The Vivantes Outpatient Center for Mental Health has made a name for itself with its wide range of services for people from different nations and language groups, from Arabic and Persian to Turkish and African dialects. Psychologist Ewa Poradowska leads a group therapy for people with sleep disorders. In an interview, she explains what you can do to fall asleep better, not lie awake at night and start the day more rested in the morning.
Ms. Poradowska, you've traveled a lot – are sleep disorders "international"?
That's right, I come from Warsaw, where I worked for six years in an inpatient psychiatric ward but also in the outpatient department of an institute of psychiatry and neurology. During this time I trained in cognitive behavioral therapy for insomnia. After a stint n Philadelphia at the University of Pennsylvania, I have been working here at Vivantes in the Center for Transcultural Psychiatry at Humboldt Klinikum since June 2020. The symptoms, mechanisms, and burdens of insomnia are probably similar internationally, even though each sleep disorder is individual. In our industrialized nations with similar lifestyles, sleep problems are on the rise - almost every second person is now affected.
Why, what connects them?
In this country, many people read on their laptops, tablets or cell phones in the evening, or they watch TV. On social media or through series, we are emotionally overstimulated instead of coming to rest. Research shows that falling asleep is delayed by up to an hour if you spend thirty minutes with this so-called "blue light" beforehand. The "reflected light" from readers, or the existing yellow filters are better, but it is still a light that is allowed very close to the eye. This sends a signal to the brain that it is bright, so no bedtime. Melatonin production is blocked, which controls the day-night rhythm.
But not everyone falls asleep hard because of it. When should you seek psychological help?
Sleep disorders are often short-lived and occur when you are under psychological stress, for example at work, in the family, or before exams. Some react more sensitively, others can sleep well despite stress. Therefore, insomnia is diagnosed only when the poor sleep quality or quantity that causes stress or impairment persists for more than three months. This requires difficulty falling asleep, sleeping through the night and/or waking up very early in the morning and not being able to get back to sleep about three times a week.
But doesn't everyone wake up at night or take a while to fall asleep?
Yes, about thirty minutes is what many people need to fall asleep, also sometimes lying awake at night for thirty minutes is perfectly normal, or waking up half an hour before the alarm clock in the morning. But if it is longer and more frequent, after two weeks it is called short-term insomnia, after three months it can become a long-term sleep disorder.
What can be done about it?
It is good to remember the principles of sleep hygiene, such as certain food before going to bed, no coffee, alcohol, fresh air, or a dark room. However, it is worth being flexible here, e.g. it does not mean that you have to give up coffee altogether, but not to drink any more after 4 pm. Everyone should check for themselves what works for them and what does not.
First of all, you should not change anything in your own habits: Those who suffer from sleep deprivation should not go to bed earlier, should not get up later, and should also continue their usual social, physical activities - such as meeting friends and exercising. Long-term sleep disturbances usually become when you try to "catch up on sleep." Just because you're in bed longer doesn't mean you're sleeping more or better. On the contrary - we eventually associate lying around in bed with restlessness and brooding, mentally spinning in circles because we want to force ourselves to sleep. What remains is the thought "how am I going to get through the day tomorrow?"
Such thoughts are difficult to prevent...
Therefore, it is better to get up for about 30 minutes, change the place, read a book, listen to music, or do something else. After this time you should go back to bed. Or write the stressful thoughts on a piece of paper, so they are out of your head. Because for many, problems become bigger at night in a semi-conscious state than they are during the day.
Is sport before bedtime good?
Regular exercise generally leads to better sleep quality - that is, deeper sleep, not necessarily longer sleep. We also observe this in people who work hard physically. However, some people have trouble falling asleep immediately after exercise, and should be active for a few hours before going to bed to wind down. Others are also very relaxed immediately after sports.
Are sleeping pills a solution for insomnia?
Cognitive behavioral therapy is the first line of treatment for primary insomnia. However, behavioral therapy interventions are also indicated for patients with secondary forms of chronic insomnia (i.e., insomnia associated with other medical conditions). If therapy does not work, as it does in 20-30% of people, pharmacological treatment should always be done in consultation with a medical professional.