and are unhappy with your sleep. A doctor looks for the cause: sleep can be disturbed by anxiety, depression, thyroid disease, pain, snoring with pauses in breathing, and menopause. If poor sleep lasts longer than three months, don’t put off a visit. The Ladder method adds questions about what won’t let you go at night.
Updated
When to see a doctor
Book a doctor’s appointment if you notice:
- You take a long time to fall asleep
- You wake in the night and lie awake
- You wake too early and can’t fall asleep again
- You feel worn out in the morning
- Daytime sleepiness, irritability, trouble concentrating
- Snoring with pauses in breathing, night sweats, pain or restless legs
Start with a general practitioner. They will assess your sleep and order tests, and if needed refer you to a neurologist, a psychotherapist or an ear, nose and throat doctor. The protocol advises keeping a sleep diary for two weeks.
What medicine knows
Insomnia, according to the clinical protocol of the Kazakhstan Ministry of Health (2023), is trouble falling asleep or staying asleep, or waking too early, that leaves you unhappy with the amount or quality of your sleep. The NHS adds that during the day you feel tired and irritable and find it hard to concentrate.
If poor sleep lasts less than three months, it is short-term insomnia; if longer, it is chronic. For chronic insomnia the protocol requires that the problems happen at least three times a week, even when conditions for sleep are good, and without another cause.
Most often insomnia comes with stress, anxiety or depression, noise, a room that is too hot or cold, alcohol, caffeine and nicotine, or shift work. The protocol notes that insomnia is most often accompanied by depressive and anxiety disorders, and that poor sleep can be the only complaint hiding depression.
Illnesses can also disturb sleep: an overactive thyroid, restless legs syndrome, snoring with pauses in breathing, long-term pain. The NHS names menopause among the causes too. If insomnia doesn’t go away, a doctor will check these causes.
For chronic insomnia the protocol recommends cognitive behavioral therapy, sleep hygiene and working with stress. According to the protocol, sleeping pills work for short treatment, up to 4 weeks, and long-term use is usually not recommended.
In the Ladder method
In the Ladder method, insomnia becomes a reason to look at what won’t let you go at night. It is not an explanation of why you sleep badly but a question to yourself: what do you think about when the light goes out, and to whom do you owe something all day?
At night the thoughts that had no time during the day stay with you: an unfinished conversation, someone else’s judgment, fear of not coping tomorrow. There is also a second layer, fear of not falling asleep. The protocol of the Kazakhstan Ministry of Health describes it as a “fear of not falling asleep,” when the bed itself begins to be associated with sleeplessness.
On the ladder these thoughts become steps, and you can sort them out in the daytime, not at three in the morning. Diagnosis, tests and treatment of sleep stay with the doctor.
These are questions for reflection, not an explanation of what causes the condition and not a treatment.
Frequently asked questions
Can insomnia come from nerves?
Stress, anxiety and depression are among the most common causes of insomnia, the NHS says. But it can be the other way round: poor sleep may come from the thyroid, pain, snoring with pauses in breathing, or menopause. So with long-lasting insomnia you need a doctor, not only a talk about feelings.
What does insomnia mean in psychosomatics?
Insomnia has no proven “meaning.” In the Ladder method, waking in the night becomes a reason to look at what won’t let you go at night: unfinished conversations, other people’s judgments, fear of not coping. Often a fear of not falling asleep is added to this.
What should I do if I can’t fall asleep at night?
The NHS advises going to bed only when you’re sleepy, getting up at the same time every day, winding down for an hour before bed, not having coffee, tea or alcohol for 6 hours before sleep, and not looking at your phone before bed. If poor sleep lasts longer than three months or gets in the way of life, see a doctor.
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Psychosomatics does not replace tests and treatment. Only a doctor can make a diagnosis.