Treatment for Chronic Insomnia

Insomnia is the most common sleep problem reported by adults. Approximately one-half of all adults have occasional sleep problems during the course of any year.

Insomnia is the most common sleep problem reported by adults. Approximately one-half of all adults have occasional sleep problems during the course of any year. Insomnia is characterized by the inability to fall asleep or to maintain sleep, usually due to an underlying condition or cause. Both men and women of all ages suffer from insomnia, but it is more common in females and older adults. Individuals suffering from insomnia may experience any or all of the following symptoms:

• Difficulty falling asleep
• Difficulty staying asleep
• Waking too early in the morning

Typically, insomnia is associated with feelings of restlessness, irritability, anxiety, unrefreshing sleep, and daytime fatigue. Medical or psychiatric conditions that are sometimes associated with insomnia include depression, anxiety, substance abuse disorders, obstructive sleep apnea, restless legs syndrome, and chronic medical conditions. Medications and other substances, such as caffeine, alcohol, or nicotine, can also play an important role in the development or persistence of insomnia.

Some commonly used medications, such as antidepressants, antihypertensive, antihistamines, and decongestants, have been known to cause insomnia and sleep disruption. Before discontinuing any medication, however, it is very important to discuss your concerns with your doctor first.

For most people with insomnia, the symptoms last a few days to weeks, and then resolve spontaneously. In many of these cases, the underlying cause of insomnia may be a transient life stress or change in the daily routine of an individual. However, for those who have chronic insomnia, lasting for three months or longer, the effects of poor sleep can take a significant toll on quality of life and general well-being. The effects of chronic insomnia include reduced quality of life, impaired social functioning, diminished work productivity, missed work days, impaired memory and concentration, and depression. In essence, chronic insomnia can deprive individuals of their ability to function both socially and professionally, which can then lead to increasing problems in these areas of life.

In addition to decreased job performance, insomnia is associated with increased absenteeism. People with insomnia are at increased risk for various kinds of accidents, both at work and while operating motor vehicles.

Managing Insomnia

Chronic insomnia is characterized by its chronicity. Thus, individuals with chronic insomnia can expect that the problem may be life-long. However, there are successful treatments available that can help to control the severity and to minimize the long-term effects of insomnia.

Scientific research has demonstrated that the most successful treatment protocol for chronic insomnia is a combination of medication and cognitive behavioral therapy (CBT). CBT is a series of behavioral interventions used to improve one’s ability to initiate and to maintain sleep. Specifically, CBT is a group of techniques that can be learned to help one sleep better. Generally, CBT is conducted in individual or small group formats, over a period of several weeks. As mentioned earlier, CBT is most successful in conjunction with medication for the treatment of chronic insomnia. However, treatment with medication is not required in every case.

So what exactly is CBT?

CBT encompasses several different techniques, which may be used all together or individually. These various techniques include sleep hygiene training, relaxation therapy, stimulus control therapy, sleep restriction, and cognitive therapy. Sleep hygiene training refers to re-learning habits that encourage and promote sleep.

Maintenance of a quiet sleep environment may mean excluding a pet from the bedroom or getting a bed partner to seek help for a snoring problem. Relaxation therapy helps to reduce physiologic and cognitive arousal at bedtime. Some people may be unaware of how tension and stress affect their sleep. Stimulus control therapy works by limiting the presence of external stimuli or factors that may bring anxiety or stress into the bedroom environment.

Implementation of this technique can help to establish the bedroom as a place to relax and unwind, away from the stresses of the world. Sleep restriction limits the amount of time spent lying awake in bed. This technique requires close oversight by a physician or psychologist, using sleep diaries, to ensure successful treatment. Cognitive therapy works to refute an individual’s thoughts about sleeplessness and the fear and anxiety related to these thoughts. Cognitive therapy has the potential to provide patients with good tools to deal with insomnia.

CBT is generally conducted by psychologists or physicians with specialized training in these techniques. Unfortunately, CBT for chronic insomnia is not readily available everywhere; however, by doing some research through internet resources or by contacting the National Sleep Foundation (www.sleepfoundation.org) or the American Academy of Sleep Medicine (www.aasmnet.org), you may be able to find someone in your area. At the Dallas Center for Sleep Disorders, we offer Insomnia Workshops with CBT for chronic insomnia. You can contact us for more information (www.dallas-sleep.com or 972-473-7300).

Author: Dr. Raj Kakar, M.D., M.P.H.

Dr. Kakar is a Diplomate of the American Board of Sleep Medicine (D.ABSM) and he is board-certified in both Sleep Medicine and Internal Medicine. He completed fellowship training at Stanford University’s Sleep Disorders Clinic for Adults and Pediatrics. He is the medical director for the Dallas Center for Sleep Disorders in Plano, TX.

Resources: Sleep Apnea Treatment – Snoring Treatment – Sleep Disorders

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