Even a single night of sleep trouble can feel distressing and lonely. You toss and turn, stare at the ceiling, and wonder how you’ll cope tomorrow. No wonder many people start to worry they’ve developed insomnia.

Insomnia is one of the most talked-about sleep problems, but it’s also one of the most misunderstood.

But just because you can’t sleep, it doesn’t mean you have insomnia. You might have another sleep disorder, or none at all.

What is insomnia?

Let’s clear up some terms, and separate short-term or intermittent sleep problems from what health professionals call “insomnia disorder”.

Sleep problems can involve being awake when you want to be asleep. This could be lying in bed for ages trying to fall asleep, waking in the middle of the night for hours, or waking up too early. Having a sleep problem is a subjective experience – you don’t need to tally up lost hours to prove it’s a problem.

But insomnia disorder is the official term to describe a more problematic and persistent pattern of sleep difficulties. And this long-term or chronic sleep disorder has clear diagnostic criteria. These include at least three nights a week of poor sleep, lasting three months or more. These criteria help researchers and clinicians make sure they’re talking about the same thing, and not confusing it with another sleep problem.

So, what are some reasons why a sleep problem might not be insomnia?

1. It’s short term, or comes and goes

About a third of adults will have a bout of “acute insomnia” in a given year. This short-term problem is typically triggered by stress, illness or big life changes.

The good news is that about 72% of people with acute insomnia return to normal sleep after a few weeks.

Insomnia disorder is a longer-term, persistent problem.

2. It doesn’t affect you the next day

Some people lie awake at night but still function well during the day. More fragmented and less refreshing sleep is also a near-universal part of ageing.

So if your sleep problem doesn’t significantly affect you the next day, it usually isn’t considered to be insomnia.

For people with insomnia, the struggle with sleep spills into the day and affects their mood, energy, concentration and wellbeing. Worry and distress about not sleeping can then make the problem worse, which creates a frustrating cycle of worrying and not sleeping.

3. It’s more about work or caring

If you feel tired during the day, an important question is whether you’re giving yourself enough time to sleep. Sometimes sleep problems reflect a “sleep opportunity” that is too short or too irregular.

Work schedules, child care, or late-night commitments can cut sleep short, and sleep can slip down the priority list. In these cases, the problem is insufficient sleep, not insomnia.

You might have noisy neighbours or an annoying cat. These can also affect your sleep, and reduce your “sleep opportunity”.

The average healthy adult gets around seven hours sleep (though this varies widely). For someone who needs seven, it usually means setting aside about eight to allow for winding down, drifting off, and waking overnight.

4. It’s another sleep disorder

Other sleep disorders can look like insomnia, such as:

• obstructive sleep apnoea (when your breathing stops multiple times during sleep) can cause frequent awakenings through the night and daytime sleepiness
• restless legs syndrome creates an irresistible urge to move your legs in the evening that often interferes with falling asleep. It’s often described as jittery feelings or having “creepy crawlies”, and is often undiagnosed
• circadian rhythm problems, such as being a natural night owl in an early-bird world, can also lead to trouble falling asleep.

5. Medications and substances are interfering

Caffeine, alcohol and nicotine all create insomnia symptoms and worsen the quality of sleep.

Certain medications can also interfere with sleep, such as stimulants (for conditions such as attention-deficit hyperactivity disorder or ADHD) and beta-blockers (for various heart conditions).

These issues need to be considered before labelling the problem as insomnia. However, it’s important to keep taking your medication as prescribed and discuss any concerns with your doctor.

Getting the right help

If your sleep is worrying you, the best first step is to see your GP. They can help rule out other causes, review your medications, or refer you for a sleep study if needed.

However, once insomnia becomes frequent, chronic (long term) and distressing, you can worry too much about your sleep, constantly check or track your sleep, or try too hard to sleep, for instance by spending too much time in bed. These psychological and behavioural mechanisms can backfire, and make good sleep even less likely.

That’s why “cognitive behavioural therapy for insomnia” (or CBT-I) is recommended as the first-line treatment.

This is more effective, and longer-lasting than sleeping pills. This therapy is available via specially trained GPs, and sleep psychologists. You can take part in person or online.

In the meantime

If you’re in a rough patch of sleep:

• remind yourself that short runs of poor sleep usually settle on their own
• avoid lying in bed panicking if you wake at 3.30am. Instead, step out of bed or use the time in a way that feels restful
• keep a consistent wake-up time, even after a poor night. Try to get some morning sunlight to reset your body clock
• make sure you’re putting aside the right amount of time for sleep – not too little, not too much.

Amelia Scott, Honorary Affiliate and Clinical Psychologist at the Woolcock Institute of Medical Research, and Macquarie University Research Fellow, Macquarie University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Do you suffer from low back pain that recurs regularly? If you do, you’re not alone. Roughly 70% of people who recover from an episode of low back pain will experience a new episode in the following year.

The recurrent nature of low back pain is a major contributor to the enormous burden low back pain places on individuals and the health-care system.

In our new study, published today in The Lancet, we found that a program combining walking and education can effectively reduce the recurrence of low back pain.

The WalkBack trial

We randomly assigned 701 adults who had recently recovered from an episode of low back pain to receive an individualised walking program and education (intervention), or to a no treatment group (control).

Participants in the intervention group were guided by physiotherapists across six sessions, over a six-month period. In the first, third and fifth sessions, the physiotherapist helped each participant to develop a personalised and progressive walking program that was realistic and tailored to their specific needs and preferences.

The remaining sessions were short check-ins (typically less than 15 minutes) to monitor progress and troubleshoot any potential barriers to engagement with the walking program. Due to the COVID pandemic, most participants received the entire intervention via telehealth, using video consultations and phone calls.

The program was designed to be manageable, with a target of five walks per week of roughly 30 minutes daily by the end of the six-month program. Participants were also encouraged to continue walking independently after the program.

Importantly, the walking program was combined with education provided by the physiotherapists during the six sessions. This education aimed to give people a better understanding of pain, reduce fear associated with exercise and movement, and give people the confidence to self-manage any minor recurrences if they occurred.

People in the control group received no preventative treatment or education. This reflects what typically occurs after people recover from an episode of low back pain and are discharged from care.

What the results showed

We monitored the participants monthly from the time they were enrolled in the study, for up to three years, to collect information about any new recurrences of low back pain they may have experienced. We also asked participants to report on any costs related to their back pain, including time off work and the use of health-care services.

The intervention reduced the risk of a recurrence of low back pain that limited daily activity by 28%, while the recurrence of low back pain leading participants to seek care from a health professional decreased by 43%.

Participants who received the intervention had a longer average period before they had a recurrence, with a median of 208 days pain-free, compared to 112 days in the control group.

Overall, we also found this intervention to be cost-effective. The biggest savings came from less work absenteeism and less health service use (such as physiotherapy and massage) among the intervention group.

This trial, like all studies, had some limitations to consider. Although we tried to recruit a wide sample, we found that most participants were female, aged between 43 and 66, and were generally well educated. This may limit the extent to which we can generalise our findings.

Also, in this trial, we used physiotherapists who were up-skilled in health coaching. So we don’t know whether the intervention would achieve the same impact if it were to be delivered by other clinicians.

Walking has multiple benefits

We’ve all heard the saying that “prevention is better than a cure” – and it’s true. But this approach has been largely neglected when it comes to low back pain. Almost all previous studies have focused on treating episodes of pain, not preventing future back pain.

A limited number of small studies have shown that exercise and education can help prevent low back pain. However, most of these studies focused on exercises that are not accessible to everyone due to factors such as high cost, complexity, and the need for supervision from health-care or fitness professionals.

On the other hand, walking is a free, accessible way to exercise, including for people in rural and remote areas with limited access to health care.

Walking also delivers many other health benefits, including better heart health, improved mood and sleep quality, and reduced risk of several chronic diseases.

While walking is not everyone’s favourite form of exercise, the intervention was well-received by most people in our study. Participants reported that the additional general health benefits contributed to their ongoing motivation to continue the walking program independently.

Why is walking helpful for low back pain?

We don’t know exactly why walking is effective for preventing back pain, but possible reasons could include the combination of gentle movements, loading and strengthening of the spinal structures and muscles. It also could be related to relaxation and stress relief, and the release of “feel-good” endorphins, which block pain signals between your body and brain – essentially turning down the dial on pain.

It’s possible that other accessible and low-cost forms of exercise, such as swimming, may also be effective in preventing back pain, but surprisingly, no studies have investigated this.

Preventing low back pain is not easy. But these findings give us hope that we are getting closer to a solution, one step at a time.

Tash Pocovi, Postdoctoral research fellow, Department of Health Sciences, Macquarie University; Christine Lin, Professor, Institute for Musculoskeletal Health, University of Sydney; Mark Hancock, Professor of Physiotherapy, Macquarie University; Petra Graham, Associate Professor, School of Mathematical and Physical Sciences, Macquarie University, and Simon French, Professor of Musculoskeletal Disorders, Macquarie University

This article is republished from The Conversation under a Creative Commons license. Read the original article.