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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.