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Insomnia

* Fears and Anxiety * Pain Management * Compulsive Behaviors * PTSD *

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Rest is crucial.  Sleep resets the chemicals in your brain. Sleep rebalances your emotions.  Rest is vital for better mental health, increased concentration and memory, a healthier immune system, reduced stress, improved mood and even a better metabolism. 

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Sleep, on the other hand, is a body-mind state in which individuals experience sensory detachment from our surroundings. Sleep is an essential function of the body and impacts every system from our cognitive function to immune health. Quality sleep can help us reset, recover and recharge. It’s absolutely vital to brain function, memory, concentration, immune health and metabolism. Unlike rest, sleep is something your body cannot function without. In fact, if you are sleep deprived, your body will force you to sleep, no matter what you’re in the middle of. 

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We all know the sleep hygiene routine.  Set a bedtime.  No food or water right before bed.  Stay away from electronics an hour before you plan to sleep.  Etc. Etc.

What is not widely known is that these steps provide only marginal improvements to sleep.

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Staff Perspective: The Problem with Sleep Hygiene

BY DIANA DOLAN  ON 01.03.2017 12:09 PM

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Here’s the unfortunate truth: sleep hygiene does not work for chronic insomnia, or difficulties sleeping lasting three months or more.  Yes, it can be helpful to improve sleep further in mostly normal sleepers.  Yes, it can be helpful for those who would otherwise be able to sleep but have a poor sleep environment.  Yes, it can be helpful for those experiencing a few bad nights, such as adjusting to stress and changes like a return from deployment or move.  In some cases, implementing sleep hygiene early on can prevent long-term sleep difficulties.  It just doesn’t work once chronic sleep difficulties set in.

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The American Academy of Sleep Medicine (AASM) says in their Clinical Practice Guideline for Chronic Insomnia that “Although all patients with chronic insomnia should adhere to rules of good sleep hygiene, there is insufficient evidence to indicate that sleep hygiene alone is effective in the treatment of chronic insomnia. It should be used in combination with other therapies” (Schutte-Rodin et al, 2008).

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For example, in one study, a comparison of a technique called sleep restriction in addition to sleep hygiene tips to sleep hygiene alone found that sleep hygiene alone did not normalize sleep efficiency, sleep onset latency, or early morning awakenings (Taylor et al, 2010).  In contrast, sleep restriction was effective with moderate to large effect sizes, and those who had sleep restriction were able to largely eliminate medication use and maintained their improvements for a year.  Even relaxation has been shown to be more helpful for sleep than sleep hygiene (Morin et al, 2006).  In many studies, sleep hygiene is used as a control condition as opposed to an active condition; that is, researchers equate sleep hygiene with no or minimal treatment. 

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So, what’s the problem with sleep hygiene?  Well, here are my thoughts:

• Given time pressures in busy medical and mental health clinics, often the only attention paid to sleep problems is to hand over a sleep hygiene pamphlet or perhaps have a brief discussion.  One provider I spoke with said “But it’s so much easier to give patients a handout [than provide CBTI].”  Sleep hygiene displaces interventions that are known to be effective. 

• A worse cost may come when patients actually try these recommendations and inevitably fail.  We may know because of the above research that of course these recommendations are unlikely to be successful, but the patient made a good faith effort and may now give up or even develop a sense of hopelessness about sleep.  Sleep hygiene may prevent these patients from seeking further behavioral treatment or following up on a referral to a behavioral sleep medicine provider. 

• If patients do present for behavioral treatment such as CBTI, hopelessness from sleep hygiene efforts may hinder adherence.  If this happens, low adherence can translate into poor CBTI outcomes thus resulting in a self-fulfilling prophecy.

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The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.

 

References:

Qaseem, A., Kansagara, D., Forciea, M.A., Cooke, M., & Denberg, T.D. (2016).  Management of chronic insomnia disorder in adults: a clinical practice guideline from the American College of Physicians.  Annals of Internal Medicine 165(2): 125-133.

Morin, C.M., Bootzin, R.R., Buysse, D.J., Edinger, J.D., Espie, C.A., & Lichstein, K.L. (2006).  Psychological and behavioral treatment of insomnia: update of the recent evidence (1998-2004).  Sleep 29(11): 1398-1414.

Schutte-Rodin, S., Broch, L., Buysse, D., Dorsey, C. & Sateia, M.  (2008).  Clinical guideline for the evaluation and management of chronic insomnia in adults.  Journal of Clinical Sleep Medicine 4(5): 487-504.

Taylor, D.J., Schmidt-Nowara, W., Jessop, C.A., & Ahearn, J. (2010).  Sleep restriction therapy and hypnotic withdrawal versus sleep hygiene education in hypnotic using patients with insomnia.  Journal of Clinical Sleep Medicine 6(2): 169-175.

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Diana C. Dolan, Ph.D., CBSM is a clinical psychologist serving as an evidence-based psychotherapy trainer with the Center for Deployment Psychology at the Uniformed Services University of the Health Sciences in Bethesda, Maryland.

https://deploymentpsych.org/blog/staff-perspective-problem-sleep-hygiene

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So beside sleep hygiene, what else can be done?

There ARE sometimes physical reasons for insomnia.  When I have a broken arm, I go get a cast.  It is also true that what many people feel as insomnia is actually mental fatigue or their brain's inability to slow down.

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One way to get better sleep is through hypnosis.  We can work to reduce racing thoughts.  We can help with anxiety. We can slow down the body through mindfulness.  Post-hypnotic suggestions have been shown to be incredibly powerful.  

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Hypnotherapy is a powerful, effective tool that many have found useful in reclaiming their lives.  

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Talk to me about how to get your life back.

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