Cognitive Behavioural Therapy is an established and very effective modality in the management of chronic insomnia ◦ Stimulus control ◦ Cognitive therapy ◦ Sleep restriction ◦ Relaxation training ◦ Sleep hygiene
Conditioned arousal – situations associated with sleep become alerting rather than relaxing – further impairing sleep.
Principle: to re-associate bed, bedtime and the bedroom with sleepiness and sleep Go to bed only when sleepy Use the bed only for sleep or sex If unable to sleep after 20 minutes, move to another room Return to bed only when sleepy Repeat the above as often as necessary Get up at the same time every morning Do not nap Maybe contraindicated in patients with mania, epilepsy or at high risk of falls.
Insomnia occurs acutely in relation to both predisposing and precipitating factors. e.g? Insomnia is then maintained by maladaptive coping behaviours Cognitive Behavioural therapy focuses on eliminating the perpetuating factors that lead to the development of chronic insomnia
Help you understand, challenge and change unhelpful thoughts Can be as simple as “I must have 8hours of sleep each night”
Challenging self-defeating thoughts that fuel insomnia Unrealistic 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.
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.
Requires the patient to: ◦ Limit his /her time in bed to amount that equals their total sleep time ◦ Time restrictions determined by clinician and patient using sleep diaries and balancing the patient’s lifestyle – 5 day sleep diary ◦ Establish a fixed wake up time ◦ Delay bed time ◦ As sleep efficiency increases patients are gradually allowed to spend more time in bed – increased in 15 minute increments ◦ Over course of therapy, patients begin to find it difficult to stay up until prescribed hour.
Deep breathing Progressive muscle relaxation More effective than no treatment but not as effective as sleep restriction More effective with younger rather than older adults
Avoid alcohol, nicotine, caffeine, chocolate Cut down on non-sleeping time in bed Avoid bedside clock Exercise regularly Have a hot shower and/or hot drink before bedtime Establish a regular sleep schedule
Adjust bedroom environment ◦ Dark, cool ◦ Minimum lighting if you have to use bathroom at night ◦ White noise machine or fan to drown out other sounds ◦ Comfortable bed
Treating the underlying reason for the sleep disorder may be what is required and may resolve the sleep issues.