Behavioral Sleep Medicine (B.S.M.) is an effective non-drug therapy for sleeping problems. B.S.M. includes cognitive behavioral treatment for a variety of sleeping disorders, including insomnia, circadian rhythm disorders, obstructive sleep apnea, and pediatric sleeping disorders. Poor sleep can be a contributor to the development of mood disorders such as depression and anxiety, and mood disorders often contribute to disruption of sleep.
Let’s look at factors that might lead to the development of insomnia. Psychological factors such as stress and anxiety related to day coping can lead to difficulty falling asleep. Stressful events, such as a family crisis, car accident, and even happy events such as getting married can also interfere with the ability to fall asleep. Short-term difficulties falling asleep sometimes lead to anxiety regarding to fall asleep, which can cause long-term sleep disorders such as insomnia.
Health issues such as chronic pain or arthritis can interfere with falling and staying asleep, including issues with positioning, muscle tone, and mobility. Up to forty percent of individuals affected by neuromuscular disease suffer from a sleeping disorder. Elimination problems such as increased frequency at nighttime can lead to frequent nighttime waking and disrupted sleep. Over time, factors such as these may lead to a person developing chronic insomnia.
Treatment for insomnia involves a combination of techniques tailored to the individual client. Techniques include behavioral methods to improve habits that impair the ability to sleep well and cognitive methods to develop positive thoughts and attitudes regarding sleep.
Research strongly supports the use of B.S.M. for insomnia. According to the National Institutes of Health (2005), cognitive behavioral therapy for insomnia has been found to be “as effective as medication for short-term treatment of chronic insomnia.” The Practice Parameters developed by the American Academy of Sleep Medicine (2018) support cognitive behavioral therapy as effective and recommended treatment for insomnia.
Specific cognitive behavioral techniques used for insomnia include stimulus control, sleep restriction, relaxation training, sleep hygiene training, and cognitive-behavioral methods. Psychotherapy for other mental health issues that interfere with sleep such as anxiety and depression may also be used.
Treatment for other sleeping disorders, such as obstructive sleep apnea (OSA), also uses cognitive behavioral techniques (AASM, 2018). Individuals with OSA experience periods of difficulty breathing and/or periods of cessation of breathing due to obstructed airflow during sleep. Untreated, sleep apnea can cause fatigue and/or headaches during the day, and nightmares and poor quality of sleep during the night. Individuals with untreated OSA are also at increased risk for mental health disorders such as depression and anxiety. Further, sleep apnea may cause significant health consequences, such as cardiac and metabolic issues, and increased risk for vehicle accidents.
Specific cognitive behavioral techniques may be used to increase a person’s ability to tolerate medical treatment for Obstructive Sleep Apnea. For example, desensitization procedures may be used to decrease anxiety related to using ventilator assistance such as CPAP or BiPAP.
In order to assess for and treat medical issues that contribute to disorders of sleep, individuals seeking Behavioral Sleep Medicine services should also consult with their physician. Behavioral Sleep Medicine, used in conjunction with appropriate medical interventions, can help individuals to get a better night’s sleep and to function better during the day.
References:
Meir, H., et al., (2010). Principles and Practices of Sleep Medicine (Fourth Edition), Elselvier Saunders: Philadelphia, PA.
AASM.org (2018). Practice guidelines. Available at http://www.aasmnet.org/practiceparameters.aspx?cid=109 . Retrieved 4/30/18.
By Jori Reijonen, Ph.D.
She is fully licensed as a psychologist in Michigan. She has also been Certified in Behavioral Sleep Medicine by the American Academy of Sleep Medicine. Dr. Reijonen currently practices with Thriveworks in their Kalamazoo, Michigan office, and is available to see children and families, as well treating individuals experiencing problems issues with sleep.
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