Sleep disorder treatments fall into a variety of categories, including sleep hygiene, psychotherapy, medications ranging from mild over-the-counter sleep aids to powerful sleep sedatives and hypnotics, and holistic approaches. It is not uncommon for two or more treatment approaches to be used concurrently.
Sleep hygiene is defined as the various practices put into place to support normal, quality nighttime sleep and full daytime alertness (National Sleep Foundation). It includes habits such as avoiding napping; decreasing or eliminating stimulants such as caffeine, nicotine, or alcohol; getting enough exercise; establishing a bedtime routine; and arranging the bedroom for optimal sleep (i.e., decreasing the temperature, eliminating unnecessary light, and removing technology devices). It can also include such practices as avoiding clock watching when in bed, exposing oneself to bright light or sunlight after waking, refraining from large meals before bedtime, and keeping a regular wake and bedtime schedule. While sleep hygiene can help the average person address general sleep difficulties, it alone is not sufficient to overpower the symptoms of major sleep disorders. With true sleep disorders, a combination of multiple treatment approaches earns the most effective results.
Cognitive behavioral therapy, which looks at the relationships between the mind, body, emotions, behaviors, and illness, is the gold standard of therapeutic care for treatment of sleep disorders such as insomnia. This therapeutic approach helps clients to make behavioral changes to improve sleep hygiene, while also changing thought patterns to decrease the catastrophic thinking, anger, frustration, or hopelessness that is common for clients struggling with sleep disorders. Therapeutic tools like sleep journals, cognitive restructuring, guided imagery, and hypnosis can help clients gain objectivity about their sleep and grow out of the destructive narrative that leads to the anger and worry.
Medications such as sedative-hypnotics are commonly used to treat sleep disorders, though some research argues that they are not the most effective form of treatment. While they do increase an individual’s overall quantity of sleep, they do not always increase the quality of sleep. These medications can impact brain chemistry and often leave clients feeling groggy, foggy, unclear, and drained of energy, even after a full night’s sleep. They can also, over time, increase mortality risks. That being said, sedative-hypnotics may be helpful as a short-term treatment for sleep disorders, but therapeutic and holistic approaches to treatment are much more effective and safer.
There are several holistic treatments that can help decrease or eliminate sleep disorders. For example, clients can learn to use self-hypnosis or meditation at bedtime, which can not only help decrease a client’s worry and anxiety, but also work to relax the sympathetic nervous system and increase the client’s probability of falling asleep. Similarly, activities like regular exercise, acupuncture, and massage can also have positively impact on a client’s body and mental state, decreasing symptoms of sleep disorders and resulting in greater sleep quality.
Sometimes, sleep disorders are the root issue for a client’s sleep difficulties. Oftentimes, however, sleep disorders are just a symptom of a bigger problem, be it a physical ailment or a psychological condition. For example, symptoms of PTSD, complex grief, or trauma can all manifest as insomnia. In these instances, treating the insomnia can help improve quality of sleep but will not necessarily treat the root issue. For this reason, sleep hygiene usually is not sufficient – the underlying issue has to be treated as well.
I call myself a holistic behavioral medicine psychologist. I believe in the power of SSRIs like Celexa, or Effexor, or Lexapro, or Paxil, or Prozac, and know they can be very effective people with complex anxiety, depression, or insomnia. I also believe, however, that treatment needs to address more than just the symptom. It needs to get to the core issue, and I use therapeutic and holistic treatments for this.
In my practice treating sleep disorders, I always incorporate at least two forms of treatment to help my clients. Integrating cognitive behavioral therapy techniques with more holistic forms of treatment allows the client and me to identify the root cause to provide more sustainable results by looking at several aspects of their well-being. My approach blends cognitive restructuring with things like hypnosis meditation to teach people how to overcome areas where they’ve gotten stuck, whether it is a sleep disorder or something more. Studies show that people can function on five and a half hours of sleep, which is considered the core physiology sleep. When people who suffer from sleep disorders get five and a half to six and a half hours and are prone to catastrophizing, it is important to reinforce to them that they are actually getting their core physiological restorative sleep, their stage 3 and 4 delta EEG wave sleep, which allows them to function sufficiently throughout the day.
Acceptance and tolerance can also have a big impact on treatments for sleep disorders. When clients start catastrophizing, trying to find the ‘whys,’ or predicting the future, they are actually increasing their anxiety and increasing the activity in their sympathetic nervous system. At that point, I coach clients to let go of the need to know why. I help them redirect their efforts to focus on the solution, and direct them to stop doing research and searching the internet to learn more about the problem. When clients are prone irritability or susceptible to anxiety or depression, cognitive reframing can help them shift their perspective to tolerate sleep loss and have an above average day.
Sleep mantras can be helpful in building acceptance. I like help people incorporate sleep mantras such as “Even though I haven’t slept well in the last 2-3 days, I now have more sleep inertia or sleep drive. And therefore it increases the likelihood that I’ll sleep well tonight or tomorrow night.” into their nightly habits. I guide my patients to say that they will sleep well tonight or tomorrow night so they don’t put a lot of pressure on themselves that they have to perform and sleep that night. When I help patients understand that they can take the pressure off themselves to “have to sleep”, it allows them to paradoxically increase the probability that they will fall asleep.
I also incorporate a spiritual approach to help clients accept their challenges, trust in a greater power, and release their need for control. When I bring spirituality into my treatments, I do not focus on one specific being. Rather, I ask my clients to identify a higher power that works for them and help the client to build a stronger relationship with that power in a way that they are comfortable.
Integrating spirituality can also help uncover any cultural components of sleep disorders. For example, certain immigrant cultures, such as the Somali people or Iraqi people, may suffer from tremendous PTSD due to trauma experienced in their home country. With this population, the PTSD may manifest through anger, substance abuse, and insomnia, which then can impact their spiritual life. They may feel guilty because it’s an abomination to Allah or to God because they’re violating the temple, the body. In working with these clients, it is critical to be aware of these cultural factors that are causing the sleep disorder symptoms.
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