Improving Sleep

8 Key excerpts on "Improving Sleep"

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  eBook - PDF

  Sleep Disorders

  Diagnosis and Therapeutics

  • S. R. Pandi-Perumal, Joris Verster, Jaime Monti, Salomon Langer, S. R. Pandi-Perumal, Joris Verster, Jaime Monti, Salomon Langer(Authors)
  • 2008(Publication Date)
  • CRC Press

    (Publisher)

  19–26 Figure 12.1 presents a schematic illustration of the interaction and integration among the psychological, behavioral, and physiological aspects of insomnia. The psychological and behavioral factors can disrupt sleep through the mediation of the neurophysiological sys-tems. The psychological domain that has received most research attention is probably sleep-related cog-nition. Several studies have reported a significant asso-ciation between negative sleep cognitions and poor sleep quality or insomnia. 27–29 Excessive cognitive arousal caused by worries and planning associated with daily life hassles or major stressors may transiently inter-fere with both sleep initiation and maintenance. As sleep problems draw out, patients may develop the belief that their poor sleep is ‘inevitable’ and that all their problems are due to poor sleep. They therefore tend to be preoccupied with their sleep problem and daytime functioning, which induce further arousal that is detrimental to sleep. The resulting sleeplessness further reinforces their perceived validity of the negative beliefs. 30 This vicious cycle serves to perpetuate insomnia, even when the initial triggering event has been resolved. Addressing dysfunctional beliefs about sleep through sleep hygiene education and/or cognitive therapy has been associated with sleep improvement. 31,32 116 SLEEP DISORDERS: DIAGNOSIS AND THERAPEUTICS Sleep cognition Behavioral practices Psychological/behavioral factors Neurophysiological systems Homeostatic system Circadian system Arousal system Sleep Emotional arousal Figure 12.1 A conceptual model of the psychological/behavioral factors that influence sleep through the mediation of the neurophysiological regulation of normal sleep.

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  Sleep and Psychosomatic Medicine

  • S.R. Pandi-Perumal, Meera Narasimhan, Milton Kramer, S.R. Pandi-Perumal, Meera Narasimhan, Milton Kramer(Authors)
  • 2017(Publication Date)
  • CRC Press

    (Publisher)

  11 Even in a physiologically based sleep disorder, such as mild sleep-related breathing disorder, anxiety over poor sleep and daytime functioning, or inappropriate sleep practices can further disrupt the already fragile sleep. Therefore, behavioral intervention is beneficial not only in the treatment of sleep disorders of psychosocial origins, but also in the management of physiologically based sleep problems.

  Many behavioral and psychological interventions are effective in the treatment of sleep disorders, especially in the management of chronic insomnia.12 – 14 Some of the behavioral techniques have also been applied to insomnia associated with medical or psychiatric disorders with positive results.12 ,15 – 18 In addition to improvements in sleep, psychiatric symptoms decreased.19 ,20 Widely applicable behavioral interventions have been used to enhance the compliance with medical treatment in sleep-related breathing disorders.21 ,22

  In this chapter, we will describe how psychological and behavioral factors influence the neurophysiological mechanisms of normal sleep regulation, and will provide a framework for the clinician to conceptualize the development of insomnia in individual patients. Further, we will review the behavioral techniques that are effective in the treatment of insomnia. Since there are some recent review articles on the treatment efficacy of cognitive–behavioral therapy for insomnia,23 – 25 our chapter will focus more on the conceptual rationales and practical aspects of the cognitive– behavioral interventions. Lastly, we will briefly review the behavioral interventions for specific sleep disorders other than insomnia.

  Psychosocial and Behavioral Factors Affecting Sleep–Wake Regulation

  Sleep disturbances can be conceptualized as disruptions of the mechanisms that regulate the normal processes of sleep and wakefulness. Thus, understanding the mechanisms of normal sleep control is important for the evaluation and treatment of sleep disorders. It is now recognized that human sleep is regulated by the interactions of two major systems: a homeostatic system that regulates the optimal level of sleep drive in order to maintain the internal balance between sleep and wakefulness; and a circadian process that generates a biological rhythm of sleep and wake tendency over a day.26 – 28

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  Clinical Sleep Medicine

  A Comprehensive Guide for Mental Health and Other Medical Professionals

  • Emmanuel H. During, Clete A. Kushida, Emmanuel H. During, Clete A. Kushida(Authors)
  • 2020(Publication Date)
  • American Psychiatric Association Publishing

    (Publisher)

  Hauri 1991 ). Environmental factors include establishing a protected sleep environment. Lifestyle practices include appropriate timing and consumption of meals, exercise, alcohol, and caffeine. For example, individuals are encouraged to keep their bedroom comfortable, dark, quiet, and cool (62°F–68°F), although preferences can vary. Recommendations for keeping screens and electronic devices out of the bedroom are becoming increasingly common. Meals, exercise, alcohol, and caffeine should all be timed appropriately so they do not interfere with sleep (i.e., meals, alcohol, and vigorous exercise should be finished 3–4 hours before bedtime; caffeine should be finished 10–14 hours before bedtime). Caffeine and alcohol should be limited or eliminated in individuals who are sensitive to their effects. Nicotine should be discontinued because of adverse effects on sleep and health. Proper sleep hygiene can support good sleep but does not, by itself, correct poor sleep.

  Cognitive-Behavioral Therapy for Insomnia

  Description and Indication

  CBT-I is a brief, collaborative, skills-based, multicomponent treatment that uses a variety of therapies, some of which are effective as stand-alone interventions, to target thoughts and behaviors that interfere with sleep and perpetuate insomnia. Specific therapies include stimulus control, sleep restriction, relaxation, cognitive reframing, sleep hygiene, and sleep education. Changing unhelpful beliefs and behaviors can circumvent the vicious circle that ensues when unhelpful cognitions, negative emotions, and maladaptive behaviors exacerbate and perpetuate insomnia, an understanding that informs CBT treatment for other chronic conditions (Hofmann et al. 2012 ). CBT-I can be safely implemented with young, middle-aged, and older adults with chronic insomnia. See Table 5–1

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  Managing Hot Flushes with Group Cognitive Behaviour Therapy

  An evidence-based treatment manual for health professionals

  • Myra Hunter, Melanie Smith(Authors)
  • 2014(Publication Date)
  • Routledge

    (Publisher)

  So while sleep difficulties can be very distressing, as is the case for hot flushes and night sweats, we can look at a range of lifestyle and behavioural factors that you can influence to improve sleep, and to help you to cope if you haven’t got as much sleep as you would have liked to. Again, this uses a cognitive (thinking) and behavioural (behaviour) approach:

  • We can address behaviour at bedtime to maximise sleep onset and what to do if woken by night sweats.
  • We can look at the role of thoughts, when we are having difficulty sleeping or if we have woken up, and their impact on how we feel.
  • We can also look at daytime effects of not getting enough sleep and to reduce tiredness during the day.

  The strategies we will be covering are also evidence based and have been shown to improve sleep quality and quantity. We will start by looking at behavioural strategies initially with the aim of improving overall sleep quality. These can then be implemented as homework this week. Once changes have been made to enhance general sleep quality, next week we will look specifically at thinking and sleep, and also strategies for managing night sweats.

  Behavioural Interventions to Enhance General Sleep Quality

  Session 4, Slide 9 Handout 13

  The information at the beginning of the session aims to encourage participants to implement behavioural strategies, which may run counter to their normal habits used to manage sleep. In this section group members are introduced to a range of practical behavioural strategies to improve sleep quality. The behavioural interventions are:

  • Sleep habits and environment
  • Stimulus control and associating bed with sleep
  • Wind-down routine and relaxation
  • Sleep scheduling
  • Managing daytime tiredness (by maintaining and not reducing activity).

  Improving basic sleep habits and environment is a good starting point that enables participants to introduce small and manageable changes to their bedroom environment and lifestyle. The facilitator can run though these quickly with participants; the following information can be provided linking with Slide 9:

  Caffeine

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  Clinical Handbook of Psychological Disorders

  A Step-by-Step Treatment Manual

  • David H. Barlow(Author)
  • 2021(Publication Date)
  • The Guilford Press

    (Publisher)

  American Psycholo- gist, 65(2), 73–84. Miller, W. R., & Rollnick, S. (2002). Motivational interview- ing: Preparing people to change. New York: Guilford Press. Montgomery, P., & Dennis, J. (2003). Cognitive behavioural interventions for sleep problems in adults aged 60+. Co- chrane Database of Systematic Reviews, 1, CD003161. Morin, C. M. (1993). Insomnia: Psychological assessment and management. New York: Guilford Press. Morin, C. M., Blais, F., & Savard, J. (2002). Are changes in beliefs and attitudes about sleep related to sleep improve- ments in the treatment of insomnia? Behaviour Research and Therapy, 40, 741–752. Morin, C. M., Bootzin, R. R., Buysse, D. J., Edinger, J., D., Espie, C. A., & Lichstein, K. L. (2006). Psychological and behavioral treatment of insomnia: An update of recent evi- dence (1998–2004). Sleep, 29, 1396–1406. Morin, C. M., Culbert, J. P., & Schwartz, S. M. (1994). Non- pharmacological interventions for insomnia: A meta-anal- ysis of treatment efficacy. American Journal of Psychiatry, 151, 1172–1180. Morin, C. M., & Espie, C. A. (2007). Insomnia: A clinical guide to assessment and treatment. New York: Springer Sci- ence & Business Media. Morin, C. M., Gaulier, B., Barry, T., & Kowatch, R. A. (1992). Patients’ acceptance of psychological and pharma- cological therapies for insomnia. Sleep, 15, 302–305. Morin, C. M., Koetter, U., Bastien, C., Ware, J. C., & Woo- ten, V. (2005). Valerian–hops combination and diphen- hydramine for treating insomnia: A randomized placebo- controlled clinical trial. Sleep, 28(11), 1465–1471. Morin, C. M., Vallieres, A., Guay, B., Ivers, H., Savard, J., Merette, C., et al. (2009). Cognitive behavioral therapy, singly and combined with medication, for persistent in- somnia: A randomized controlled trial. Journal of the American Medical Association, 301(19), 2005–2015. Morin, C. M., Vallieres, A., & Ivers, H. (2007). Dysfunction- al Beliefs and Attitudes about Sleep (DBAS): Validation of a brief version (DBAS-16).

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  Insomnia

  Diagnosis and Treatment

  • Michael J. Sateia, Daniel Buysse, Michael J. Sateia, Daniel Buysse(Authors)
  • 2016(Publication Date)
  • CRC Press

    (Publisher)

  Additionally, individuals with insomnia appeared to handle conflicts and stressors through internalizing emotions (as opposed to through irritability or hostility) (35). However, the research on this topic has been mostly correlational and thus the question remains as to whether personality characteristics predispose individuals to insomnia or result from insomnia. CONTEXTUAL/ENVIRONMENTAL FACTORS Context likely underlies the expression of and interaction between all the psychological factors we have discussed, including behavior, cognition, affect, and personality. The role of context, or environmental factors, is also understudied. Examples of potentially important contextual 48 TALBOT AND HARVEY factors include bed partners who may interfere with each other’s sleep through snoring, move-ment, or dyssynchronous bedtimes. Other contextual factors include the noise and safety levels of the environment that could lead to sleep disturbance and/or hypervigilance for threat. Increased use of technology and busier schedules may also impact insomnia through increased stress and poorer sleep habits. CONCLUSION A number of the important psychological models have been reviewed in this chapter, ranging from behavioral to cognitive to several hybrid cognitive-behavioral models. These substantial theoretical contributions have led to the development of numerous efficacious treatments (4), but more work remains. In particular, future research on the role of emotion, personality, and contextual factors could pave the way for even more successful treatments. REFERENCES 1. Spielman AJ, Caruso LS, Glovinsky PB. A behavioral perspective on insomnia treatment. Psychiatr Clin North Am 1987; 10:541–553. 2. Spielman AJ. Assessment of insomnia. Clin Psychol Rev 1986; 6:11–25. 3. Glovinsky P, Spielman A. The insomnia answer: a personalized program for identifying and overcom-ing the three types of insomnia. New York: Penguin, 2006. 4. Morin CM, Bootzin RR, Buysse DJ, et al.

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  Lifestyle Psychiatry

  Through the Lens of Behavioral Medicine

  • Gia Merlo, Christopher P. Fagundes, Gia Merlo, Christopher P. Fagundes, Christopher P. P. Fagundes, Gia Merlo, Christopher P. P. Fagundes(Authors)
  • 2023(Publication Date)
  • CRC Press

    (Publisher)

  Section III Risk and Protective Lifestyle Factors for Mental Health and Psychological Well-Being Passage contains an image

  17 Sleep-Related Disorders

  Matthew R. Cribbet, PhD, Andrea N. Decker, MA, Francisco D. Marquez, ScM, MA, and Emily A. Halvorson, MA

  DOI: 10.1201/b22810-20

  KEY POINTS

  • Insomnia disorder is associated with short-term and long-term deficits in functioning, including co-morbid medical and psychiatric complaints.
  • Cognitive Behavioral Therapy for Insomnia is an evidence-based treatment with demonstrated efficacy and effectiveness.
  • Scaling up insomnia treatments will address growing demands for patient care.

  17.1 Introduction

  Insomnia disorder is characterized by difficulties falling asleep, staying asleep, or non-restorative sleep that occurs despite the opportunity for adequate sleep. Insomnia disorder is associated with significant distress or impairment in functioning, along with daytime symptoms, including mood disturbances, fatigue, daytime sleepiness, and impairments in cognitive functioning.1 While nearly one-third to one-fourth of individuals in industrialized countries report disrupted sleep at some point during their lives, approximately 10% to 25% of the population meets the diagnostic threshold for insomnia disorder.2 Insomnia is a chronic problem in one-third to three-fourths of patients,3 , 4 with more than two-thirds of patients reporting symptoms for at least 1 year.5 Without intervention, chronic insomnia is unremitting, disabling, costly, and may pose a risk for additional morbidity and potentially mortality.6 , 7 Given the scope and significance of this problem the identification and implementation of efficacious and effective forms of treatment is necessary. Cognitive behavioral therapy for insomnia (CBT-I) is not only efficacious and effective, it is now considered the standard of treatment for chronic insomnia8 and is recommended as the initial treatment by the American College of Physicians.9

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  CBT for Schizophrenia

  Evidence-Based Interventions and Future Directions

  • Craig Steel(Author)
  • 2012(Publication Date)
  • Wiley-Blackwell

    (Publisher)

  (1999) state that sleep-hygiene education covers health ­practices (e.g. diet, exercise, substance use) and environmental factors (e.g. light, noise, temperature, comfortable bed, bedding and bedroom conditions) that may be beneficial or detrimental to sleep. These factors are rarely severe enough to be the primary cause of insomnia but they can hinder the treatment process or complicate the existing sleep problem (Manber et al., 2008). The following sleep-hygiene recommendations were provided: (a) not to drink caffeine 4 to 6 hours before bedtime and to reduce excessive consumption; (b) cut down or reduce nicotine 4 to 6 hours before bedtime; (c) avoid alcohol as a sleep aid; (d) regular exercise, but not in the 3 hours prior to bedtime; (e) minimize excessive light (thicker curtains or cover window with a blanket), high temperatures and noises during the sleep period, and (f) avoid clock watching. Additional recommendations that may overlap with stimulus control included reducing daytime napping and time spent in bed not sleeping. Interestingly, poor sleepers have been found to be generally better informed about sleep hygiene, but still engage in more unhealthy practices than good sleepers (Lacks and Rotert, 1986). Sleep-hygiene education, therefore, aims to both inform and encourage these behaviours. Sleep hygiene was discussed and if any of these factors were relevant to the individual’s sleep difficulties then a specific plan of action was agreed for the following week. Stimulus control therapy Stimulus control therapy is based on the idea that insomnia is a conditioned response to temporal (bedtime) and environmental (bed/bedroom) cues that are usually associated with sleep (Morin et al., 1999). Someone without insomnia, therefore, has a conditioned response to sleep with ­bedtime and bedroom cues. Stimulus control therapy aims to train the individual to re-associate bedtime, bed and the bedroom with rapid sleep onset

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