Rachel Bega Psychologist Insomnia Hypersomnia Narcoleps

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Psychological treatment of insomnia

• Rachel Bega
• Psychologist

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Numerous sleep disorders

• Insomnia
• Hypersomnia
• Narcolepsy
• Parasomnia nightmares etc
• Sleep disorders due to...

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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

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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

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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

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Stimulus Control

• Conditioned arousal situations associated with
  sleep become alerting rather than relaxing
  further impairing sleep.

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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.

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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

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Cognitive Behavioural Therapy

• Help you understand, challenge and change
  unhelpful thoughts
• Can be as simple as I must have 8hours of sleep
  each night

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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 shouldnt have a problem!
• Lots of people struggle with sleep from time to
  time. I will be able to sleep with practice.
• Exaggeration Its 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 dont get some sleep, Ill
  tank my presentation and jeopardize my job.
• I can get through the presentation even if Im
  tired. I can still rest and relax tonight, even
  if I cant sleep.
• Hopelessness Im never going to be able to sleep
  well. Its out of my control.
• Insomnia can be cured. If I stop worrying so much
  and focus on positive solutions, I can beat it.

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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.

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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
  patients 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.

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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

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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

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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

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Final note

• Treating the underlying reason for the sleep
  disorder may be what is required and may resolve
  the sleep issues.