Insomnia is one of the most common complaints heard by primary care physicians. Insomnia affects approximately 30 to 40 million adult Americans at any one time and has a tremendous impact on everyday activities and lifestyle. Insomnia comes in three basic forms: 1) difficulty falling asleep, 2) difficulty staying asleep, and 3) waking up too early. A person can have any one of these or a combination of the three. To have insomnia, also, you must experience a change in daytime functioning, such as, irritability, mood alterations, fatigue, performance alterations, and cognitive difficulties, such as, poor memory, poor concentration, and short attention span. Insomnia can be acute as well as chronic. Acute insomnia, the most common, lasts for a few days and sometimes, weeks while chronic insomnia is insomnia that lasts beyond two months. The longer it lasts, the more difficult it is to treat. Up until recently, the only treatment for insomnia has been medications, such as, Ambien, Lunesta, and Sonata. Occasionally, low dose antidepressants are also used because at a low dose they have a more sedative effect that facilitates sleep onset. We are finding that sleep medications, particularly the sedative/hypnotics, have the potential for creating further difficulties like dependency, amnesia, cognitive alterations, and tolerance. Older people taking these medications are at high risk for additional problems, such as, falls, poor memory, and dependency. Medications such as these were initially designed to be used briefly, then discontinued. Unfortunately, people are now taking them for months and years. Not only have they become dependent on them, the initial benefit is gone. Efforts to stop only result in what is called "rebound insomnia" due to withdrawal symptoms and they are quickly resumed. Medications don't really treat the underlying causes of insomnia. They just treat the symptom and when stopped, the insomnia returns. Most physicians don't know what else to do for people who suffer from chronic insomnia other than prescribe a medication.
Within the past 10 years, however, a new nonmedication treatment has been developed at Harvard University and the University of Massechusetts Medcial Center that has shown consistent effectiveness in terms of improving sleep quality and reducing medication dependency. This new treatment approach, developed by Gregg Jacobs, Ph.D. is called Cognitive Behavioral Therapy for Insomnia, or CBT-I. CBT-I is a brief, problem-focused treatment that treats the perpetuating factors responsible for maintaining insomnia. Psychotherapy is not necessary to improve your sleep. Relying on sleeping pills is also ineffective in the long run. There are specific attitudnal and behavioral factors that maintain chronic insomnia and when properly attended to can lead to a better night's sleep. CBT-I is much more effective than sleeping pills and the research shows the benefits last much longer after treatment has stopped. When most people stop taking sleeping pills, the insomnia they experienced before starting sleeping medication returns. With CBT-I, improved sleep quality is maintained. The cognitive/attitude portion of the model challenges thoughts and ideas you may have about sleep that directly affects your sleep. For example, you may be convinced that 8 hours of sleep per night is essential for functioning well the day after, like many people erroneously think. The truth is we only really need 7 and some people may even need less. Eight may be preferred, which is understandable, but 7 is really what we can get by with and still function well. Actually, 5.5 hours gives us what is called core sleep and satisfies deep sleep needs and REM sleep, rapid eye movement sleep. Since most of us are not "short sleepers", 7 gives us what we need. Sleep state misperception, a characteristic typical of chronic insomniacs, occurs when one thinks they slept less hours than they actually did or believe it took them much longer to get to sleep than it actually took. For example, insomniacs often claim "I don't sleep" when, in fact, they may get 5 hours each night. Sleep state misperception is a characteristic of chronic insomnia. People sleep much longer than they think and fall to sleep quicker than they give themselves credit for.
The behavioral part of the program helps the insomniac reprogram the parts of the brain that restores the sleep-wake cycle, or circadian rhythm. Utilizing such principles as sleep scheduling, sleep restriction, stimulus control, sleep hygiene, and deep relaxation helps restore a consistent sleep pattern that gives the person a balanced sleep-wake schedule. Biofeedback, meditation, and clinical hypnosis help in this way as well. Though taking sleeping pills are fast acting, they don't really address the causes of insomnia. Insomnia returns once pills are stopped. CBT-I, however, may take longer to be effective but the results are more long lasting and stable. People who have been successfully treated with CBT-I prefer this method over sleeping pills. There are now several well-controlled research studies that support this finding. CBT-I is now the most effective treatment for primary, or conditioned, insomnia. It does not help with parasomnias, apnea, restless legs, narcolepsy, periodic limb movements, or hypersomnia.
Within the past 10 years, however, a new nonmedication treatment has been developed at Harvard University and the University of Massechusetts Medcial Center that has shown consistent effectiveness in terms of improving sleep quality and reducing medication dependency. This new treatment approach, developed by Gregg Jacobs, Ph.D. is called Cognitive Behavioral Therapy for Insomnia, or CBT-I. CBT-I is a brief, problem-focused treatment that treats the perpetuating factors responsible for maintaining insomnia. Psychotherapy is not necessary to improve your sleep. Relying on sleeping pills is also ineffective in the long run. There are specific attitudnal and behavioral factors that maintain chronic insomnia and when properly attended to can lead to a better night's sleep. CBT-I is much more effective than sleeping pills and the research shows the benefits last much longer after treatment has stopped. When most people stop taking sleeping pills, the insomnia they experienced before starting sleeping medication returns. With CBT-I, improved sleep quality is maintained. The cognitive/attitude portion of the model challenges thoughts and ideas you may have about sleep that directly affects your sleep. For example, you may be convinced that 8 hours of sleep per night is essential for functioning well the day after, like many people erroneously think. The truth is we only really need 7 and some people may even need less. Eight may be preferred, which is understandable, but 7 is really what we can get by with and still function well. Actually, 5.5 hours gives us what is called core sleep and satisfies deep sleep needs and REM sleep, rapid eye movement sleep. Since most of us are not "short sleepers", 7 gives us what we need. Sleep state misperception, a characteristic typical of chronic insomniacs, occurs when one thinks they slept less hours than they actually did or believe it took them much longer to get to sleep than it actually took. For example, insomniacs often claim "I don't sleep" when, in fact, they may get 5 hours each night. Sleep state misperception is a characteristic of chronic insomnia. People sleep much longer than they think and fall to sleep quicker than they give themselves credit for.
The behavioral part of the program helps the insomniac reprogram the parts of the brain that restores the sleep-wake cycle, or circadian rhythm. Utilizing such principles as sleep scheduling, sleep restriction, stimulus control, sleep hygiene, and deep relaxation helps restore a consistent sleep pattern that gives the person a balanced sleep-wake schedule. Biofeedback, meditation, and clinical hypnosis help in this way as well. Though taking sleeping pills are fast acting, they don't really address the causes of insomnia. Insomnia returns once pills are stopped. CBT-I, however, may take longer to be effective but the results are more long lasting and stable. People who have been successfully treated with CBT-I prefer this method over sleeping pills. There are now several well-controlled research studies that support this finding. CBT-I is now the most effective treatment for primary, or conditioned, insomnia. It does not help with parasomnias, apnea, restless legs, narcolepsy, periodic limb movements, or hypersomnia.
