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By Julie Hergenrather, Ph.D., A.C.T.
Insomnia is a widespread problem affecting between
15% and 30% of the adult population. It is second
only to pain as the most prevalent health complaint
in doctors' offices, and about 50% of sufferers
perceive their sleep problem to be severe. In fact,
chronic insomnia can cause much distress, anxiety
and frustration. At its most severe, insomnia is
linked to the development of clinical depression
and problems with concentration and focus.
What is insomnia?
In primary insomnia, the individual has difficulty
falling asleep, staying asleep, wakes too early
in the morning, or experiences poor quality sleep.
Often, the individual reports an inability "turning
off thoughts," chronic restlessness, frustration,
discouragement, worries about daily functioning,
irritableness, and an overall dissatisfaction and
unhappiness. As noted, primary insomnia can even
lead to a major depressive disorder and problems
with concentration that affect functioning at work
or in school.
Primary insomnia can be differentiated from other
sleep problems by its origin. Sleep problems are
linked to many factors, including: medication; health
problems such as narcolepsy, Parkinson's disease,
pulmonary disease, gastrointestinal problems, cardiac
disease and the like; Restless Legs Syndrome and
Periodic Limb Movement Disorder; sleep-related breathing
disorders (apnea); mental health issues such as
major depressive disorder; excessive alcohol intake;
and even normal aging. Primary insomnia is unrelated
to medical or psychological disorders.
Not surprisingly, research reveals that people
with primary insomnia work hard to sleep, and worry
quite a bit about the consequences of not sleeping.
Like a negative feedback loop, however, the effort
and worry actually contribute to one's inability
to fall and stay asleep. In fact, people usually
report significant frustration with themselves and
anger about the situation when, in the wee hours
of the morning, they are still awake. This emotional
distress triggers physical arousal, which serves
to only heighten one's wakefulness. Yet techniques
such as distraction (reading, watching TV) and relaxation
in order to calm down and stop the worry cycle don't
work soon enough to ensure enough hours of sleep,
or are simply unhelpful.
Don't most people have sleep problems from time
to time?
Most adults experience short-term insomnia at some
time in their lives. Major life transitions, grief,
significant worries, dietary and other lifestyle
factors, and illness can all cause short-term sleep
disturbance that resolves relatively quickly without
intervention. However, people with primary insomnia
experience persistent sleep difficulties that span
several weeks, occur in the absence of psychosocial
issues, and affect the quality of daily life. Most
people who come for treatment of primary insomnia
report trying many techniques over a long period
of time to restore their sleep. Sometimes, the individual
has suffered from insomnia for years.
What treatments are available for primary insomnia?
Primary insomnia can be successfully treated in
the short term with medications called hypnotics
(sleeping pills), and many doctors prescribe medication
to help their patients sleep. Unfortunately, once
the patient discontinues use of medication, the
symptoms of insomnia often inevitably return. This
is because while sleeping pills effectively promote
sleep, they do not treat the cause of the sleep
disturbance.
Cognitive Behavior Therapy for Primary Insomnia
Cognitive Behavior Therapy (CBT) is a relatively
short-term behavioral and psychological intervention
that has been found to be particularly effective
in the treatment of primary insomnia. People with
sleep problems learn to identify the factors, behavioral,
environmental and thought-related, which contribute
to the sleep problem. Therapy focuses on changing
the thinking and behavioral patterns that keep one
locked in the dysfunctional sleep cycle. Learning
skills that improve overall sleep ensures that,
unlike medication, the changes are permanent. And,
if insomnia recurs for some reason, the individual
can implement these skills to return the sleep pattern
to normal.
In CBT, the therapist and client collaborate together,
setting specific goals, monitoring progress and
devising targeted interventions. Each session has
an agenda and builds on previous work. The client
is routinely assigned "homework" to practice
new skills and beliefs, and often the client works
with a manual or worksheets so that progress is
made between and not just during sessions. Typically,
fewer than 6 sessions are required to treat insomnia.
Help for Insomnia
In summary, there is no need for people who suffer
from insomnia to continue losing sleep. We offer
effective, drug-free therapy to treat the underlying
cause of this disorder and restore the natural sleep
cycle. If you have insomnia and want to get help,
please call us at Montana Neurobehavioral Specialists.
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