Therapy & Medication for Insomnia
Sleep is one of the most important psychological and physical processes. Sleep is an active process fundamental to brain function, mental health, key physical processes and survival.
What is Insomnia?
Insomnia is a sleep disorder suffered by 35% of adults! The American Academy of Sleep Medicine defines insomnia as a perceived difficulty falling asleep or staying asleep, poor sleep quality, waking too early, or the inability to get the amount of sleep a person needs to function effectively.
Insomnia can cause daytime impairment that affects your mood, attention, and memory, causes fatigue or low energy, results in errors and accidents at work and while driving, or negatively impacts social and occupational function. It can trigger headaches, gastrointestinal symptoms, daytime sleepiness, mood disturbances, irritability, and can aggravate worries.
What is the Difference Between Acute and Chronic Insomnia?
Insomnia can be acute or chronic and these two variants require different approaches. Acute insomnia is short-term, lasting less than three months but often occurs for just a few days to a few weeks. It is the most common type and is associated with a stressful life event like a loss, a medical diagnosis, or a major change in a relationship or job, and can occur as a rebound when a medication is discontinued. Acute insomnia can become chronic. For this reason, it sometimes warrants attention by a therapist or psychiatrist, particularly because chronic insomnia is associated with and often precedes the onset of major depression. Most causes of acute insomnia resolve on their own without any formal treatment.
Chronic insomnia is defined as sleep disturbance experienced at least three nights a week for at least three months. It is not likely to fully resolve on its own. Instead, chronic insomnia is characterized by cycles of relapse and remission or by persistent symptoms. It can be impacted by stress, irregular sleep schedules, poor sleep habits, eating too late in the evening, persistent nightmares, mental health disorders, an underlying physical or neurological problem, medications, or a bed partner. It can sometimes be a symptom of other sleep disorders such as sleep apnea.
Who is Affected by Insomnia?
Insomnia is a common occurrence in all sociodemographic groups. It is a particularly common sleep disorder in older adults (up to 50% of them report symptoms of insomnia) and a risk factor for poor physical and mental health. Also, women frequently experience insomnia caused by hormone changes during menstruation and menopause.
The Risks of Insomnia
Sleep and mental health go hand in hand. Mental health problems are common causes of insomnia, and insomnia can worsen mental health conditions. Chronic insomnia is also an important risk factor for common medical conditions including cardiovascular disease, hypertension, type 2 diabetes, GERD, and asthma.
How is Insomnia Diagnosed?
The diagnosis is established by a detailed history of sleep behaviors and an exploration of medical and mental health disorders that might be causing the insomnia, including examining the role of medications and recreational substance use. Sometimes a record of sleep patterns is recorded in a sleep diary. A sleep study is generally not indicated, absent other symptoms.
How is Insomnia Treated?
Medication and psychotherapy can both have a role in treating insomnia. For acute insomnia associated with stressors, short term medication can be very effective. For chronic insomnia, cognitive behavioral therapy, including a form of cognitive behavioral therapy specifically developed for insomnia (“CBT-I”) is a particularly safe and effective treatment and has been shown to be superior to medication for chronic insomnia. CBT-I sessions will include sleep education, sleep restriction (eliminating naps, changing bed times), restricting behaviors like eating or reading in bed or late-night use of digital devices, and promotes the use of the bed for sleep only. Some sessions may include relaxation therapy such as practicing breathing exercises, meditation or yoga, and stress management with mindfulness training.
When you or a loved one has difficulty with sleep to the extent that it interferes with function, contact The Midtown Practice. We can help you identify the cause of your insomnia and provide appropriate treatments to improve your sleep.
Edinger, J. D., Bonnet, M. H., Bootzin, R. R., Doghramji, K., Dorsey, C. M., Espie, C. A., Jamieson, A. O., McCall, W. V., Morin, C. M., Stepanski, E. J., & American Academy of Sleep Medicine Work Group (2004). Derivation of research diagnostic criteria for insomnia: report of an American Academy of Sleep Medicine Work Group. Sleep, 27(8), 1567-1596. https://doi.org/10.1093/sleep/27.8.1567
Schutte-Rodin, S., Broch, L., Buysse, D., Dorsey, C., & Sateia, M. (2008). Clinical guideline for the evaluation and management of chronic insomnia in adults. Journal of clinical sleep medicine: JCSM : official publication of the American Academy of Sleep Medicine, 4(5), 487-504.
Scott, A. J., Webb, T. L., & Rowse, G. (2017). Does improving sleep lead to better mental health? A protocol for a meta-analytic review of randomised controlled trials. BMJ open, 7(9), e016873. https://doi.org/10.1136/bmjopen-2017-016873
Baglioni, C., Nanovska, S., Regen, W., Spiegelhalder, K., Feige, B., Nissen, C., Reynolds, C. F. III, & Riemann, D. (2016). Sleep and mental disorders: A meta-analysis of polysomnographic research. Psychological Bulletin, 142(9), 969-990. https://doi.org/10.1037/bul0000053
Kahn, M., Sheppes, G., & Sadeh, A. (2013). Sleep and emotions: bidirectional links and underlying mechanisms. International journal of psychophysiology : official journal of the International Organization of Psychophysiology, 89(2), 218-228. https://doi.org/10.1016/j.ijpsycho.2013.05.010
Harrington, M. O., Ashton, J. E., Sankarasubramanian, S., Anderson, M. C., & Cairney, S. A. (2021). Losing Control: Sleep Deprivation Impairs the Suppression of Unwanted Thoughts. Clinical psychological science : a journal of the Association for Psychological Science, 9(1), 97-113. https://doi.org/10.1177/2167702620951511
Patel, D., Steinberg, J., & Patel, P. (2018). Insomnia in the Elderly: A Review. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 14(6), 1017-1024. https://doi.org/10.5664/jcsm.7172
Burman D. (2017). Sleep Disorders: Insomnia. FP essentials, 460, 22-28.
Bollu, P. C., & Kaur, H. (2019). Sleep Medicine: Insomnia and Sleep. Missouri medicine, 116(1), 68-75.
Riemann, D., & Voderholzer, U. (2003). Primary insomnia: a risk factor to develop depression? Journal of affective disorders, 76(1-3), 255-259. https://doi.org/10.1016/s0165-0327(02)00072-1