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- March 19, 2021
Part 1 of Our Science Series | Learn about why sleep matters and how poor sleep can affect your physical health, mental health, and productivity. Learn the causes behind insomnia.
Struggling with insomnia can be a frustrating and exhausting experience, affecting both your physical and mental well-being. Fortunately, there are a variety of sleep training approaches that offer hope for those looking to improve their sleep patterns and find relief from the grip of insomnia. From Cognitive Behavioral Therapy for Insomnia (CBT-I) to Autogenic Training (AT), and even innovative techniques like Cognitive Behavioral Sleep-Pain Training, these approaches cater to different needs and preferences. In this blog, we’ll delve into the world of sleep training for insomnia, exploring various methods and their benefits, while also shedding light on potential side effects and challenges. Whether you’ve been grappling with chronic sleepless nights or simply seeking to enhance your sleep quality, understanding the diverse array of treatment options available is the first step towards achieving the restful slumber you deserve.
Sleep training for insomnia involves various behavioral and cognitive approaches. Cognitive Behavioral Therapy for Insomnia (CBT-I) is a multi-component treatment that targets difficulties with initiating and/or maintaining sleep. It includes strategies like sleep restriction therapy, stimulus control therapy, sleep hygiene, and cognitive therapy, delivered over six to eight sessions.
Another approach is Autogenic Training (AT), a non-drug approach that has shown to improve sleep patterns, reduce anxiety, and depression in patients with various health conditions.
Cognitive training has also been found to improve sleep quality and cognitive function among older adults with insomnia.
Intensive Sleep Re-Training is a new therapy for chronic insomnia, completed over a 24-hour period during a state of sleep deprivation, showing improvements in sleep and daytime impairments.
Lastly, a new cognitive behavioral sleep-pain-training has been evaluated for patients suffering from chronic pain and comorbid insomnia, showing improvements in sleep quality and pain intensity. These therapies should be considered based on individual needs and preferences. [1] [2] [3] [4] [5] [6]
Autogenic Training (AT) is a self-induced relaxation technique based on autosuggestion. It is typically taught over eight or nine sessions and involves learning six mental exercises designed to induce a calm state of mind and body. These exercises are not specifically focused on sleep, but they can lead to improvements in sleep patterns. The main psychophysiological effects of AT include autonomic cardiorespiratory changes paralleled by modifications in central nervous system activity and psychological outputs. These changes can lead to reduced anxiety and depression, both of which may result from and cause insomnia. The improvements in sleep patterns occur despite, or possibly due to, not focusing on sleep during training. AT may provide an approach to insomnia that could be incorporated into primary care. [7] [8] [9]
Cognitive Behavioral Sleep-Pain-Training is a therapy specifically developed for patients suffering from chronic pain and comorbid insomnia. It aims to improve symptoms of both conditions. The training consists of four 90-minute modules and includes several methods of cognitive behavioral therapy for the treatment of insomnia and pain. These methods include:
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The training specifically addresses the relationship between sleep and pain, acknowledging that chronic pain not only impairs sleep, but poor sleep quality can also worsen the perception of pain. The goal is to break this cycle and improve both sleep quality and pain intensity. [10]
The American Academy of Sleep Medicine provides guidelines for the use of behavioral and psychological treatments for chronic insomnia disorder in adults. They recommend multicomponent cognitive behavioral therapy for insomnia (CBT-I) as the first-line treatment for chronic insomnia disorder in adults. Other therapies like stimulus control, sleep restriction therapy, and relaxation therapy are suggested as single-component therapies. However, sleep hygiene is not suggested as a single-component therapy.
The choice of therapy should be guided by the clinician’s knowledge and experience, and should strongly consider the patient’s values and preferences. When deciding on the most suitable approach, healthcare providers should consider the specific needs, preferences, and circumstances of the patient. This includes their overall health, the severity of their insomnia, and their response to previous treatments. It’s also important to consider the availability and accessibility of the different therapies, as well as the patient’s willingness and ability to engage in them. [11]
Cognitive Behavioral Therapy for Insomnia (CBT-I): Generally considered safe, but it can be challenging for some people due to the commitment required and potential initial increase in insomnia during the early stages of treatment.
Pharmacological treatments: These can have side effects and risks. For instance, benzodiazepines and non-benzodiazepines can cause altered sleep architecture, psychomotor and memory impairment, rebound insomnia, withdrawal effects, tolerance, dependence, and potential abuse. Melatonin, while generally regarded as safe and well-tolerated, can cause daytime sleepiness, headache, dizziness, and hypothermia. Some medications, although effective in treating their focal indication, can induce insomnia as a side effect.ย
Long-term use of hypnotics: This should be individualized and balance the potential risks of continuing hypnotic medication use with the risks of untreated persistent insomnia and associated functional limitations. [12] [13] [14]
It’s important to consult with a healthcare provider to understand the potential side effects and risks associated with any treatment for insomnia.
There are several potential challenges and limitations associated with the implementation of sleep training approaches.
Individuals should be aware of these potential challenges and limitations before starting the treatment. Itโs advisable to discuss any concerns with their healthcare provider or sleep specialist.
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