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Insomnia Treatment

Insomnia

I have specialised in the treatment of chronic insomnia and other sleep disorders for most of my career, combining cognitive behavioural therapy, strategies to optimise circadian drive, and techniques to foster appropriate thermoregulation. People seek help for insomnia with problems including:

  • Difficulty falling asleep: This is often what most people associate with insomnia. It is characterised by lying awake for a long time before sleep arrives.

  • Excessive awakenings: People with insomnia struggle to return to sleep from awakenings during the night, leading to fragmented and unrefreshing sleep.

  • Early morning awakening: Some people with insomnia wake up too early and cannot return to sleep. This leads to a significantly reduced sleep duration.

  • Restless and unsatisfactory sleep: Despite spending adequate time in bed, people with insomnia often feel that their sleep is light, restless, or of poor quality. They may even have the feeling of being awake throughout the night even if they did sleep.

  • Daytime impairment: Chronic insomnia leads to various daytime problems, including fatigue, mood disturbance, difficulty focusing, impaired memory, and reduced motivation. These problems can affect personal life, work life, or other areas.

  • Preoccupation with sleep: People suffering from insomnia often worry about their sleeplessness and the consequences of not sleeping. The increased negative thinking and emotion can, in turn, exacerbate the sleeplessness, creating a vicious cycle.

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Sleep Pressure and Circadian Rhythm: A Primer

Sleep is regulated to a large degree by two interacting systems: sleep pressure and the circadian drive. Restoring good quality sleep requires an understanding of their roles.

  • Sleep pressure: This drive becomes stronger with the length of time that a person has been awake. This system makes a person increasingly likely to sleep after a sufficiently long period of wakefulness.

  • Circadian Rhythm: Functioing as an internal clock, the circadian rhythm maintains the 24-hour cycle, regulating periods of sleepiness and wakefulness. It creates the inherent 'drive' for staying awake during the day and staying asleep during the night (for most people).

  • Interplay Between the Systems: The combination of sleep pressure and circadian rhythm determines our sleeping patterns. Disruption in these systems can lead to insomnia.

  • Treatment Approach: Addressing insomnia means optimising both sleep pressure and the circadian rhythm. Treatment success typically requires environmental adjustments, fine-tuning daily routines, and implementing specific strategies and protocols to enhance sleep quality.

Cognitive Behavioural Therapy for Insomnia
Cognitive Behavioural Therapy for Insomnia, or CBT-I is a leading treatment for insomnia. It is free from some of the potential risks associated with sedative medication. This active intervention focuses on thought processes, emotions, behaviours, and environmental factors that affect sleep. This intervention involves learning new habits that promote sound sleep.

  • Cognitive Component: CBT-I helps you tackle the problematic thoughts and beliefs that hinder your ability to sleep. By understanding and addressing these cognitive barriers, you can free yourself from the negative thoughts and worries that often keep you awake.

  • Behavioural Component: This aspect of CBT-I emphasises the development of positive sleep habits while eradicating behaviours that might disrupt sleep. Techniques may include stimulus control therapy, sleep compression, relaxation techniques, paradoxical intention, and others.

  • Addressing Additional Factors: Insomnia therapy also considers the magnitude and alignment of your circadian rhythm, along with facilitating the body temperature changes associated with sleep. Implementing the right routines and environmental adjustments plays a crucial role in this process.

  • Personalised Sleep Plan: Tailoring a sleep plan to your specific situation is essential, as it involves careful assessment and planning. By following this approach, you become your own sleep therapist, maintaining your progress and recovering quickly from potential future lapses.

To address your insomnia with these techniques, book online or email me.

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