Insomnia

Insomnia therapy

Insomnia, or sleeplessness, is an inability to fall asleep or to stay asleep as long as desired.[1] While the term is sometimes used to describe a disorder demonstrated by polysomnographic evidence of disturbed sleep, insomnia is often practically defined as a positive response to either of two questions: “Do you experience difficulty sleeping?” or “Do you have difficulty falling or staying asleep?”[1]

Thus, insomnia is most often thought of as both a sign and a symptom[1][2] that can accompany several sleep, medical, and psychiatric disorders characterized by a persistent difficulty falling asleep and/or staying asleep or sleep of poor quality. Insomnia is typically followed by functional impairment while awake. Insomnia can occur at any age, but it is particularly common in the elderly.[3] Insomnia can be short term (up to three weeks) or long term (above 3-4 weeks), which can lead to memory problems, depression, irritability and an increased risk of heart disease and auto-mobile related accidents.[4]

Sleep-onset insomnia is difficulty falling asleep at the beginning of the night, often a symptom of anxiety disorders. Delayed sleep phase disorder can be misdiagnosed as insomnia as it causes a delayed period of sleep, spilling over into daylight hours.

Nocturnal awakenings are characterized by difficulty returning to sleep after awakening in the middle of the night or waking too early in the morning: middle-of-the-night insomnia and terminal insomnia. The former may be a symptom of pain disorders or illness; the latter is often a characteristic of clinical depression.

Treatment

It is important to identify or rule out medical and psychological causes before deciding on the treatment for insomnia.[27] The 2005 NIH State-of-the-Science Conference on insomnia concluded that cognitive behavioural therapy (CBT) “has been found to be as effective as prescription medications are for short-term treatment of chronic insomnia. Moreover, there are indications that the beneficial effects of CBT, in contrast to those produced by medications, may last well beyond the termination of active treatment.”[28] Pharmacological treatments have been used mainly to reduce symptoms in acute insomnia; their role in the management of chronic insomnia remains unclear.[5]

Cognitive Behavioural Therapy

There is some evidence that cognitive behavioural therapy for insomnia is superior in the long-term to benzodiazepines and the nonbenzodiazepines in the treatment and management of insomnia.[38] In this therapy, patients are taught improved sleep habits and relieved of counter-productive assumptions about sleep. Numerous studies have reported positive outcomes of combining cognitive behavioural therapy for insomnia treatment with treatments such as stimulus control and the relaxation therapies. Hypnotic medications are equally effective in the short-term treatment of insomnia but their effects wear off over time due totolerance. The effects of CBT-I have sustained and lasting effects on treating insomnia long after therapy has been discontinued.[39][40]

We can help you sleep better at night with our insomnia therapy techniques. Please arrange your 30-minute free consultation by calling 07976 301463 or email jan@edgbastonhypnotherapy.com

1. Roth, Thomas (15 August 2007). “Insomnia: Definition, Prevalence, Etilogy, and Consequences”. J Clin Sleep Med3 (5 Suppl): S7–S10. PMC1978319.PMID17824495. //www.ncbi.nlm.nih.gov/pmc/articles/PMC1978319/.

2. Hirshkowitz, Max (2004). “10, Neuropsychiatric Aspects of Sleep and Sleep Disorders (pp. 315–340)”. In Stuart C. Yudofsky and Robert E. Hales. Essentials of neuropsychiatry and clinical neurosciences (4 ed.). Arlington, Virginia, USA: American Psychiatric Publishing. ISBN978-1-58562-005-0.http://books.google.com/books?id=XKhu7yb3QtsC&pg=PA315. Retrieved 2009-12-06. “…insomnia is a symptom. It is neither a disease nor a specific condition. (p. 322)”

3. American College of Physicians (2008).Annals of Internal Medicine, 148, 1, p. ITC1-1

4. Zahn, Dorothy, “Insomnia: CPJRPC”, The Canadian Pharmaceutical Journal, Oct 2003

5. “Dyssomnias” (PDF). WHO. pp. 7–11. http://www.who.int/selection_medicines/committees/expert/17/application/Section24_GAD.pdf. Retrieved 2009-01-25.

27. Wortelboer U, Cohrs S, Rodenbeck A, Rüther E (2002). “Tolerability of hypnosedatives in older patients”. Drugs Aging19 (7): 529–39. doi:10.2165/00002512-200219070-00006. PMID 12182689.

28. NIH State-of-the-Science Panel. Manifestations and management of chronic insomnia in adults. 2005;22:1-30

38. Mitchell, MD.; Gehrman, P.; Perlis, M.; Umscheid, CA. (May 2012). “Comparative effectiveness of cognitive behavioral therapy for insomnia: a systematic review.”. BMC Fam Pract13 (1): 40. doi:10.1186/1471-2296-13-40. PMID 22631616. http://www.biomedcentral.com/1471-2296/13/40.

39. Jacobs, Gregg; Edward F. Pace-Schott, Robert Stickgold, Michael W. Otto (2004). “Cognitive Behavior Therapy and Pharmacotherapy for Insomnia: A Randomized Controlled Trial and Direct Comparison”. Archives of Internal Medicine164 (17): 1888–1896. doi:10.1001/archinte.164.17.1888. PMID 15451764.

40. Morin, C. M.; Colecchi, C; Stone, J; Sood, R; Brink, D (1999). “Behavioral and Pharmacological Therapies for Late-Life Insomnia: A Randomized Controlled Trial”. JAMA the Journal of the American Medical Association281 (11): 991–9. doi:10.1001/jama.281.11.991. PMID 10086433.

41. K. E. Miller (2005). “Cognitive Behavior Therapy vs. Pharmacotherapy for Insomnia”. American Family Physician.http://web.archive.org/web/20110606060237/http://www.aafp.org/afp/2005/0715/p330.html.