Cognitive-behavioral treatment

Today our blog hosts an important research led by our american partners from Miami: Gravity Cool. Please, keep on reading and discover the best way to cure your… Insomnia!

In clinical settings, cognitive-behavior therapy (CBT) has a 70-80 percent success rate for helping those who suffer from chronic insomnia. Almost one third of people with insomnia achieve normal sleep and most reduce their symptoms by 50 percent and sleep an extra 45-60 minutes a night. When insomnia exists along with other psychological disorders like depression, say the experts, the initial treatment should address the underlying condition.

But sometimes even after resolving the underlying condition, the insomnia still exists, says psychologist Jack Edinger, PhD, of the VA Medical Center in Durham, North Carolina and Professor of Psychiatry and Behavioral Sciences at Duke University and cautions that treating the depression usually doesn’t resolve the sleep difficulties. From his clinical experience, he has found that most patients with insomnia should be examined for specific behaviors and thoughts that may perpetuate the sleep problems. When people develop insomnia, they try to compensate by engaging in activities to help them get more sleep. They sleep later in the mornings or spend excessive times in bed. These efforts usually backfire, said Edinger.

From his clinical work and research on sleep, psychologist Charles M. Morin, PhD, a Professor in the Psychology Department and Director of the Sleep Disorders Center at University Laval in Quebec, Canada says that ten percent of adults suffer from chronic insomnia. In a study released in the recent issue of Sleep Medicine Alert published by the NSF, Morin outlines how CBT helps people overcome insomnia. Clinicians use sleep diaries to get an accurate picture of someone’s sleep patterns. Bedtime, waking time, time to fall asleep, number and durations of awakening, actual sleep time and quality of sleep are documented by the person suffering from insomnia.

A person can develop poor sleep habits (i.e. watching TV in bed or eating too much before bedtime), irregular sleep patterns (sleeping too late, taking long naps during the day) to compensate for lost sleep at night. Some patients also develop a fear of not sleeping and a pattern of worrying about the consequences of not sleeping, said Morin. “Treatments that address the poor sleep habits and the faulty beliefs and attitudes about sleep work but sometimes,” said Morin, “medication may play a role in breaking the cycle of insomnia. But behavioral therapies are essential for patients to alter the conditions that perpetuate it.”

CBT attempts to change a patient’s dysfunctional beliefs and attitudes about sleep. “It restructure thoughts — like, ‘I’ve got to sleep eight hours tonight’ or ‘I’ve got to take medication to sleep’ or ‘I just can’t function or I’ll get sick if I don’t sleep.’ These thoughts focus too much on sleep, which can become something like performance anxiety — sleep will come around to you when you’re not chasing it,” said Edinger.

What works in many cases, said Morin and Edinger, is to standardize or restrict a person’s sleep to give a person more control over his or her sleep. A person can keep a sleep diary for a couple of weeks and a clinician can monitor the amount of time spent in bed to the actual amount of time sleeping. Then the clinician can instruct the patient to either go to bed later and get up earlier or visa versa. This procedure improves the length of sleeping time by imposing a mild sleep deprivation situation, which has the result of reducing the anxiety surrounding sleep. To keep from falling asleep during the day, patients are told not to restrict sleep to less than five hours.

Standardizing sleep actually helps a person adjust his or her homeostatic mechanism that balances sleep, said Edinger. “Therefore, if you lose sleep, your homeostatic mechanism will kick in and will work to increase the likelihood of sleeping longer and deeper to promote sleep recovery. This helps a person come back to their baseline and works for the majority.”

A person can also establish more stimulus control over his or her bedroom environment, said Morin. This could include: going to bed only when sleepy, getting out of bed when unable to sleep, prohibiting non-sleep activities in the bedroom, getting up at the same time every morning (including weekends) and avoiding daytime naps.

Finally, a person can incorporate relaxation techniques as part of his or her treatment. For example, a person can give herself or himself an extra hour before bed to relax and unwind and time to write down worries and plans for the following day.

In CBT, said Morin, breaking the thought process and anxiety over sleep is the goal. “After identifying the dysfunctional thought patterns, a clinician can offer alternative interpretations of what is getting the person anxious so a person can think about his or her insomnia in a different way.” Morin offers some techniques to restructure a person’s cognitions. “Keep realistic expectations, don’t blame insomnia for all daytime impairments, do not feel that losing a night’s sleep will bring horrible consequences, do not give too much importance to sleep and finally develop some tolerance to the effects of lost sleep.

According to Edinger, aging weakens a person’s homeostatic sleep drive after age 50. Interestingly, the length of the circadian cycle stays roughly the same over the lifespan but the amplitude of the circadian rhythm may decline somewhat with aging.

Annunci

Tag:, , , ,

Rispondi

Inserisci i tuoi dati qui sotto o clicca su un'icona per effettuare l'accesso:

Logo WordPress.com

Stai commentando usando il tuo account WordPress.com. Chiudi sessione / Modifica )

Foto Twitter

Stai commentando usando il tuo account Twitter. Chiudi sessione / Modifica )

Foto di Facebook

Stai commentando usando il tuo account Facebook. Chiudi sessione / Modifica )

Google+ photo

Stai commentando usando il tuo account Google+. Chiudi sessione / Modifica )

Connessione a %s...

%d blogger hanno fatto clic su Mi Piace per questo: