Sleeping pills aren’t the first-line treatment for insomnia – cognitive behavior therapy is.

Source: How to Fall Asleep – and Stay Asleep – the Natural Way – US News

Nearly half of all Americans suffer from occasional sleeplessness, and a staggering 15 percent have chronic, unremitting insomnia. We live in a culture where resorting to medication tends to be the first-line treatment. Most people only know about the medications available to treat insomnia: We constantly hear about them on TV, and many friends write about their insomnia sleeping pill use on social media (in the middle of the night). Medications can indeed be helpful for insomnia, and they surely have their place in insomnia management. However, many people are not aware that sleep specialists do not consider sleeping pills to be the first-line treatment for insomnia. Instead, sleep medicine’s gold standard treatment for insomnia is cognitive behavior therapy for insomnia, which is also known as CBT-I.

CBT-I is a non-drug, short-term treatment and has benefitted people of all ages and many types of patients who have trouble sleeping, including those with insomnia related to chronic pain, depression or anxiety. CBT-I consistently produces results that are comparable to, or even exceed, those of sleeping pills. Even one year after ending treatment, many patients continue to sleep well (rates that far outperform sleeping pills).

There are many ways one can engage in CBT-I, starting with self-help tips that I will mention in this post. There are a number of books on the market that focus on CBT-I as well as apps that you can download that will take you through the treatment in a more focused way. If you consistently try the techniques here (or in a book or app) and it isn’t working, consider seeing a specialist who will specifically target treatment to your particular situation. You can find a specialist here. Most sessions with a specialist last between three and 12 visits.

CBT-I is based on the concept that chronic insomnia is sustained by a variety of factors that maintain the problem. Examples of these behaviors are sleeping in, going to bed early, napping, using alcohol as a sedative, caffeine use, worrying about your sleep and tossing and turning in bed. These factors are the focus of the treatment.

The first step in CBT-I is tracking your sleep. Completing a sleep diary for two weeks can bring to light issues with sleep hygiene and sleep scheduling and make you more objective about your overall sleep pattern. There are many sleep diaries available online, but a good one should track your bedtime, wake time, how long it takes you to fall asleep and how much you are awake in the middle of the night. It should also record caffeine intake, exercise, napping, alcohol and sleeping pill use. Look for any patterns in your sleep diary. For example, do you notice it takes you longer to fall asleep on nights where you napped or dozed off earlier in the day?

The next module is sleep hygiene. Sleep hygiene should be thought of as the basic building blocks forinsomnia treatment. If you don’t have proper sleep hygiene, the other modules won’t work as well. However, fixing sleep hygiene alone typically isn’t a cure for more chronic insomnia. It is the starting point in treatment. Sleep hygiene rules include limiting caffeine within eight hours of bedtime, stopping alcohol, heavy meals, liquids, nicotine and exercise within three hours of bedtime, avoiding clock-watching at night, engaging in exercise in the late afternoon/early evening, avoiding screens/electronics, winding down within one hour of going to bed and keeping your bedroom quiet, dark, comfortable and cool throughout the night.

Stimulus control is a highly effective and essential component of CBT-I. Insomnia patients often lie in bed watching TV, reading, worrying and thinking. As a result, the bed becomes associated not only with sleep, but also as a place to be awake. The rule is simple: The bed is only for sleep and sex. If you are awake in bed (usually for roughly 20 minutes, but don’t look at the clock – just guess!), get up, go to a different room (or if you’re in a studio, get up and sit in a chair next to the bed) and do something quiet, calm and relaxing in dim light. When you get sleepy again, go back to bed. If you don’t fall asleep after a little while, repeat the process. No lying in bed awake, no TV in bed, no eating in bed, no phones/computers in bed or during the night. Do this throughout the night until your alarm clock goes off in the morning. It is tough, but very effective when done consistently.

The next module, sleep restriction, limits your time in bed, therefore increasing your body’s drive to sleep. It goes squarely against common sense that tells us to go to bed earlier or sleep in during the morning to try and “catch up” on lost sleep. However, it’s this common sense that gets us in trouble. Although books, apps and working with a therapist will give you much more detailed and personalized instructions for stimulus control, the overall principle is simple. If you have trouble sleeping, go to bed later and wake up at the same time every single day. For example, if you only sleep six hours on average per night (based on your sleep diary data), set a fixed wake time daily, count back six hours from that time and this is your wake time. Reassess a week later, and if you’re improving, go to bed 15 minutes earlier each week. Keep the wake time the same. Don’t restrict to less than five hours, and if you have other issues such as sleep apnea, epilepsy, sleepwalking or bipolar disorder, speak with a sleep specialist before doing full-on sleep restriction.

The cognitive module teaches patients to recognize and modify inaccurate thoughts that affect your ability to sleep. A number of my patients have the thought “I must get eight hours of sleep tonight to function well tomorrow.” This thought puts additional pressure on patients to get eight hours of sleep, causing them to be tense and anxious – a state that clearly does not induce sleep. Try to swap inaccurate thoughts for more evidence-based ones. It is quite possible that you might function well on seven hours of sleep instead.

Relaxation exercises can be used to help quiet the mind and relax the body. There are a number of techniques that can be taught, such as muscle relaxation, deep breathing and biofeedback. You must find what works for you, and many websites (as well as therapists) can guide you through techniques. Patients who feel tense before bedtime show the most benefit from this module.

You do not necessarily need to discontinue sleep medication to benefit from CBT-I. Many patients gradually taper off their sleep medications once they have learned alternative techniques for their insomnia. This is a highly effective treatment for many people, but it isn’t as easy as taking a pill. The key is to remember that insomnia develops over time in many people, and it isn’t cured overnight. Consistency is key with insomnia management: The more you stick with the treatment, the better the outcomes.

An exhausted mum beats insomnia with hypnosis sessiona after six years of surviving on just one hours sleep every night

Source: Exhausted mum beats insomnia after six years of surviving on one hour’s sleep – BT

CBT  for Insomnia

According to  East End Psychological Services, P.C.:

“Insomnia refers to difficulty falling asleep, staying asleep, or constantly waking up early. People with insomnia feel dissatisfied with their sleep and usually experience fatigue, low energy, difficulty concentrating, mood disturbances, and decreased performance in work or at school.

The National Institutes of Health estimates that roughly 30 percent of the general population complains of sleep disruption, and approximately 10 percent have associated symptoms of daytime functional impairment. In January 2014, the Centres for Disease Control and Prevention reported that insufficient sleep is a “public health epidemic.”

“Sleep is essential for our physical and emotional well-being,” says Dr. Joseph Volpe, Clinical Psychologist and Executive Director.  “Children require healthy sleep to function at school and in their daily lives with friends and family.  Adults need their sleep as they attend to responsibilities at home, work, and their relationships.”

The Cognitive-Behavioural Therapy for insomnia (CBT) program is adapted from the work of Dr. Gregg Jacobs who developed his approach to insomnia at Harvard Medical School and the University of Massachusetts Memorial Medical Centre.

The program begins with an evaluation that includes clinical interview, sleep hygiene worksheets, medical history questionnaires, and brief psychological measures. The treatment uses stimulus control techniques, sleep restriction methods, cognitive restructuring, mindfulness meditation, relaxation using hypnotherapy and educational materials describing effective sleep habits.

CBT is one of the only empirically-validated treatment options for insomnia.  CBT improves sleep in a majority of treated patients and reduces the need for sleeping pills and over-the-counter remedies. Moreover, there are typically no adverse side effects associated with CBT as a non-medical intervention.”

SOURCE East End Psychological Services, P.C.

Insomnia…What can you do to get a better night sleep?

Lack of sleep can be a real issue for people and can often increase feelings of depression and anxiety in sufferers. The brain needs to fall below a certain level in conscious activity before it switches over to this restorative trance state and daily stress and worry can stop this from happening, which can lead to the sufferer becoming less able to cope or find the energy to improve their condition.

About 30 per cent of the population has disturbed sleep and 10 per cent meet the diagnostic criteria for insomnia. Insomnia is difficulty in falling asleep or staying asleep, even when the person has the chance to do so. At some point, most of us have experienced acute insomnia; for example, the night before an exam, worrying about finances or experiencing jet lag. It commonly tends to resolve without treatment.  Insomnia is considered chronic if it happens at least three nights a week for three months or longer. The consequences of chronic insomnia are varied and include impaired cognitive function, poor quality of life, increased incidence of bodily pains, poor general health, decreased job performance and increased risk of accidents.

Insomnia can be triggered by medical or psychiatric issues. Many cases of insomnia start with an acute episode, then evolve into long-term problems. The reasons for this can be varied such as worries at work or in the home, drinking alcohol before bedtime or an interruption in sleep cycles such as shift work. Once the problem becomes more chronic, worries and concerns such as “I will never sleep” start to become associated with bedtime, which reinforces the cycle of insomnia.

This is why it is important to address insomnia instead of letting it become the norm. If you have trouble sleeping on a regular basis, it is a good idea to review your sleep habits. Simple steps to improve sleep include:

• Set a regular pattern of sleep by going to bed at a similar time each night when you are generally feeling tired.
• Avoid bright light before bedtime, use dim light in the bathroom and bedroom and avoid back lights in reading devices.
• Keep your bedroom well ventilated and avoid synthetic covers and duvets that can cause overheating.
• Sound and light are likely to keep you awake and reduce the quality of sleep. You may fall asleep in front of the television but the irregularity of the sound and light will interfere with the lighter stages of sleep.
• Reading helps you feel sleepy as it mimics the sideways eye movements found in REM sleep.
• Begin rituals that help you relax each night before bed. A few minutes of reading or a warm bath are two ideas. Practice simple breathing exercises and disconnect from close-range electronic devices (laptops, phones) that can disrupt your sleep.
• Get up at the same time, within reason, every morning, even on weekends and holidays.
• Avoid taking naps. If you must take a nap, keep it short (less than one hour) and avoid napping after 3 p.m.
• No caffeine after lunch, no alcohol within six hours of your bedtime.
• No smoking before bedtime. Nicotine is stimulating.
• Avoid heavy exercise within six hours of your bedtime.
• No big meals near bedtime.
• Assign “worry time” earlier in the day.
• If you do wake up in the night remember that your body is still resting and repairing itself so just by staying relaxed and comfortable you are gaining valuable rest. Use the time to create some positive feelings by imagining you are in a wonderfully calm and peaceful place. Using pictures links you back to dreamlike states so try and really see where you are, avoiding words and full sentences.

Hypnotherapy and cognitive behavioural therapy (CBT), which include psychological and behavioural techniques, can also be used to treat insomnia. Hypnotherapy and CBT challenge unhealthy beliefs and fears around sleep and teaches rational, positive thinking. Relaxation training, breathing exercises, mindfulness meditation and guided imagery can help to calm the mind and induce sleep. Exercise and body-mind work, such as yoga, can also be very helpful. Some of these techniques can be self- taught, while for others it is better to work with a trained therapist.