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Is Your Client’s Insomnia Caused by Physical Factors?

It could be your client's body, not their mind, that's keeping them awake or causing nighttime waking

Sometimes it's external factors that are denying your client's mind the calmness it needs to sleep

“The first wealth is health.”— Ralph Waldo Emerson

The thrashings of disturbed sleep often originate from emotional disturbance.

On high alert, your mind frantically rifles through a barrage of swirling mental debris. What happened? What might happen? What might have happened that you don’t even know about?

Depression, anxiety, and chronic anger all lay healthy sleep to waste. And that shattered sleep cycle in turn worsens those emotional conditions.

As if that weren’t enough, we know that prolonged bad sleep harms not only mental health but physical health too. Damaging the cardiovascular system(1), the immune system(2), the endocrine system(3), and everything in between, poor sleep can really wreak havoc with your body.

But it’s not just emotional problems that interfere with sleep – lifestyle factors play an equally important role. We live in overstimulated times, and it’s all too easy to keep the brain in daytime mode when it should be pushing up the zeds through the night.

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When we look to help our clients sleep better, we need to look carefully and sensibly. We need to dig deep to discover what factor – or combination of factors – is stealing the sleep from right under their weary noses.

First things first

Before probing too deeply into the possible causes of poor sleep, start by looking at your client’s emotional and lifestyle health. Sleep is habitual, and this means that even if the cause has faded (perhaps worries have been resolved), the habit of poor sleep may still be seriously marring someone’s life.

When a client comes to you complaining of poor sleep you’ll see there’s often a cycle, a horrible vicious spiral in which poor sleep generates the kinds of feelings and behaviours that promote… poor sleep. You know the story: We don’t sleep because we worry, we worry because we don’t sleep.

The danger is that as practitioners trained in looking at and into the mind we can assume that sleep disturbance is always or only an emotional issue. But…

Physical problems can be at the root of sleep disturbance

Physical pain is perhaps the most obvious physical cause of broken sleep.

The searing sting of terrible sunburn tortured by the merest touch of the sheets. The grinding ache of that rotator cuff injury every time we roll over. The shrill scream of toothache, the pressurized thump of headache, the slow wave of nausea.

For millions, it’s back pain that pinches not only their nerves but also their slumber. Night after night the pain siphons their sleep, leaving them exhausted and unable to function well the next day.

But there are other physical contributors to poor sleep, and it’s worth going through these with your clients. Here’s a checklist of possibilities, but bear in mind it’s not exhaustive. Only a medical doctor can truly rule out a physical cause of sleeping problems, so if you can’t get to the bottom of your client’s insomnia, talk to them about referral.

1. Does your client have a neurological condition?

Some neurological conditions, such as Parkinson’s disease or multiple sclerosis, may interfere with sleep. This is especially so if the condition produces bodily twitches, shakes and spasms.

But even in severe cases, helping your client to relax may afford some control. For example, it has been found that Parkinsonian symptoms such as tremors subside in the short term when patients believe they are taking medication, even if it is only a placebo(4).

So psychological factors do contribute to some degree. And at the very least we can help these patients manage their stress about their condition.

2. Is your client on any medications?

Statins, cough and cold remedies, blood pressure tablets, SSRI antidepressants, nicotine replacement products, and many other medications can be damaging to sleep. Check if your client is on meds and, if so, whether they have known side effects relating to sleep.

Again, if your client has to take medication it doesn’t mean you can’t work with them to help them sleep better. But if it’s a real problem they may need to address it with their doctor.

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3. Does your client’s stomach keep them up at night?

Eating before bed is to sleep what midday Arizona sunshine is to ice cubes.

Ask your client about their eating routines and what they habitually consume. Early in my career one client told me she would get up in the night to drink black coffee – and no, not decaf! Needless to say, this was hardly conducive to a good night’s sleep. Similarly, as satisfying as it may feel at the time, eating fries, burgers and onions an hour before bed isn’t a great recipe for slumber.

We can also ask about acid reflux or ‘heartburn’, which happens when stomach acid splashes up from the stomach into the oesophagus. Heartburn can be really uncomfortable and is a surprisingly common cause of poor sleep. The answer may be as simple as a change in diet, but some clients may require medical treatment.

4. Does your client have heart disease?

Heart failure, characterized by a gradual decline in the capacity of the heart to pump blood, can cause fluid to build up in the tissues and lungs. This often manifests as breathlessness at night, which can make it seem near impossible to get to sleep.

People with heart disease often also struggle with sleep apnoea. A person with sleep apnoea repeatedly stops breathing – sometimes hundreds of times – throughout the night, resulting in many micro-awakenings.

Sleep apnoea is also associated with obesity, so exercise and weight loss may well have direct benefits for sleep (not to mention all the health benefits that come with improved sleep quality).

5. Does your client have diabetes?

Diabetes can affect sleep in a range of ways. Poorly controlled blood sugar levels can cause a frequent need to urinate (not great for sound sleep), night sweats, or even nausea and rapid heartbeat in cases of hypoglycaemia (low blood sugar). Nerve damage from the diabetes can result in pain, which may also disturb sleep.

6. Does your client have a musculoskeletal disorder?

Conditions such as arthritis, neuralgia, or fibromyalgia, a condition characterized by painful ligaments and tendons, can cause a great deal of pain. This can make it hard for people to fall asleep and to resettle when they shift positions. Exacerbating the problem is the fact that these conditions are often treated with steroids – a medication that frequently causes insomnia.

Chronic or severe pain can prevent people from entering the really deep sleep needed for recuperation and energy renewal, and therefore for optimum health.

7. Does your client have nocturia?

Getting up multiple times in the night to pay homage to the smallest room in the house doesn’t exactly engender deep and peaceful sleep.

Now if you’re used to quaffing a few beers before bed – or even just a few waters – it shouldn’t surprise you if you need to get up to pee later in the night. But there may be physical causes of ‘nocturia’ (waking at night to urinate) that have nothing to do with fluid consumption.

Medical causes of nocturia include enlarged prostate, heart failure, urinary tract infections, liver disease, and kidney disease (which can also cause insomnia for other reasons, such as ‘restless legs syndrome’).

Some medications, including diuretics, antidepressants and blood pressure medications, can also increase urination or cause incontinence, potentially disturbing sleep.

8. Does your client have thyroid disease?

Occasionally a client may tell you they have thyroid disease. Then again, they may not. Many people are living with thyroid disease without even knowing it.

Hyperthyroidism, or an overactive thyroid gland, causes overstimulation of the nervous system, making it hard for sufferers to get to sleep and sometimes causing night sweats. Conversely, feeling cold and tired or sleepy can be a sign of hypothyroidism, or an underactive thyroid.

If signs of thyroid disease are present, suggest to your client that they see their doctor – testing the thyroid level is quick and easy.

9. Does your client have breathing problems?

It’s no secret that asthma can greatly interfere with sleep in and of itself, but some steroids used in the treatment of asthma can have a stimulating effect that makes matters even worse.

Asthma is often worse at night, too, when circadian alterations in muscle tone around the airways can make the airways constrict. This increases the risk of an asthma attack and therefore, of course, disturbed sleep.

Other lung or breathing-related conditions such as bronchitis and emphysema can cause shortness of breath that makes it harder to get to sleep and increases the chance of waking during the night. Coughing and excessive production of sputum can also corrode healthy sleep.

And finally…

There may be other causes

As I mentioned, this is by no means an exhaustive list. Even physical conditions that don’t directly impact on sleep can still keep clients up worrying about their condition. Either way, we’re dealing with an unhappy cocktail of psychological and physical causes of poor sleep.

If you suspect there is a physical contributor to your client’s poor sleep, then you need to know:

  • Are they aware of a physical problem? If so, is it being treated or managed?
  • If they are not aware of a problem, do they suspect it? Are they prepared to get it checked out?

Even if your client’s physical problems can’t be cured, it doesn’t mean you can’t still help them relax and sleep better by addressing their behaviours and thinking around sleep and using hypnosis and relaxation techniques.

After all, psychological healing can track alongside physical healing. Mind and body are so interconnected as to be indistinguishable, and sleep is one of the most prominent examples of this interdependence.

To manage the body is to manage the mind, and vice versa. But sometimes we need to look to the body first for clues to the path healing needs to take.

And you can learn helpful hypnotic techniques through our introductory course in conversational hypnosis here, or if you want to upgrade your skills, try our Precision Hypnosis course.

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Mark Tyrrell

About Mark Tyrrell

Psychology is my passion. I've been a psychotherapist trainer since 1998, specializing in brief, solution focused approaches. I now teach practitioners all over the world via our online courses.

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