Thus, expanding the provider pool and exporting this treatment to the venues wherein most insomnia patients receive their initial treatment remain as challenges to this therapeutic modality. Of course, there are those who 80 respond more gradually but do achieve a satisfactory outcome. Edinger, Professor, Department of Medicine, National Jewish Health, and Colleen E. None None None None None None None 2. Typically it is helpful to initially have the patient continue on her usual medication, and to plan to take this medication routinely, as prescribed, prior to going to bed each night.
Please list all medications, prescribed and over-the-counter, you are presently taking or have recently stopped taking and the reason for taking these medications. There are ways to change this signal. These worries can be very frightening, so it is often helpful to take a more critical look at the types of beliefs that lead to such distress. In general, you should go to bed when you feel sleepy. During review of the sleep log with the therapist, the patient noted a practice of watching television in bed for an hour or more before intending to fall asleep. With these changes, the patient was able to relax and gradually showed nocturnal sleep improvements over the ensuing month of treatment. P: Well, very little anyway.
Think of a time, perhaps even last night when you had strong feelings or upsetting thoughts related to your insomnia. Lying in bed awake and trying harder and harder to go to sleep only increases anxiety and frustration which make the sleeping problem worse. Would you like to try a new approach over the next couple of weeks? This information also appears in the corresponding patient workbook. Most treatment-seeking insomnia patients are notably distressed by their sleep-wake disturbances and desire rapid relief from such symptoms. Those patients who regularly use the Thought Record typically report that they are extremely helpful in making a cognitive shift. What were you doing or where were you when you had these feelings or thoughts? If you are able to do that, you likely will start to see some improvements in your sleep within the next 2 to 3 weeks. Download patient education handouts in multiple languages.
If you start this practice you probably will have fewer intrusive thoughts while you are in bed. Over 23,000 people ordered the accompanying course material, and data from a random subset of these showed that sleep improvements and reductions in hypnotic use, medical visits, and physical complaints were achieved by this educational program. This practice resulted in the patient spending 9 or more hours in bed many nights during the week and usually experiencing extended awakenings during the course of the night. Cognitive behavior therapy and pharmacotherapy for insomnia: A randomized controlled trial and direct comparison. T: Maybe we could spend a few minutes talking about stress symptoms and how to manage them? These observations are common features of people with insomnia irrespective of whether they have Major Depressive Disorder. Sleep 29 suppl : A233. Ask the patient to focus on the emotions as clues to what she was thinking.
Yes No circle one 5. If left untreated, chronic insomnia reduces quality of life and increases risk for psychiatric and medical disease, especially depression and anxiety. Sleep Initiation and Maintenance Disorders—therapy. In addition, a variety of other medications including antidepressants such as the sedating tricyclics e. Published by Oxford University Press, Inc.
You may use the following sample dialogue: 32 This treatment will require you to make some major changes in your sleep habits so you can improve your sleep. Currently both the original parent version and an abbreviated version are 25 available for clinical and research use. In our previous work Edinger, et al. At this point, it is important to set aside any previous notions or beliefs you might have about your sleep needs. Library of Congress Cataloging-in-Publication Data Edinger, Jack D.
It is important for the therapist not to directly challenge beliefs; rather, encourage the patient to scrutinize the belief. Keep track in earlier sessions of any evidence the patient cited that is contrary to the belief. None None None None None None 3. In some respects, losing sleep one night may lead to getting more or better sleep the following night. Such a belief will lead to further anxiety when sleep does not come quickly. What do you feel is the major cause s of your sleep problem? Whereas the middle-aged and older adults are most prone to develop one of the many subtypes of insomnia, primary insomnia is the most common diagnosis found in younger age groups. Insomnia: Psychological assessment and management.
How often do you travel across time zones? On the graph below, indicate how sleepy you generally feel at the times indicated by choosing the most appropriate corresponding number from the scale below and circling that number on the graph. You were to leave the room when you were unable to sleep. Furthermore, those who are trained and skilled in these techniques tend to be found in larger medical centers or specialty sleep centers and not in the general medical practice settings where most treatment-seeking insomnia patients present for their care. Intrusive thoughts and their relationship to actigraphic measurement of sleep: Towards a cognitive model of insomnia. Psychological and behavioral treatment of insomnia: Update of the recent evidence 1998—2004.