Insomnia Sleep Disorders

Insomnia or sleep disturbance can be caused by many factors. Transient or short-term insomnia can be related to time changes (jet-lag, travel), altitude, change in medications, life-stress (loss of a loved one, job loss, divorce or separation), and poor sleep conditions (noise, light, disruptive bed partner). Substance abuse issues can also cause sleep problems, such as withdrawal from alcohol, drugs, or medications. Medical problems such as obesity (obstructive sleep apnea, snoring), chronic pain, chronic fatigue, acid reflux disease, asthma, coronary artery disease with chest pain, arthritis, smoking, and neurological problems can cause sleep disorders. Specific medical conditions which disrupt sleep include sleep apnea (obstructive or central), restless leg syndrome, periodic limb movement disorder, and disorders of circadian rhythms. Psychological issues such as depression, mania, bipolar disorder, anxiety disorders, or Post-traumatic stress disorder (PTSD) also go hand in hand with disordered sleep. Insomnia can be a prime indicator of underlying psychological difficulties.

Persons with sleep disorders may have difficulty staying awake during the day, feeling fatigued or exhausted . They may have difficulty concentrating at work or school. Due to disordered sleep patterns, they may have anxiety or feel irritable or angry during the day. Impaired motor coordination may result in difficulties operating equipment or driving a motor vehicle. Further daytime impairment may occur when a person with a sleep disorders takes stimulants during the day to stay awake.

Sleep Disorders or insomnia should be evaluated by a mental health professional. In severe cases sleep studies may be necessary. A thorough medical history is necessary, to elicit problems related to airway obstruction (obstructive sleep apnea), or other medical conditions responsible for the sleep problems. Sleep studies can be done off-site, to characterize the specific type of sleep disorder. A full psychological and psychiatric evaluation is needed, as well, to determine if underlying psychological issues are causing disordered sleep. Depression, Bipolar Disorder and anxiety disorders are frequently associated with sleep problems. The Client’s family history is also explored, as well as any history of drug or alcohol abuse, which can also disrupt sleep cycles.

Sleep Disorders can be effectively managed with psychological treatment and medication (if necessary), once the cause has been identified. In Clients with underlying psychological problems, effective psychotherapy, stress management, and psycho-education in conjunction with sleep therapy can significantly improve their wellness. Clients who receive effective treatment experience improvement in their ability to function normally during the day, including an increase in the number of days they feel well, and an improved ability to focus on and participate in their psychological treatment.

A person with disordered sleep and underlying psychological problems may require intensive treatment. Despite the fact that poor sleep is a central symptom of depressive, bipolar and anxiety disorders, psychological treatments have traditionally neglected the importance of healthy sleep. Recently however, psychologists have developed highly effective approaches for helping people fall asleep quicker, stay asleep longer and manage night-time racing thoughts that so often can disrupt restful sleep. These cognitive-behavioral approaches do not rely on traditional medications, but instead are based on three premises stating that insomnia is perpetuated by: 1) a set of poor sleep habits; 2) a poor sleep environment; 3) night-time worries, frustrations and despair. Cognitive-behavioral approaches have been so effective that the American Academy of Sleep Medicine describes them as the first line treatment for chronic primary insomnia.

At PCH Treatment Center, our approach is unlike any other psychological program in that cognitive-behavioral approaches for insomnia are integrated into our treatment planning for each client. The secret to understanding why these approaches work while others do not is that cognitive-behavioral approaches are rooted in extensive neuroscience research. The foundation of this research is that there are two separate functional systems involved in generating and maintaining good sleep: one is based on sleep debt and the other is based on our internal body clock. When people experience insomnia, they are experiencing breakdowns in both of these systems. By using approaches that address inefficiencies in both these systems, cognitive-behavioral strategies can produce long-lasting improvements in sleep quality. In weekly meetings, individuals learn basic sleep facts versus myths, the triggers that elicit sleep and how to use these triggers to improve their sleep problems, two highly effective relaxation strategies to manage night-time mood and specific, individually tailored guidance on improving sleep. Sleep problems differ from person to person. Our approaches focus on the specific difficulties a person is experiencing including inability to relax at night, difficulty falling asleep, difficulty staying asleep, or waking too early.