Sleep disorders: Psychosocial treatment
Education about normal sleep and sleep hygiene is an essential part of insomnia and sleep treatment. Information to discuss with patients includes:
- average and individual sleep need
- change of sleep need with age
- circadian rhythm
- importance of a regular sleep schedule
- role of napping in compensating for lost sleep contributing to the perpetuation of chronic insomnia
- consequences of sleep deprivation
- effects of caffeine, nicotine, medications and alcohol on sleep
There are specific behavioural techniques to help consolidate sleep (bed restriction). Strategies also exist to help withdraw patients from long-term hypnotic drug use. The use of actigraphy (a portable device used to assess sleep/wake patterns and circadian rhythms) can be useful for these behavioural therapies.
Cognitive-behavioural therapy (CBT) is a short-term treatment (commonly five to eight sessions) that addresses the maladaptive behaviours and dysfunctional beliefs that sustain insomnia.
According to the cognitive-behavioural model of insomnia, people with acute insomnia adopt behavioural strategies and cultivate sleep-related anxiety, which are fuelled by unhelpful cognitions about sleep. These issues, independent of the cause of the insomnia, perpetuate the condition.
CBT can be administered alone or in combination with hypnotics. By eliminating maladaptive behaviours and cognitions, CBT leads to improvements that endure well beyond the termination of active treatment.