1. Psychological treatment of insomnia
Rachel Bega
Psychologist

2. Numerous sleep disorders
Insomnia
Hypersomnia
Narcolepsy
Parasomnia – nightmares etc
Sleep disorders due to...

3. Insomnia How is it defined?
Difficulties falling asleep – Initial Insomnia
Difficulties staying asleep – middle insomnia
Difficulties ??
Consequences of not sleeping:
irritability, difficulty concentrating, accidents, mood disturbance, interpersonal difficulties

4. Causes of insomnia Mental illness: depression, anxiety, stress
Substance use: alcohol, drugs
Medication: Antidepressants
Medical conditions: asthma, allergies, chronic pain
Other conditions: shift work, pregnancy

5. Non-drug treatments
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

6. Stimulus Control
Conditioned arousal – situations associated with sleep become alerting rather than relaxing – further impairing sleep.

7. Stimulus Control
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.

8. Cognitive therapies
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

9. Cognitive Behavioural Therapy
Help you understand, challenge and change unhelpful thoughts
Can be as simple as “I must have 8hours of sleep each night”

10. Cognitive Behavioural Therapy
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.

11. Worries 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.

12. Sleep restriction 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.

13. Relaxation 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

14. Sleep hygiene 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

15. More healthy sleep habits
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

16. Final note…
Treating the underlying reason for the sleep disorder may be what is required and may resolve the sleep issues.