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  • 1. AWP 2010, Portland, OR Conceptualization of Insomnia A Holistic Approach to Insomnia Sovann Pen, MA, Counseling Kaiser Insomnia Clinic
  • 2. The Importance of Sleep Sleep is vital to our health and well being. National Sleep Foundation reveal that 60 percent of adults report having sleep problems a few nights a week or more. In addition, more than 40 percent of adults experience daytime sleepiness severe enough to interfere with their daily activities at least a few days each month - with 20 percent reporting problem sleepiness a few days a week or more. At least 40 million Americans suffer from sleep disorders, yet more than 60 percent of adults have never been asked about the quality of their sleep by a physician and fewer than 20 percent ever initiated a discussion. Poor sleep has a price. Millions of individuals struggle to stay alert at home, in school, on the job - and on the road. Tragically, fatigue contributes to more than 100,000 police-reported highway crashes, causing 71,000 injuries and 1,500 deaths each year in the United States alone.
  • 3. Insomnia Insomnia is defined as difficulty initiating sleep, maintaining sleep, final awakenings that occur much earlier than desired or sleep that is non-restorative and of poor quality and results in impairment in daytime function.
  • 4. Epworth Sleepiness Scale Use the following scale to choose the most appropriate number for each situation: 0 = no chance of dozing 1 = slight chance of dozing 2 = moderate chance of dozing 3 = high chance of dozing Sitting and reading____________ Watching TV____________ Sitting inactive in a public place (e.g a theater or a meeting)____________ As a passenger in a car for an hour without a break____________ Lying down to rest in the afternoon when circumstances permit____________ Sitting and talking to someone____________ Sitting quietly after a lunch without alcohol____________ In a car, while stopped for a few minutes in traffic____________
  • 5. Insomnia is MessyInsomnia is MessyInsomnia is MessyInsomnia is Messy
  • 6. Cognitive Behavioral Therapy
  • 7. Chicken or the Egg?
  • 8. Sleep-interfering process
  • 9. Spielman Model
  • 10. Insomnia over time Premorbid Acute Short-term Chronic How long? What triggered/started the problem?
  • 11. Predisposing Factors Genetic Biological Psychological Social
  • 12. Genetic Factors Co-morbidities Medical Sleep Disorders Mood Disorders
  • 13. Biological Hyperarousal Hyperactivity (ADD/ADHD) Startle Physical tension
  • 14. Psychological Personality: Worry, rumination Type-A; driven, determined Cognitive style: analytical, problem- solver
  • 15. Psychological cont. Compassionate, co-dependent, sympathetic/empathetic Creatives Perfectionism
  • 16. Social Living situation Significant other Family of Origin
  • 17. Precipitating Factors Medical Life Stressors Negative changes Positive changes Women Men Shiftwork
  • 18. Negative changes Illness Conflict Job stress Financial Unemployment Abuse Divorce
  • 19. Positive changes Retirement Marriage Moving Work Vacation Travel
  • 20. Spielman Model
  • 21. Perpetuating Factors Compensatory strategy Counter Fatigue measures/ Stimulants Rituals and Strategies Self-medication
  • 22. Pain and Sleep Stress and Pain Stress and Sleep Sleep and Mood Mood and motivation Mood and activity Activity and weight Caffeine and Sleep
  • 23. Compensatory strategy Go to bed early Give myself more of a chance to get some sleep Sleep in (wake up later) Catch up Only chance I have to sleep Napping Cons: Deprimes sleep homeostat. Dysregulation of circadian rhythm
  • 24. Erratic sleeping patterns Your bedtime varies greatly depending on your mood, favorite television program, or the day of the week. This sends confusing messages to the sleep-regulating centers of your brain a guarantee for all kinds of problems with sleep.
  • 25. Counter Fatigue measures/ Stimulants Increased use Inappropriately-timed Avoid or decrease physical activity Cons: arousal, mood, conditioning
  • 26. Rituals and Strategies Increase in non-sleep in bedroom and bed Sleep in other places Rituals for sleep Avoidance of behaviors thought to inhibit sleep Cons: lack of stimulus control, dependence, anticipatory anxiety
  • 27. Dysfunctional Beliefs Rewards and reinforcement Forcing the issue Catastrophic thinking Rigid expectations
  • 28. I think, therefore I
  • 29. Cognitive vs Somatic Lichstein & Rosenthal 1980 Cognitive arousal 10x more likely to be cited as major cause than somatic arousal
  • 30. Unwanted intrusive thoughts Worry or Cognitive arousal Most Common - Racing thoughts I am unable to empty my mind I cant turn off my mind My mind keeps turning things over
  • 31. Pre-sleep stress/cognitive activity Hall, et al 1996 Wicklow & Espie 2000 Good sleepers threatened with making a speech Increased sleep latency
  • 32. WHAT ARE YOU THINKING? Watts, Coyle, East 1994 Mental activity and rehearsal Thoughts about sleep Family and long-term concerns Positive plans and concerns Somatic preoccupations Work and recent concerns
  • 33. Affect-laden thoughts