We spend about a third of our lives sleep, and while everyone knows a good night’s sleep is important, it is also widely neglected. If you have a sleep disturbance, however, you are more than aware of the toll it takes on your relationships, your work life if you work, and your everyday sense of well-being.
Sleep disorders fall into three main categories:
- hypersomnias (excessive sleepiness)
- parasomnia (nightmares, sleepwalking, etc.)
Some sleep disturbances are caused by medical conditions or physical problems, while others occur because of stress or the like. The most common sleep disorder, and the one I treat, is insomnia.
Insomnia until now has been diagnosed as one of two main types:
- primary insomnia (insomnia itself is the main problem)
- secondary insomnia (the result of a medical or psychiatric cause)
Less and less distinction is being made between primary and secondary as the insomnia often remains in secondary even after the problem cause is dealt with.
My clients’ complaints about insomnia fall into four main categories:
- sleep onset (problems getting to sleep quickly enough)
- sleep maintenance (walking up periodically in the middle of the night)
- late or terminal insomnia (walking up too early in the morning and not getting back to sleep)
- poor sleep quality
The criteria for an actual diagnosis of insomnia varies, but the following generally applies:
- you are experiencing poor sleep
- it takes longer than 30 minutes for you to fall asleep or you stay awake longer than 30 minutes on waking in the middle of the night
- you are asleep only 85% or less of time you are in bed
- you have a sleep problem at least 3 nights out of the week
- the insomnia problem has gone on longer than 6 months
- you feel tired, you feel your performance on tasks is impaired, your mood is affected
- because these things and/or the sleep disturbance make it very hard for you to function well in your relationships and when you have things to do, you have additional distress
If the insomnia has been going on for less than 2 weeks, it is called “transient”.
If it has continued for 2-4 weeks, it is considered “short-term” or “acute”.
If it has gone on for over 4 weeks, it is called “chronic”.
“I can’t believe it! I have listened to the recording of our session every day, and my sleep is so much more restoring. But also, for the first time in years, I am sleeping between 7 and 8 hours a night!”
I treat getting to sleep, staying asleep and having a good quality of sleep. Other issues such as sleepwalking are outside the scope of my expertise.
As a first step I conduct detailed evaluations with the client to fully understand all factors affecting their sleep.
I then present the treatment plan, which consists of:
- maintaining a sleep journal (to track progress, target areas to work on)
- sleep hygiene (are you putting all chances on your side for sleep?)
- sleep education (informing and removing misconceptions about sleep)
- relaxation training (the key to restful sleep)
- sleep scheduling (reconditioning your body to know it’s time to sleep)
- cognitive restructuring (stopping the late-night ruminations that keep you up)
- hypnotherapy (hypnosis and self-hypnosis instruction to reinforce and change thinking
For many clients, insomnia is caused by a combination of muscular tension and racing thoughts encouraged by the tension, generally treated about 2 to 3 sessions, which may be less in cases of short-term insomnia.