Andrew Berger PhD San Francisco and Dallas Mental Health Specialist How much do you know Video 1 amp 2 If You Have Insomnia You Are Not Alone 75 of Adults Had One Symptom of Sleep Disorder ID: 745728
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Slide1
The Behavioral Treatment of Insomnia
Andrew Berger, PhD
San Francisco and Dallas Mental Health SpecialistSlide2
How much do you know?Slide3
Video #1 & #2Slide4
If You Have Insomnia You Are Not Alone
75% of Adults Had One Symptom of Sleep Disorder
30-40 Percent of US Population Occasionally Suffers from Insomnia
Partners Affected
Americans Average 6.9 Hours of Sleep Slide5
Consequences of Poor Sleep
Poor Health
Higher Death Rates
Physical AilmentsSlide6
More Consequences of Poor Sleep
Hormone and Metabolism Changes
Sleep Debt Is Cumulative
Sleep Deprivation and Driving
Catastrophes
Cost to AmericansSlide7
Benefits of Sleep
Alertness/Performance
Memory/Concentration/Creativity
Better HealthSlide8
Many Types of Sleep Disorders
Primary Insomnia
Primary
Hyperinsomnia
Narcolepsy
Breathing Related Disorders
Circadian Rhythm Sleep Disorder
Nightmare DisorderSlide9
Many Types of Sleep Disorders
Sleep Terror Disorder
Sleep Walking Disorder
Substance Induced Sleep Disorder
Sleep Disorder Due To Medical ConditionSlide10
DSM4-TR Insomnia Essential Features
Onset and Intermittent Insomnia
Non-Restorative Sleep
Preoccupation and Distress
Better Sleeping Away From Home
Decreased Well-Being and ConcentrationSlide11
DSM4-TR Primary Insomnia
The predominant symptom is difficulty initiating or maintaining sleep or non-restorative sleep for at least one month
The sleep disturbance (or associated daytime fatigue) causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
The sleep disturbance does not occur exclusively during the course of narcolepsy, breathing-related sleep disorder, circadian rhythm sleep disorder, or
para-somniaSlide12
DSM4-TR Continued
The disturbance does not occur exclusively during the course of another mental disorder (e.g., major depressive disorder, generalized anxiety disorder, a delirium).
The disturbance is not due to the direct physiological effects of a substance (e.g., drug abuse, medication) or a general medical condition.Slide13
Primary Insomnia
Occurs Independently
Not Due To An Obvious Cause
Rarely From Infancy
Learned
Predisposed Due To Overactive Nervous SystemSlide14
People With Insomnia Have:
Higher Metabolic Rates
Higher Levels of Stress Hormones
Associate Bedroom with Anxiety
Poor CopingSlide15
What Is Secondary Insomnia?
Results From Another Cause
Sleep Disorder
Non-Sleep Condition
SubstancesSlide16
Disorders That Can Disrupt Sleep
Angina
Diabetes
Hyperthyroidism
Parkinson’s Disease
Epilepsy
Alzheimer’s
HeadachesSlide17
More Disorders Affecting Sleep
Strokes/Tumors
Asthma
Chronic Obstructive Pulmonary Disease (COPD)
Anxiety
DepressionSlide18
More Disorders Affecting Sleep
Bipolar Disorder
Schizophrenia
Gastro esophageal Reflux Disease (GERD)
Kidney Disease
ArthritisSlide19
Medications That Can Disturb Sleep
Alpha blockers
Anti-arrhythmic
Beta blockers
Diuretics
AntidepressantsSlide20
More Medications Affecting Sleep
Beta Agonists
Corticosteroids
Nicotine Patches
Stimulants
Theophylline
Thyroid Replacement DrugsSlide21
Types of Sleepers
Standard Sleepers
Larks
OwlsSlide22
Adolescent and Young Adult Sleep Patterns
Teens
Young AdultsSlide23
Dr Lawrence Epstein’s Six Step Plan To A Good Night’s Sleep
Recognizing the importance of sleep
Adopting a healthy lifestyle
Maintaining good sleep habits
Creating the optimal
sleep environment
Seeking help for persistent sleep problemsSlide24
Recognize The Importance of SleepSlide25
Adopt A Healthy Lifestyle
Exercise Regularly
Maintain A Healthy Diet
Don’t Drink to Excess or SmokeSlide26
Maintain Good Sleep Habits
Keep A Regular Sleep/Wake Cycle
Develop A Pre-Sleep Routine
Reserve Bedroom for Sleep and Intimacy
Avoid Naps
If You Can’t Sleep Get Out of BedSlide27
Create An Optimal Sleep Environment
Control Bedroom Noise
Block Out Light
Keep It Cool and Well Ventilated
Hide The Clock
Make Your Bed ComfortableSlide28
Sleep Saboteurs
Limit Caffeine
Use Alcohol Cautiously
Stop Smoking or Chewing Tobacco
Find Right Balance of Fluids
Avoid Heartburn FoodSlide29
Seek Help For Persistent Sleep ProblemsSlide30
Behavioral Treatments of
Insomnia
Reconditioning/Stimulus Control
Sleep Restriction
Relaxation TechniquesSlide31
Reconditioning/Stimulus Control
Go To Bed Only When Sleepy
Use Bed Only For Sleep or Sex
Get Up After 20 Minutes of No Sleep
Repeat Step 3 As Needed
Get Up At Same Time Every Morning
No NapsSlide32
Sleep Restriction
Less Time In Bed Promotes More Efficient Sleep
Estimate Sleep and Subtract From Wake Up Time
Continue Adding 15 to 30 Min
Less Than 5 Hours Not Recommended—Consult MDSlide33
Relaxation Techniques
Progressive Muscle Relaxation
Deep Breathing
Meditation
Visualization
BiofeedbackSlide34
Cognitive Therapy
Misattributions
Hopelessness
Unrealistic Expectations
Exaggerating Consequences
Performance AnxietySlide35
Cognitive Behavioral Therapy
Often Provided with Behavioral Therapy—Cognitive Behavioral Therapy (CBT)
CBT More Effective Than Any Behavioral Therapy Alone
More Effective Than Sleeping Pills
Largest Obstacle Lack of Patient CommitmentSlide36
Sleeping Pills
10 Percent Adults Use Prescription or OTC Sleep Meds
Short-Term Solution Causes Long Term Problem
Do Not Help People Become Normal Sleepers
Fail To Treat Causes of InsomniaSlide37
Herbal Supplements
Valerian
Lavender
Chamomile
Passionflower
MelatoninSlide38
Bibliography
Ohayon MM. Epidemiology of Insomnia: what we know and what we still need to learn. Sleep Med Rev. 2002:;6:97-111
National Sleep Foundation. Summary of Findings: 2005 Sleep in America Poll. March 2005.
http://www.sleepfoundation.org
Alattar M, Harrington JJ, Mitchell CM, et al. Sleep problems in primary care: a North Carolina Family Practice Research Network study. J Am Board Faro Med. 2007;20:365-374Slide39
Bibliography Continued
(4) NIH State-of-the-Science Conference Statement on manifestations and management of chronic insomnia in adults. NIH Consens State Sci Statements. 2005; 22:1-30
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4
th
ed, Text Revision (DSM-IV-TR). Washington, De: American Psychiatric Association; 2000:597-663
Sateia
MJ, Pigeon WR. Identification and management of insomnia. Med
Clin
North Am. 2004;88:567-596Slide40
Bibliography Continued
(7) American Academy of Sleep Medicine. International Classification of Sleep Disorders, revised: Diagnostic and Coding Manual. Chicago, IL,: American Academy of Sleep Medicine; 2001
(8) Insomnia in the primary care practice. Journal of Family Practice, April, 2008
(9) Gregg D Jacobs, PhD Say Good Night To Insomnia, Henry Hold and Company, LLC 115 West 18
th
Street, New York, New York 10011Slide41
Bibliography Continued
(10) Lawrence J. Epstein, MD The Harvard Medical School Guide To A Good Night’s Sleep, McGraw Hill, 2007
(11) William C Dement, MD, PhD and Christopher Vaughan The Promise of Sleep, 1999, Dell Publishing, A division of Random House, Inc, 1540 Broadway, New York, New York 10036