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A Fix for Broken Sleep That Doesn't Involve Medication

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To fend off nightly tossing and turning, some people with chronic insomnia—difficulty initiating, maintaining or obtaining good-quality sleep—take a sleep medication. But this strategy can have drawbacks.

Sleep medications can induce daytime sleepiness and put you at risk for confusion, falls and accidents. Hypnotic medications in the benzodiazepine group can cause respiratory suppression, particularly when mixed with alcohol or pain medication. And then there’s the issue of dependency.

While these remedies can be safe if properly used, they’re typically meant to be a temporary fix. Drugs don’t address behavioral and other underlying issues that cause nocturnal disturbances.

A safer solution

Unlike sleeping pills, an effective nondrug treatment called cognitive behavioral therapy for insomnia (CBT-i) addresses the underlying causes of sleep disorders. Sleep therapists often recommend CBT-i or a similar behavioral therapy as an initial treatment for insomnia once physical causes, such as a medical illness, a mental health problem, substance abuse or another sleep disorder, are ruled out. CBT-i is sometimes combined with drugs. As insomnia improves, the drug is tapered off.

A meta-analysis of 20 studies of nearly 1,200 participants (average age, 56) by Australian researchers, which appeared in the June issue of the Annals of Internal Medicine, concluded that at least four sessions of therapy significantly improved sleep measures over other nondrug treatments. After their treatment, participants reported improvements in sleep onset latency, or the time it took to fall asleep; the length of time spent awake after they initially fell asleep; total sleep time; and sleep quality.

CBT-i: What to expect

CBT-i methods may vary among therapists, but most forms are a combination of the following five components:

  1. Cognitive therapy involves discussing irrational beliefs you have about sleep, such as always needing to get at least eight hours of sleep, and then attempts to change your thinking patterns.
  2. Stimulus control analyzes your sleep habits and actions that may be keeping you from getting a good night’s rest. Examples of recommended measures include leaving the bedroom if you can’t fall asleep and returning to bed when you feel sleepy.
  3. Sleep restriction aims to decrease the amount of time you’re in bed. Your doctor may recommend going to bed later to create a feeling of sleep deprivation. The goal is to make you feel more tired the next night. This phase of therapy may initially leave you feeling worse but should last only a few days. Once your sleep improves, your doctor will gradually increase your time in bed.
  4. Sleep hygiene education addresses such key elements to a good night’s rest as bedroom environment (keep the room cool, dark and quiet), diet (limit alcohol, caffeine and tobacco intake) and anxiety reducers (turn your clock away from you).
  5. Relaxation encourages you to use techniques to reduce alertness and tension, such as meditation, controlled breathing and progressive muscle relaxation.

CBT-i typically lasts several weeks for two to eight or more sessions. Although CBT-i has been shown to be an effective treatment, access to the therapy is limited since few clinicians are specially trained to perform it. To find a sleep specialist near you, visit the Society of Behavioral Medicine’s Web site ( FindSpecialist.aspx) or the National Sleep Foundation’s site ( find-sleep-professional).  An online program called SHUTo ( is also available.

Posted in Healthy Living on December 25, 2015

Medical Disclaimer: This information is not intended to substitute for the advice of a physician. Click here for additional information: Health After 50 Disclaimer

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