What causes chronic insomnia?
The classic view of insomnia is that it is usually due to an
underlying emotional problem. Treating it directly is viewed as
pointless. It will disappear when the real problem has been
successfully treated. The modern, evidence-based view is quite
different.
Modern therapists look at a brief period of insomnia as a noxious
but expected reaction to worry and stress. In these cases,
insomnia usually disappears without treatment, as the classic
model predicts. Anxiety disorders (and a few others) can also
create chronic problems with insomnia.
However, most insomnia is primary. Either it has no
detectable cause or it has taken on a life of its own, continuing
long after the original problem is done with.
Behavioral therapists believe that patients make a chronic
problem out of insomnia through their misguided, but
seemingly reasonable, attempts to deal with the occasional
sleepless night. These include laying in bed waiting to get
sleepy, watching the clock and worrying about how much time
is left to sleep, sleeping late, napping, and going to sleep early
the next day.
Sleep problems can also be classically
conditioned. Like Pavlov's dog (who salivated every time a bell
was rung) people's bodies learn to be uncomfortably awake
(and usually anxious) at bedtime.
While medication can help during short periods of insomnia
due to stress, they are likely to create a chronic problem.
People become conditioned and dependent on the pill.
|
|
Sleep Training is an Effective Treatment
Sleep Training is a cognitive behavioral therapy for
insomnia. It is based on the CBT-I protocol: an eight-session
structured format for treatment that has been proven to work in
repeated clinical trials.
Patients who complete CBT-I average a 50%
reduction in insomnia during the course of treatment. They
continue to improve after treatment has been completed with
symptom reduction somewhere in the 75% range at twelve
month follow up.
Though these are good results, I've modified CBT-I for my
patients' needs. It's what I call Sleep Training.
My approach is a bit more flexible and gentle. It includes a few
more sessions
for relaxation training, cognitive therapy, and patient education.
It also includes several widely spaced sessions at the tail end of
treatment, to make sure that gains are maintained. Patients
should expect similar or better result than the CBT-I protocol.
This treatment is not for everyone. Patients who suffer from
excessive worrying while awake, probably have generalized
anxiety disorder. They require treatment both for anxiety
and for insomnia. Patients who frequently awaken from
nightmares benefit from a nightmare treatment protocol.
If a patient's nightmares relate to a severe trauma, they may have
post-traumatic stress disorder (PTSD). I offer treatment for these
conditions. It's just that they are different from
Sleep Training.
If your insomnia is caused primarily by pain or by a medical
condition, it makes sense to get that treated first.
Sleep Training requires considerable effort from the
patient. It includes keeping a sleep journal and modifying
sleep schedules. I work with my patients to
make this as easy as possible, but it is an
absolute requirement for effective treatment.
Not everyone gets the same results from treatment as the
average results found from clinical trials. Patient motivation is a
big factor. If you are motivated by the prospect
of a 50% reduction in insomnia symptoms in eight to twelve weeks,
with further improvement to follow, this program works.
|
