PSYCHOTHERAPY FOR INSOMNIA
Psychotherapy Relieves Insomnia
by Helen Borel, Ph.D.
Insomnia is globally prevalent and widely underdiagnosed and, therefore, undertreated, reports Dr. Thomas Roth of the Sleep Disorders and Research Center at the Henry Ford Hospital in Detroit.
Neurotrasmitters (brain chemicals) responsible for sleep induction and sleep maintenance include gamma-aminobutyric acid (GABA) and melatonin. In contrast to prior pharmacotherapies, newer soporifics are being prescribed that affect these neurochemical systems by promoting improved sleep with lower side-effect profiles than older agents had exhibited. These newer "sleeping pills" were necessitated because of specific limitations of the older drugs.
The old sleep-inducing barbiturates (of which the famous phenobarbital, for example, was once the heavy hitter, but with the disadvantage of a prominent hangover profile) interfere with normal amounts of REM (rapid-eye-movement) sleep - a segment of the sleep cycle necessary for dreaming. And, since dreaming (whether you remember your dreams or not) is essential for the sleeptime repair of many physiologic and psychologic functions, any disruption of this phase of sleep is destructive to healthy functioning of both mind and body.
Therefore, notes Dr. Roth, "Effective management of...insomnia, including both medication and nonpharmacologic modalities, is...critical." By which he undoubtedly means therapy that gets you to sleep within 15 to 30 minutes, keeps you asleep for a normal 8 hours - more or less - and is free of all or most burdensome side effects that could ruin your waking hours.
Since there exists no drug, in any pharmacologic category including sleeping medication, that is completely free of side effects or adverse reactions in some people, it's useful to note that, Cognitive-Behavioral Therapy (CBT) - one of many psychotherapeutic techniques - "has shown clinical effectiveness in patients with insomnia," according to Dr. Roth. And also that a chronic insomnia study by the National Institutes of Health (NIH) concludes that CBT may be "as effective as prescription medications for short-term treatment of chronic insomnia."1
Furthermore, states psychiatry professor, Dr. Wallace B. Mendelson, "Cognitive and behavioral therapies are the mainstay of nonpharmacologic treatments for insomnia....and, unlike medications, may have efficacy that lasts beyond the duration of treatment."2
Cognitive-Behavioral Approaches to Improve Your Sleep
Some CBT methods that will help you sleep well include:
- training in muscle relaxation
- restricting sleep to specific times of the night
- restricting sleep location to the bedroom
- anxiety reduction methods
- interventions to dislodge mistaken ideas about sleep loss and sleep length
- promoting habits of sleep regularity
Other methodologies incorporated into most general psychotherapy sessions, that address issues related to loss, worry, grief, relationships, problems arising from childhood memories, and so forth, can also be applied to help promote improved sleep.
1. National Institutes of Health (NIH) sleep study. http://consensus.nih.gov/2005/2005InsomniaSOS026html.htm
2. Mendelson, WB: J Clin Psychiatry 2007;68 (suppl 5)
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