INSOMNIA

Treatment involves:
1.  Cognitive therapy       2.  Sleep hygiene     3. Relaxation    4. Stimulus control     5.  Sleep restriction

1. Cognitive therapy
People who experience insomnia often express attitudes and beliefs about sleep that prompt worry and anxiety about their ability to get the sleep they need. This anxiety and worry contribute to arousal that interferes with sleep which prompts more worry and anxiety thus establishing a self-fulfilling cycle which is difficult to break. They tend to lie in bed ruminating, they watch the clock and worry about how they will be able to function the next day.

Cognitive therapy focuses on identifying these beliefs and replacing them with more adaptive belief and attitudes. One common tendency is the worry about presumed catastrophic consequences of a poor nights’ sleep. CBT helps to challenge these beliefs and expectations thus reducing anxiety levels experienced as bedtime approaches.

This is achieved by a number of interventions some of which are mentioned below:

  1. Interventions to reduce worry and rumination – the client is taught to identify thoughts and challenge them
  2. Interventions to reduce unhelpful beliefs about sleep- use of behavioural experiments
  3. Intervention to reduce misperception (of the impact of poor sleep) this includes addressing how much sleep we think we need and get and how much we actually get.

2. Sleep hygiene
General recommendations and advice are provided to help aid sleep and promote good habits. This addresses a number of activities and habits some of which include: avoiding activities such as day time naps, drinking caffeine and limiting alcohol prior to bedtime. Promoting activities such as establishing a bedtime routine, ensuring the bedroom is free from noise, is the correct temperature and avoiding checking the clock.

3. Relaxation
Techniques that can be taught are dependent on the persons preference some of which include breathing techniques, progressive muscular relaxation and Qi Gong.

4. Stimulus control
This is based on learning theory were sleep difficulties are associated with the person becoming anxious about the bed and bedroom and unsuccessfully falling asleep. (i.e. sleeplessness and arousal are a nightly occurrence and now the person associates the bed and bedroom with sleep problems). Some of the interventions include only going to bed when tired and avoiding non-sleep activities in the bedroom such as watching TV.

5. Sleep restriction
This focuses on reducing the amount of time spent in bed during the night by prescribing a time in bed that more closely resembles the actual amount of time the patient spends sleeping.

This is achieved by a number of interventions which include:

  1. calculating the amount of sleep the person actually needs by keeping a sleep diary for up to 2 weeks
  2. restricting the time spent in bed to sleep only (get up when awake)
  3. having a consistent rising time
  4. avoiding naps to “bank” sleep

Eventually establishing a specific sleep prescription which changes the amount of time in bed as the sleep pattern returns.