5Non-drug treatmentsCognitive Behavioural Therapy is an established and very effective modality in the management of chronic insomniaStimulus controlCognitive therapySleep restrictionRelaxation trainingSleep hygiene
6Stimulus ControlConditioned arousal – situations associated with sleep become alerting rather than relaxing – further impairing sleep.
7Stimulus ControlPrinciple: to re-associate bed, bedtime and the bedroom with sleepiness and sleepGo to bed only when sleepyUse the bed only for sleep or sexIf unable to sleep after 20 minutes, move to another roomReturn to bed only when sleepyRepeat the above as often as necessaryGet up at the same time every morningDo not napMaybe contraindicated in patients with mania, epilepsy or at high risk of falls.
8Cognitive therapiesInsomnia occurs acutely in relation to both predisposing and precipitating factors.e.g?Insomnia is then maintained by maladaptive coping behavioursCognitive Behavioural therapy focuses on eliminating the perpetuating factors that lead to the development of chronic insomnia
9Cognitive Behavioural Therapy Help you understand, challenge and change unhelpful thoughtsCan be as simple as “I must have 8hours of sleep each night”
10Cognitive Behavioural Therapy Challenging self-defeating thoughts that fuel insomniaUnrealistic expectations:I should be able to sleep well every night like a normal person. I shouldn’t have a problem!Lots of people struggle with sleep from time to time. I will be able to sleep with practice.Exaggeration: It’s the same every single night, another night of sleepless misery.Not every night is the same. Some nights I do sleep better than others.Catastrophizing: If I don’t get some sleep, I’ll tank my presentation and jeopardize my job.I can get through the presentation even if I’m tired. I can still rest and relax tonight, even if I can’t sleep.Hopelessness: I’m never going to be able to sleep well. It’s out of my control.Insomnia can be cured. If I stop worrying so much and focus on positive solutions, I can beat it.
11Worries Have an allocated worry time Keep a note book next to your bed to write down thoughts or any issues. They will still be there in the morning.
12Sleep restriction Requires the patient to: Limit his /her time in bed to amount that equals their total sleep timeTime restrictions determined by clinician and patient using sleep diaries and balancing the patient’s lifestyle – 5 day sleep diaryEstablish a fixed wake up timeDelay bed timeAs sleep efficiency increases patients are gradually allowed to spend more time in bed – increased in 15 minute incrementsOver course of therapy, patients begin to find it difficult to stay up until prescribed hour.
13Relaxation Deep breathing Progressive muscle relaxation More effective than no treatment but not as effective as sleep restrictionMore effective with younger rather than older adults
14Sleep hygiene Avoid alcohol, nicotine, caffeine, chocolate Cut down on non-sleeping time in bedAvoid bedside clockExercise regularlyHave a hot shower and/or hot drink before bedtimeEstablish a regular sleep schedule
15More healthy sleep habits Adjust bedroom environmentDark, coolMinimum lighting if you have to use bathroom at nightWhite noise machine or fan to drown out other soundsComfortable bed
16Final note…Treating the underlying reason for the sleep disorder may be what is required and may resolve the sleep issues.