A simple one-hour therapy session in the early stages of insomnia may be all it takes to help treat the condition, according to a new study. Within just three months of participating in the 60-minute session, which helped them better understand insomnia and taught them coping strategies, almost three quarters of participants reported improvements in sleep quality.
The approach isn’t anything revolutionary – scientists have been using cognitive behavioural therapy for decades to help people sleep better – but this is the first time anyone has attempted to treat acute insomniacs within the first three months of sleep disruption, before the condition becomes chronic.
Further testing may be done in a sleep lab, including polysomnography and multiple sleep latency testing.
Insomnia management requires personal recommendations to correct underlying etiological or contributory conditions. Proper sleep hygiene must always be taught to the patient and the family or those who share the sleep environment. This includes:
- Regular time set for going to bed
- Turning off all noise-producing gadgets and devices, including radio and television, around bedtime
- Exercising moderately a few hours before bedtime shortens the sleep latency, and improves the duration and depth of sleep in a manner comparable to benzodiazepines
- Avoiding caffeine, alcohol, and smoking shortly before bedtime
There are many modes of management of sleep-onset insomnia, and treatment should be tailored to specific needs. The effectiveness of each treatment is measured by whether it reduces the time to sleep onset, or increases sleep time by at least 30 minutes.
The non-pharmacologic treatment of sleep-onset insomnia includes a wide range of measures.
- Cognitive behavioral therapy
This is based on helping the patient to recognize and modify the pressuring and unpleasant thoughts associated with inability to go to sleep at once. This is accompanied by help in changing behavioral responses appropriately. CBT may be given in individual or group sessions, followed by reviews. CBT helps the patient calm down over the whole day rather than just help decrease the time to sleep onset at night.
Even if the sleep time remains the same, the patient is satisfied and unworried which has the same or better effect on health. It is highly effective, surpasses the effects of drugs, and is even better alone than when combined with medications. It has the additional advantage of having minimal adverse effects.
Self-administered CBT via written or audiovisual presentations is being explored, which will increase the availability of this mode of therapy. The only hindrance might be the need to standardize the distributed materials to conform to the principles of CBT.
The following components are involved:
- Cognitive recognition of the thought process which delays sleep onset, along with offering a truthful challenge to the negative thoughts, thus altering the thoughts and calming the mind
- Behavioral changes, such as sleep restriction and temporal control, stimulus control, and relaxation therapy. Sleep restriction is an intervention which limits time in bed to little more than the actual sleep time, so that the time spent sleepless in bed is shortened. However, the waking time is retained unchanged, thus bringing about a slight sleep deprivation and adjusting the circadian rhythm. It increases sleep efficiency and improves its restfulness.
- Some behavioral modifications include: stimulus control which is a means of establishing a conditioned reflex associating the sight and experiences of bedtime to sleep instead of wakefulness. The bedroom is reserved for sleep and physical intimacy alone. In addition, the patient is expected to leave the bed after 20 minutes if sleep does not supervene, and pursue any quiet restful activity until sleepy. Progressive relaxation is often combined with stimulus control and this might increase the breadth of response to the intervention.
- Relaxation training helps the patient get ready for sleep by ensuring relaxed muscles, deep quiet breathing, and focusing the mind, all of which calm down the mind.
- Paradoxical intention is the name for the process of helping the mind let go of the distress associated with sleeplessness by reversing the focus of attention from the inability to fall asleep to the need to stay awake. This reduces the anxiety of trying to fall asleep by distracting the mind in the opposite direction.
- Imagery training is a means of stopping futile thoughts or focusing on peaceful or neutral images to help reduce the arousal level.
Sleep restriction, stimulus control, and cognitive recognition, help more patients than other types of CBT techniques, though each may have its own role to play.