Treatment: CBT-I

There are many ways to improve sleep that involve psychological and behavioural steps. Cognitive behavioural treatments for insomnia (CBT-I), relaxation techniques, and general sleep hygiene guidelines can help many people with sleep difficulties.

A type of counselling called cognitive-behavioural therapy (CBT) can help relieve the anxiety linked to chronic (ongoing) insomnia. Anxiety tends to prolong insomnia.

1. Cognitive behavioural therapy for insomnia:

The cognitive part of CBT-I teaches to recognize and change beliefs that affect ability to sleep. It can help to control or eliminate negative thoughts and worries that keep awake. It may also involve eliminating the cycle that can develop where someone worry so much about getting to sleep that can't fall asleep.

The behavioural part of CBT-I help in developing good sleep habits and avoid behaviours that keep from sleeping well.

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Strategies include, for example:

1. Stimulus control therapy:

This method helps remove factors that condition the mind to resist sleep. For example, one might be coached to set a consistent bedtime and wake time and avoid naps, use the bed only for sleep and leave the bedroom if can't go to sleep within 20 minutes, only returning when feels sleepy.

2. Relaxation techniques:

Progressive muscle relaxation, biofeedback and breathing exercises are ways to reduce anxiety at bedtime. Practicing these techniques can help to control breathing, heart rate, muscle tension and mood so that one can relax.

3. Sleep restriction:

This therapy decreases the time spend in bed and avoids daytime naps, causing partial sleep deprivation, which makes more tired the next night. Once the sleep has improved, time in bed is gradually increased.

4. Remaining passively awake:

Also called paradoxical intention, this therapy for learned insomnia is aimed at reducing the worry and anxiety about being able to get to sleep by getting in bed and trying to stay awake rather than expecting to fall asleep.

5. Light therapy:

If one fall asleep too early and then awaken too early then light should be used to push back to internal clock.

Eligibility Criteria

Patient must be an adult (children only have bedtime worries not insomnia); would have had problems with sleep (either initiating or maintaining) for at least 3 nights a week for a couple of weeks.

Either primary (the insomnia is an independent condition) and secondary (the insomnia is a symptom of another health condition, medication, or substance) insomnia.

1) A principle complaint of dissatisfaction with sleep (quality or quantity) characterised, either singularly or in combination, by initial, middle or late insomnia

2) There should be ‘clinically significant’ distress or impairment to daily functioning

3) It should occur at least three nights per week

4) Be present for at least three months

5) Occur despite adequate opportunity for sleep

6) Not be better explained by another sleep disorder

7) Is not attributable to a medication or substance

8) It should not be adequately explained by a mental or medical condition

Protocol

Basic Package of Six weeks (1 hour per session)

1) Sleep Education

2) Sleep Hygiene and begin Sleep Restriction

3) Stimulus Control and Cognitive Control/Restructuring

4) Paradoxical Intention and Thought Control / Distraction

5) Dealing with Dysfunctional Beliefs

6) Mindfulness / relaxation techniques. Review for possible extensions

In Sleep 729 we always review previous session at beginning of next session and look at sleep diary to determine any changes in Sleep titration.