Behavioral Treatment for Adults and adolescents focus upon the following main issues:
- The practice of good sleep hygiene
- Diagnosis of insomnia versus another sleep disorder creating insomnia (primary versus secondary)
- Diagnose and treat related emotional disorder of anxiety and/or depression
- Behavioral issues involved in other sleep disorders that are treated using medication or CPAP device (CPAP compliance, safety issues with parasomnias)
- Treatment of circadian rhythm sleep disorders using chronotherapy and sleep schedule alteration.
- Work with treating psychiatrist on sleep issues related to psychiatric disorders treated with medication
Good Sleep Hygiene:
The more individualized and specifically geared to the person’s needs, the greater opportunity for success. Help of sleep specialist to address the following:
- Individualized pattern for bed and wake time
- Individualized bedtime routine
- Positive bedtime environment
- Matching wake and sleep time to person’s lifestyle
- Determine how much sleep the person actually needs
- Bedtime consistent with when the person feels sleepy
- Address variables of exercise, snack before bed, use of bed for work or watching television, remember everyone is different.
- Napping and consequences
- Use of music
- Keeping track of thoughts before sleep or dreams during sleep
- Sleep log
Treatment approaches for insomnia:
- Rule out other sleep disorders contributing to insomnia with help of sleep specialist (restless legs, periodic limb movements, obstructive sleep apnea, upper airway resistance syndrome, parasomnias, narcolepsy, circadian disorders (especially shift work) night terrors, rhythmic sleep disorders, posttraumatic stress disorder, pain, fibromyalgia, menopause, thyroid disorders, sleep deprivation or sleep debt, depression, panic disorder, gastroesophageal reflux disease, Parkinson’s Disease, cardiovascular disease, pulmonary disease, dementia, seizures, other medical disorders or medications affecting sleep).
- Sleep specialist diagnoses type of insomnia (sleep onset, maintenance, early awakening): Adjustment or acute, inadequate sleep hygiene, psychophysiological, paradoxical, idiopathic, if it is related to childhood, substance abuse, medication use, medical condition, psychiatric or mental disorder. Did the insomnia precede the depression or vice versa?
- Specific behavioral programs to address misperceptions about sleep, the anticipatory anxiety that develops, unrealistic sleep expectations and worry about sleeping.
- Work with sleep specialist to identify the predisposing factors (the person’s temperament, anxiety level, tendency to make things worse or worse than they actually are, and low drive for sleep), the precipitating factors (those events that triggered the first episode of insomnia; events that increase anxiety or arousal; loss of a loved one, hospitalization, fearful event, upsetting or traumatic events in one’s life) and the perpetuating factors (poor sleep habits, continual thinking and worrying about sleep, daytime naps, irregular sleep and wake times, less active lifestyle, and eating at night).
- Seek help of behavioral sleep specialist or psychologist to treat co-existing depression and anxiety disorders as well as other contributing emotional disorders.
- Separate out all of the variables surrounding the diagnosis of insomnia.
- Address effects of napping.
Cognitive Behavior Therapy has been the most successful in treating insomnia using a combination of therapies including stimulus control, sleep restriction, relaxation techniques, sleep education and hygiene.
Address behavioral components of other disorders that are also treated by the sleep medicine specialist or sleep neurologist such as narcolepsy, CPAP compliance, safety issues and family concerns related to REM Sleep Behavior Disorder, Sleep Related Eating Disorder and Sleepwalking.
Work with behavioral sleep specialist to:
- Establish a beneficial sleep schedule
- Maintain accurate records of sleep
- Scheduled daytime naps
- Safety necessary for certain sleep disorders (REM sleep behavior disorder, sleep related eating disorder, parasomnias)
- Awareness of types of triggers that for narcolepsy related to REM attack during the day.
- Use of sleep study to improve CPAP compliance, (interface device, mask, arousals, restorative sleep and so on)
- Structure behavioral plan to use CPAP with step by step increase in time
- Behavioral plan to select mask or interface device
- Weight loss, exercise routine, referral to functional medicine or nutritionist
- Work with family members and impact of sleep disorder upon their lives
Treatment of circadian rhythm sleep disorders using chronotherapy and sleep schedule alteration.
- Consult with sleep center in your area.
- Consider the person’s work schedule. For example, those with delayed sleep phase where they are not tired until 3:00 in the morning and sleep well until 11:00 in the morning, do quite well as musicians. The elderly benefit by trying to stay up longer and using daylight and a walk at dusk.
Work with treating psychiatrist on sleep issues related to psychiatric disorders treated with medication:
- Address behavioral component of diagnosed psychiatric disorders that are also treated by the psychiatrist.
- Work with the individual as well as family members regarding impact of symptoms upon sleep
- Use of sleep logs to track problems and address sleep hygiene