September 2016 - Dr. Charles Freeman - San Diego Insomnia and Sleep Problems Treatment

Man lying in bed at night using his phone, with blue screen light, a common cause of poor sleep

Common Treatments for Sleep Disorders

Common Treatments for Sleep Disorders Sleep disorder treatments fall into a variety of categories, including sleep hygiene, psychotherapy, medications ranging from mild over-the-counter sleep aids to powerful sleep sedatives and hypnotics, and holistic approaches. It is not uncommon for two or more treatment approaches to be used concurrently. Sleep Hygiene Sleep hygiene is defined as the various practices put into place to support normal, quality nighttime sleep and full daytime alertness (National Sleep Foundation). It includes habits such as avoiding napping; decreasing or eliminating stimulants such as caffeine, nicotine, or alcohol; getting enough exercise; establishing a bedtime routine; and arranging the bedroom for optimal sleep (i.e., decreasing the temperature, eliminating unnecessary light, and removing technology devices). It can also include such practices as avoiding clock watching when in bed, exposing oneself to bright light or sunlight after waking, refraining from large meals before bedtime, and keeping a regular wake and bedtime schedule. While sleep hygiene can help the average person address general sleep difficulties, it alone is not sufficient to overpower the symptoms of major sleep disorders. With true sleep disorders, a combination of multiple treatment approaches earns the most effective results. Therapy Cognitive behavioral therapy, which looks at the relationships between the mind, body, emotions, behaviors, and illness, is the gold standard of therapeutic care for treatment of sleep disorders such as insomnia. This therapeutic approach helps clients to make behavioral changes to improve sleep hygiene, while also changing thought patterns to decrease the catastrophic thinking, anger, frustration, or hopelessness that is common for clients struggling with sleep disorders. Therapeutic tools like sleep journals, cognitive restructuring, guided imagery, and hypnosis can help clients gain objectivity about their sleep and grow out of the destructive narrative that leads to the anger and worry. Medication Medications such as sedative-hypnotics are commonly used to treat sleep disorders, though some research argues that they are not the most effective form of treatment. While they do increase an individual’s overall quantity of sleep, they do not always increase the quality of sleep. These medications can impact brain chemistry and often leave clients feeling groggy, foggy, unclear, and drained of energy, even after a full night’s sleep. They can also, over time, increase mortality risks. That being said, sedative-hypnotics may be helpful as a short-term treatment for sleep disorders, but therapeutic and holistic approaches to treatment are much more effective and safer. Holistic Approaches There are several holistic treatments that can help decrease or eliminate sleep disorders. For example, clients can learn to use self-hypnosis or meditation at bedtime, which can not only help decrease a client’s worry and anxiety, but also work to relax the sympathetic nervous system and increase the client’s probability of falling asleep. Similarly, activities like regular exercise, acupuncture, and massage can also have positively impact on a client’s body and mental state, decreasing symptoms of sleep disorders and resulting in greater sleep quality. MY APPROACH Sometimes, sleep disorders are the root issue for a client’s sleep difficulties. Oftentimes, however, sleep disorders are just a symptom of a bigger problem, be it a physical ailment or a psychological condition. For example, symptoms of PTSD, complex grief, or trauma can all manifest as insomnia. In these instances, treating the insomnia can help improve quality of sleep but will not necessarily treat the root issue. For this reason, sleep hygiene usually is not sufficient – the underlying issue has to be treated as well. I call myself a holistic behavioral medicine psychologist. I believe in the power of SSRIs like Celexa, or Effexor, or Lexapro, or Paxil, or Prozac, and know they can be very effective people with complex anxiety, depression, or insomnia. I also believe, however, that treatment needs to address more than just the symptom. It needs to get to the core issue, and I use therapeutic and holistic treatments for this. In my practice treating sleep disorders, I always incorporate at least two forms of treatment to help my clients. Integrating cognitive behavioral therapy techniques with more holistic forms of treatment allows the client and me to identify the root cause to provide more sustainable results by looking at several aspects of their well-being. My approach blends cognitive restructuring with things like hypnosis meditation to teach people how to overcome areas where they’ve gotten stuck, whether it is a sleep disorder or something more. Studies show that people can function on five and a half hours of sleep, which is considered the core physiology sleep. When people who suffer from sleep disorders get five and a half to six and a half hours and are prone to catastrophizing, it is important to reinforce to them that they are actually getting their core physiological restorative sleep, their stage 3 and 4 delta EEG wave sleep, which allows them to function sufficiently throughout the day. Acceptance and tolerance can also have a big impact on treatments for sleep disorders. When clients start catastrophizing, trying to find the ‘whys,’ or predicting the future, they are actually increasing their anxiety and increasing the activity in their sympathetic nervous system. At that point, I coach clients to let go of the need to know why. I help them redirect their efforts to focus on the solution, and direct them to stop doing research and searching the internet to learn more about the problem. When clients are prone irritability or susceptible to anxiety or depression, cognitive reframing can help them shift their perspective to tolerate sleep loss and have an above average day. Sleep mantras can be helpful in building acceptance. I like help people incorporate sleep mantras such as “Even though I haven’t slept well in the last 2-3 days, I now have more sleep inertia or sleep drive. And therefore it increases the likelihood that I’ll sleep well tonight or tomorrow night.” into their nightly habits. I guide my patients to say that they will sleep well tonight or tomorrow night so they don’t put a lot of pressure on themselves that they

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How to help insomnia through practical questions and solutions written on a napkin beside a coffee mug

How to Help Insomnia: Focus on Solutions, Not Causes

Cognitive Behavioral Therapy (CBT), Insomnia, Sleep Psychology, Treatment for Sleep Disorders / admin

How to Help Insomnia: Focus on Solutions, Not Causes By Dr. Charles R. Freeman, Ph.D. How to help insomnia is one of the most common questions I hear from patients. Many people spend years searching for reasons they cannot sleep, hoping that understanding the cause will solve the problem. While insight can sometimes be helpful, learning how to help insomnia usually involves practical strategies that improve sleep, reduce anxiety, and restore healthy daily functioning. Every week I remind patients that “why” questions are often less important than “how” questions. Instead of spending months searching for every possible explanation, we focus on how to reduce symptoms, improve sleep, regain emotional balance, and restore quality of life. People usually seek therapy because they want relief from suffering, not because they want a detailed historical analysis of every factor that contributed to their current challenges. How to Help Insomnia by Looking Forward Many people assume that if they can identify the exact cause of their insomnia, everything will improve. Unfortunately, life is rarely that simple. A person may know that their sleep difficulties began after a divorce, a medical diagnosis, a traumatic event, financial stress, or a period of overwhelming responsibility. Understanding that history can provide valuable context, but it does not automatically eliminate sleep problems. The same principle applies to anxiety, depression, chronic pain, and post-traumatic stress disorder. Insight can be useful, but insight alone rarely changes behavior. Lasting improvement usually occurs when people learn practical skills that help them respond differently to thoughts, emotions, physical symptoms, and daily stressors. Many patients spend years trying to answer questions that have no clear answer. Even when answers exist, they often do not create meaningful change. Treatment becomes more productive when attention shifts from asking why symptoms developed to asking how symptoms can improve. How to Help Insomnia Using CBT One of the most effective approaches for treating insomnia sleep disorder symptoms is Cognitive Behavioral Therapy for Insomnia, often called CBT-I. Research consistently shows that CBT-I can help people improve sleep quality, reduce nighttime anxiety, and achieve long-term improvements in sleep without relying solely on medication. CBT helps people identify thoughts, habits, and behaviors that contribute to trouble sleeping. Many individuals with chronic insomnia develop patterns that unintentionally strengthen the problem. They may spend excessive time in bed, worry constantly about sleep, monitor the clock throughout the night, or develop fears about the consequences of poor sleep. CBT-I teaches practical skills that help break these patterns. Instead of fighting with sleep, patients learn strategies that strengthen the body’s natural sleep system and reduce the mental and emotional factors that contribute to insomnia. For many people, CBT-I becomes one of the most effective forms of sleeplessness treatment because it addresses both behavior and thinking patterns rather than simply masking symptoms. Sleep and Mental Health Sleep and mental health are closely connected. Anxiety, depression, trauma, and chronic stress frequently contribute to sleep difficulties. At the same time, lack of sleep can worsen emotional distress and make existing symptoms more difficult to manage. When people experience ongoing sleep problems, they often report increased irritability, reduced concentration, lower frustration tolerance, and greater emotional reactivity. Small challenges can begin to feel overwhelming when the brain is not receiving adequate restorative sleep. This relationship works in both directions. Poor sleep can contribute to anxiety and depression, while anxiety and depression can make it more difficult to sleep. Successful treatment often requires addressing both sleep and mental health at the same time. As sleep improves, many patients notice improvements in mood, energy, motivation, concentration, and overall well-being. How to Help Insomnia with Practical Solutions My approach to treatment focuses heavily on practical solutions. During the initial sessions, we spend some time understanding the history of symptoms and identifying important contributing factors. That information helps guide treatment, but it does not become the primary focus of therapy. Instead, we concentrate on helping people develop skills that produce measurable improvements in daily life. For some individuals, treatment may focus on improving sleep habits and reducing behaviors that interfere with healthy sleep. Others may benefit from stress-management techniques, emotional regulation skills, cognitive restructuring, or behavioral interventions that help decrease anxiety and improve coping. Many patients are surprised by how much progress they can make when they stop searching endlessly for explanations and begin focusing on actionable steps that support recovery. Beyond Traditional Talk Therapy Psychology has evolved considerably over the past several decades. Traditional insight-oriented approaches contributed important ideas to the field, but modern treatment increasingly emphasizes evidence-based methods that help people achieve meaningful results. Depending on the individual’s needs, treatment may include Cognitive Behavioral Therapy, Cognitive Behavioral Therapy for Insomnia (CBT-I), Eye Movement Desensitization and Reprocessing (EMDR), Emotional Freedom Techniques (EFT), Dialectical Behavior Therapy (DBT), clinical hypnosis, Positive Psychology, and other evidence-based interventions. These approaches focus on building skills, increasing resilience, changing unhelpful patterns, and helping individuals gain greater control over their thoughts, emotions, and behaviors. Lifestyle Factors Matter Many people underestimate the role that lifestyle plays in emotional health and sleep quality. Nutrition, exercise, stress management, social connection, and a sense of purpose can all influence mental and physical well-being. Healthy sleep habits support emotional resilience. Regular physical activity can reduce stress and improve sleep quality. Meaningful relationships provide support during difficult times. Activities that create a sense of purpose often strengthen psychological health and improve overall life satisfaction. When these factors improve, sleep often improves as well. How to Help Insomnia and Regain Control Whether you are struggling with insomnia, anxiety, depression, PTSD, chronic pain, or other challenges, the goal of treatment is not simply to understand what happened in the past. The goal is to develop practical tools that help you function more effectively in the present and create a healthier future. Understanding your story can be valuable. Learning how to change your daily experience is often far more powerful. If you are searching for how to help insomnia, the answer usually involves more than identifying causes. Effective treatment focuses on practical solutions, evidence-based strategies, healthier habits, and new ways of responding to stress and

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Woman sleeping under a duvet beside a red alarm clock on the nightstand

The Basics of Sleep

Sleep Psychology / admin

The Basics of Sleep “Sufficient sleep is not a luxury – it is a necessity – and should be thought of as a vital sign of good health.” ~ Wayne H. Giles, MD, MS, Director, Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion. It’s not uncommon for clients we work with to experience difficulty sleeping from time to time. Perhaps there is a major life event occurring, or things have been very stressful at work. In these cases, however, the client’s challenges with falling or staying asleep are short-term, situational, and dependent on external life circumstances. Acute sleep difficulties such as these are vastly different from the chronic and consequential problems of a sleep disorder, which are ongoing and much more problematic. Defined as difficulties falling or staying asleep, falling asleep at the wrong times, sleeping too much, or abnormal behaviors during sleep (University of Maryland Medical Center), sleep disorders affect approximately 70 million Americans today (Cleveland Clinic). There are approximately 80-100 different types of sleep disorders that fall into the following four main categories (University of Maryland Medical Center): Insomnia – Defined as problems falling and staying asleep, insomnia can be short-term (lasting 3 weeks or less) or chronic and long lasting, often plaguing a client for months or years. Excessive Daytime Sleepiness – Defined as problems staying awake, excessive daytime sleepiness can be caused by the sleep disorder Narcolepsy. It can also be caused by medical conditions such as fibromyalgia, low thyroid function, or viral illnesses such as mononucleosis. Sleep Rhythm Problems – Defined as problems following a regular sleep schedule, sleep rhythm problem is often caused by irregular sleep-wake syndrome, paradoxical insomnia, or shift work sleep disorder. A minor cause of this that has an acute affect on millions of people is jet lag. Sleep-Disruptive Behaviors – Defined as unusual behaviors during sleep, sleep-disruptive behaviors include restless leg syndrome, sleep terrors, sleepwalking, and REM sleep-behavior disorder, which causes an individual to move and potentially act out dreams during REM sleep. Sleep disorders such as these can be very difficult to treat and if ongoing, can lead to major health concerns. CONSEQUENCES OF SLEEP DEPRIVATION Adequate rest and sleep are imperative for good mental and physical health, and are required to function effectively in our daily lives. A well-rested brain is needed for optimal performance in such areas as processing, retaining, and recalling information; effective decision-making; storing memories; and managing emotions. A well-rested body is needed for optimal performance in areas such as quick reflexes, sustained energy level and energy endurance, and a responsive immune system. Consequently, untreated sleep disorders and ongoing sleep deprivation can severely affect one’s mental and physical well-being. It is common knowledge that sort-term consequences of sleep deprivation include increased stress and anxiety, errors in judgment, irritability and other mood problems, decreased performance, and decreased alertness leading to accidents or other traumatic events. It is less known, however, that chronic sleep deprivation can have a lasting, detrimental impact on the body and mind overtime. Research has shown that sufficient sleep plays a prominent role in long-term health and the body’s ability to ward off chronic diseases and medical conditions. It is said to be a key aspect of chronic disease prevention, while insufficient sleep has been linked to diseases and disorders such as diabetes, cardiovascular disease, obesity, hypertension, depression, anxiety, and increased addictive behaviors (NCBI). About the Author Dr. Charles R. Freeman, Ph.D., is a psychologist specializing in insomnia, sleep disorders, PTSD, anxiety, trauma, and Cognitive Behavioral Therapy for Insomnia (CBT-I). He has more than 25 years of experience helping individuals improve sleep, emotional well-being, and overall quality of life through evidence-based treatment approaches. If you would like to learn more about treatment options or schedule a consultation, please contact Dr. Freeman. The information in this article is provided for educational purposes only and is not intended to replace professional medical or psychological advice. Individual circumstances vary, and readers should consult a qualified healthcare professional regarding their specific concerns.

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