Managing Insomnia | Treatment for Insomnia

Insomnia is common among people who have sleep problems.

Insomnia refers to a problem falling or staying asleep. Insomniacs can take hours to fall asleep or wake up in the middle of the night. Around a third of the population will experience insomnia at some point.

It is essential to recognize insomnia as a medical problem with multiple causes that can be treated effectively. Our Insomnia Clinic at Sydney Sleep Centre has specialists who can provide diagnostic and treatment services. Referrals to the Sleep Physicians at the Centre are the first step for patients with insomnia. They will confirm the diagnosis and, if necessary, order testing (such as a sleep study). Then, the Sleep Physician will initiate treatment and may involve the Sleep Psychologist at the Centre. Sydney Sleep Centre focuses on non-drug approaches to managing insomnia. These strategies are more complex than prescribing a sleeping pill, but they produce better results in the long run (better than drug therapy).

The Sleep Centre’s Sleep Psychologist is an expert in Cognitive-Behavioural Therapy (CBT), the primary non-drug approach.

What is Cognitive-Behavioural Therapy?

CBT targets unhelpful coping behaviors and cognitions intended to reduce insomnia but maintain it. It introduces sleep-conducive behavior while raising the individual’s consciousness of more realistic Sleep and daytime function expectations.

Meta-analytical studies have shown that CBT improves sleep duration and quality, reduces sleep latency, and positively impacts expectations and thoughts about Sleep.

Relearning sleep-promoting, adaptive behaviors

CBT includes effective behavioral methods, such as stimulus control therapy, which teaches the client to associate the bed environment with sleeping rather than waking, and sleep or bed restrictions, where time spent in bed is restricted to roughly equal to the actual sleep time. It challenges clients’ perceptions that more Sleep will compensate for poor Sleep when, in reality, it leads to less consolidated Sleep and more time lying awake in bed worrying about not falling asleep. Instead, treatment focuses on increasing the client’s drive to sleep by limiting time spent in bed.

CBT is effective in treating circadian rhythm sleep-wake phases disorders that are causally related to insomnia, such as advanced or delayed sleep phase disorder (where the client’s physiological sleep time, set by their internal 24-hour clock, is at odds with what they want or need for social or occupational Sleep, causing worry and distress).

CBT is crucial for behavioral sleep management. It sets a constant wake-up time, regardless of the quality or quantity of Sleep. It is more crucial than regular sleep time, which does not guarantee you will fall asleep. The morning light is crucial for resetting your circadian clock. It acts as a brake on our natural tendency to phase delay.

CBT includes education on sleep hygiene or good sleep habits. It dispels myths and clarifies factors that interfere with Sleep, such as caffeine, alcohol, tobacco, napping during the day, and exercise in the evening. Exercise is emphasized in behavioral treatment to improve mood, reduce muscle tension, and increase autonomic arousal. It promotes better Sleep. It encourages social connection and psychologically healthy behaviors, as opposed to the depressogenic behavior of lying in bed and monitoring fatigue.

CBT encourages daily relaxation techniques to reduce chronically elevated physical and mental arousal. They include controlled breathing exercises, imagery training, and progressive muscle relaxation.

How to change negative expectations and beliefs about Sleep

CBT also focuses on the client’s perceptions of daytime functioning to reduce anxiety and improve their quality of life. For example, primary insomniacs are more likely to feel “tired and jittery” than sleepy, and they worry about the quantity and quality of Sleep. Maladaptive beliefs can include: “If I do not get 8 hours of sleep, I will not function tomorrow” or “(sleep quantity)=quality.” CBT uses behavioral experiments to challenge unhelpful belief systems and safety behaviors, allowing individuals to have more realistic expectations.

The more I try to achieve “ideal” sleeping, the worse my anxiety and Sleep will be.

It’s essential to reframe unhelpful thoughts and improve self-efficacy.

Simultaneously, a daily “worry session” can reduce ongoing sleep worries (i.e., giving full attention to a concern within a specified period and using problem-solving techniques to reduce vulnerability to worry-driven sleep disruptions at night).

The CBT strategies described above illustrate how psychological treatments can change clients’ beliefs, expectations, and behaviors and lead to a long-term improvement in sleeping habits.

What should I do if I am experiencing insomnia?

Referrals from your GP are required to consult one of our Sleep Centre Sleep Physicians. They will evaluate your condition, perform any necessary tests and begin treatment.

Your GP may refer you directly to the Sleep Centre Sleep Psychologist if they are confident in the diagnosis and the treatment needed.

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