by Natasha Wolff | November 17, 2015 11:00 am
We’re a nation of bad sleepers. It’s gotten to the point that the CDC is calling insufficient sleep a public health epidemic. Currently 30 to 40 percent of adults experience full-blown insomnia at some point each year, according to the National Center for Sleep Disorders Research, and an especially tired subset—10 to 15 percent—have chronic insomnia.
The exact definition of what actually constitutes “insomnia” varies depending on who you ask, so it may be hard to tell if you’re one of them. But if you have difficulty falling asleep, staying asleep or have “non-restorative sleep” three times a week over the course of a month, you’ve probably earned some bleary-eyed bragging rights.
New studies about the importance of sleep are waking up the medical and psychological fields. (One particularly disconcerting study from the Journal of Neuroscience recently links loss of sleep to loss of brain cells—not exactly what you want racing through your mind in the middle of the night.) The attention sparked the American Psychological Association to recognize sleep psychology as a specialty in professional psychology, and it’s caused a boom in sleep therapy specialists. This past fall, the American Board of Sleep Medicine certified 400 sleep experts to administer insomnia therapy, adding to only a handful of existing accredited experts.
“Insomnia is a greatly undertreated disorder,” says Christina McCrae, PhD, a psychologist at the Insomnia & Behavioral Sleep Medicine Clinic at the University of Florida. “Our society values work over health. We often reward those to are short sleepers and long workers. The downside is our health.”
For years, professionals of all kinds—MDs, psychologists, even hypnotists—have treated sleep disorders from sleepwalking to apnea to excessive daytime fatigue. But for many insomniacs, standard treatment, including sleep medications—and there’s always a new hyped one to try out—simply don’t do the trick.
Happily, there’s a new kind of help. The specialty known as cognitive behavioral therapy for insomnia (CBT-i) falls, for the most part, under the jurisdiction of psychologists like McCrae. Cognitive behavioral therapy (CBT), which is all about helping people learn how to change their thoughts in order to change their behaviors, has been around since the 1960s, and has been shown to be effective for treating disorders like anxiety and depression. Now, CBT is being applied to sleep disorders, but it’s hard to find. According to McCrae, there are only a few hundred certified CBT-i specialists at most.
These specialists or “sleep coaches” meet with you to create a package treatment based on your sleep issues. Therapists usually start by teaching you about sleep. (No, you don’t necessarily need eight hours a night. And it’s unclear if people can train themselves to need less sleep.) They also help you shed unrealistic concerns about sleep deprivation. (You won’t die from lack of sleep.)
Therapy always includes sleep hygiene. This means coming up with a sleep schedule that jibes with your natural circadian rhythms, taking into account factors like stress, depression or certain medications. You learn how to kick bad habits. Common culprits are, unfortunately, some of life’s key pleasures: daytime naps, sleeping in on weekends, alcohol, caffeine and lounging in bed.
The two key elements, according to McCrae, are stimulus control—sometimes coupled with relaxation techniques—and sleep restriction. Stimulus control is about finding ways to lower levels of bed-time hyperarousal, like getting your bedroom into sanctuary-like shape: no TV, computer or chores allowed. Your coach may prescribe a time anchor—say 20 minutes—for restless nights, upon which you drag yourself out of bed and go to a different room.
Sleep restriction seems akin to the “exposure” idea of forcing someone to face their fears. Your therapist gives you a routine to induce partial sleep deprivation meant to make your more tired the next night. Once your sleep improves, you get to spend more time in bed.
The best part is that it works—and fast. In February, a study showed that sleep improved in 86 percent of insomnia patients who completed at least three sessions of CBT-i. The standard is usually five, including an evaluation. Some therapists may work with you by phone and occasionally consent to travel to treat a client in their own home.
Due to their scarcity, if you want a certified CBT-i therapist ASAP, you may need to flex your connections. But it’s worth it. “Using someone certified in CBT-i is so important,” says McCrae. “CBT itself isn’t enough. These specialists are aware of things typical therapists aren’t, like advanced or delayed sleep phases, Circadian treatments, and timing sleep phases.” You can check a list of therapists compiled the American Board of Sleep Medicine.
Or if you opt to shop for a general sleep expert, you can search by region on the National Sleep Foundation website. Be warned: If you’re killing time at 3 a.m. surfing for experts, try not getting sucked into site’s Sleep Shop.
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