Insomnia

Jun 17

Insomnia is one of the most frequent concerns I hear about from my patients. Unfortunately, the medications for insomnia have many side effects such as problems with thinking, memory and increased risk for falls. This makes treating insomnia in older people especially challenging. Many Geriatric Psychiatrists find that when they take people off of certain sleeping medications, their patient’s memory and cognitive abilities dramatically improve.

A normal part of aging is increased sleep fragmentation. In fact, our sleep has been fragmented our entire lives. When we are young, the amount of time we wake up during the night is so brief that we generally don’t remember it in the morning. We have the sense of sleeping through the night but that is not really the case. Our brains evolved to wake up periodically throughout the night so that we can survey the environment and make sure that there are no saber-toothed tigers about to attack.

As we get older, these episodes of night time wakefulness lengthen, and we are more aware of the fact that our sleep is broken by periods of wakefulness. This can lead to distressing thoughts about not sleeping through the night. As we battle these thoughts, we may become more tense and anxious. We focus harder on falling back asleep which has the paradoxical effect of making us more anxious and alert. Now we do feel threatened. How will we get through our day if we don’t fall back asleep? What else can I do to shut my mind down and get back to sleep? The harder we work at it, the more alert we become and the more elusive falling back to sleep seems.

Fortunately, there is another form of treatment that is effective for insomnia called Cognitive Behavioral Therapy for insomnia, or CBTi. This treatment has actually been shown to be more effective for insomnia than the medications, which is why it is the first line of treatment for insomnia for people of all ages.

CBTi is a short and structured form of therapy that is evidenced-based. CBTi connects thoughts, feelings and behaviors people have about sleeping with the quality of their sleep. Treatment generally takes about 6 sessions. There are some risks with CBTi as well, which is why I generally recommend doing it with the support of a therapist who is trained in CBTi.

For more information on CBTi, along with some online CBT-i programs,please visit the following:

Info on CBTi

https://www.sleepfoundation.org/articles/cognitive-behavioral-therapy-insomnia

https://www.mayoclinic.org/diseases-conditions/insomnia/in-depth/insomnia-treatment/art-20046677

http://sleepeducation.org/treatment-therapy/cognitive-behavioral-therapy

https://stanfordhealthcare.org/medical-treatments/c/cognitive-behavioral-therapy-insomnia/procedures.html

Apps

CBT-I Coach (free) https://mobile.va.gov/app/cbt-i-coach

Night Owl – Sleep Coach ($9.99)

Online CBT-I programs

https://www.sleepio.com/ may be only available for employers/researchers

https://www.cbtforinsomnia.com/