Insomnia: The Thief of the Night

Why Can’t I Sleep?

A current theory of sleep holds that sleep is produced when the Drive for Sleep is sufficient to overcome Arousal. The balance can be disrupted for many reasons including medical conditions, psychological conditions, or bad habits.

Medical Conditions that Produce Insomnia

Two of the most obvious examples of medical conditions that produce insomnia are Chronic Pain and Restless Leg Syndrome.

Psychological Conditions that Produce Insomnia

When one has a problem falling asleep there is a tendency to suspect the presence of anxiety. When the problem is one of maintaining sleep depression may be to blame. Both should be assessed at the beginning of treatment for chronic insomnia.

Cognitive Therapy for Chronic Insomnia

In recent years there have been significant advances in the use of cognitive therapy in the treatment of chronic insomnia. The possibility of physical illness, anxiety or depression should first be assessed. Cognitive therapy is usually brief (just a few sessions) and addresses one or more of the following factors: arousal levels, actgivity levels, the sleep environment, pre-bedtime activities, and what to do if sleep does not come as desired. Treatment may also address anxiety and/or depression if present.

Cognitive therapy almost always involves the assignment of homework exercises.

Sleep Hygiene

Sleep hygiene refers to the activities that precede bedtime that may help or hinder a good nights sleep. Avoiding caffeine and other stimulants is an obvious example. Creating a routine for winding down before turning the lights off is very important. Creating a dark and cool environment for sleeping is valuable.

Reconditioning, or Stimulus Control Techniques for Insomnia

The first psychological treatment for insomnia to be developed was called stimulus-control. Some sleep experts prefer to call it reconditioning.  The basic idea involves using the bed only for sleeping or intimacy. A cardinal rule is to avoid being in bed while frustrated that sleep is not forthcoming.

The Role of Attitudes and Beliefs

Often overlooked is the person’s attitudes toward sleep or beliefes about insomnia. To some sleep is a waste of time. Some think they must get at least 8 hours of sleep to function. For most insomnia is a frustrating conduit that must be overcome.

Physical Relaxation to Promote Sleep

Learning how to relax and becoming good at it helps to reduce arousal and increase sleep drive. It is very easy to learn how to relax if you have a good teacher. It is a skill that, like any other, must be practiced in order to gain proficiency. Some people find relaxation boring and fall asleep while listening to relaxation instructions. That is not likely to be a lasting cure. Most people require about 50 relaxation practice sessions (or 8 weeks of daily relaxation practice) to become proficient at producing a state of deep relaxation that can promote sleep.

Mindfulness to Quiet the Mind

Mindfulness meditation is an easy-to-learn method that both relaxes the body and quiets the mind. A number of studies have shown that the regular practice of this simple meditation technique helps to promote healthy sleep.

Which Technique is Best for Your Insomnia?

I know of no simple way to predict which technique is best. Most sleep clinics that use psychological techniques to promote sleep seem to integrate them all into their programs. Most of the patients referred to me for insomnia have tried one or more of these techniques already. I review the techniques they have used and suggest the others that may, in combination, produce the desired results. Often I am referred patients who wish to reduce the amount of sleep medication they are taking and we try to reproduce the medication effects with sound sleep practices.

Step 1 – Rule Out Medical Conditions

Step 2 – Evaluate Anxiety and Depression

Step 3 – Be Patient as You Explore Your Sleep Problem



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