Rachel BegaPsychologist

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

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

Mental illness: depression, anxiety, stress Substance use: alcohol, drugs Medication: Antidepressants Medical conditions: asthma, allergies,

chronic pain Other conditions: shift work, pregnancy

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.