Dr Keith Johnson
Neuropsychiatrist
Sleep disorders: Management
The management of sleep disorders frequently goes beyond the sleep hygiene principles that people might get at their local doctor's office and which we know frequently don't work in practice. Sometimes this is because an individual might not put the suggestions into practice, but more often it is because sleep hygiene doesn't address the sleep disorder's underlying determinants. Also, different conditions, e.g. insomnia disorder and a circadian rhythm disorder, require markedly different approaches.
Are medications helpful?
Most people who have taken medications for their sleep, have probably been advised that long-term use of sleep medications is not recommended. This is only partially true, because it certainly depends on a number of factors: 1) the individual, 2) the problem and 3) the medication. Medications can certainly be effective for some conditions. For some individuals and conditions they are indispensable. Medications are not without their risks, the main one for sleep medications is daytime sedation. It is untrue that all sleep medications are addictive. With benzodiazepines (the class of drugs that include valium), we do worry about tolerance, loss of effect and withdrawal, but many other sleep medications do not have this problem in the long term. Medications can frequently be a helpful addition to psychotherapy for sleep conditions so an integrated approach has many advantages.
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Cognitive Behavioural Therapy for Insomnia (CBT I)
CBT I is a non-pharmacological treatment for insomnia disorder and is the recommended gold standard treatment for this condition. There a numerous studies that have reported its efficacy with its short term efficacy equivalent to sleep medications, but better long term efficacy. It does require more time and effort, unlike medications. On average the number of sessions involved range from 6- 8 sessions spaced fortnightly to monthly. There are a number of components involved including 1) sleep restriction, 2) stimulus control, 3) cognitive restructuring, 4) sleep hygiene, and 5) relaxation/ mindfulness techniques.
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To learn more about CBT I, here is a useful article from the New York Times:
https://www.nytimes.com/2015/06/09/upshot/the-evidence-points-to-a-better-way-to-fight-insomnia.html
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