Treating Insomnia and Promoting Good Sleep Hygiene

Transcription

1 E-Resource January, 2016 Treating Insomnia and Promoting Good Sleep Hygiene Between 10-18% of adults in the general population and up to 50% of adults in the primary care setting have difficulty sleeping. Sleep problems are even more prevalent in the psychiatric setting, affecting 50-80% of these patients. Though sleep problems are often viewed as a symptom of psychiatric disorders, studies demonstrate they may raise the risk for, contribute to the development of psychiatric disorders and/ or exacerbate the symptoms of existing behavioral health conditions. This newsletter contains useful information and clinical guidance for detecting and managing insomnia in primary care Insomnia, one of the most common sleep disorders, is the experience of inadequate or poor quality sleep characterized by: Difficulty falling asleep Difficulty maintaining sleep Waking up too early in the morning The occurrence of non-refreshing sleep Insomnia may lead to daytime symptoms including feeling tired, lacking energy, difficulty concentrating, and irritability. Sleep Disorders in Psychiatric Patients Depression: Sleep problems are common among depressed patients. Most suffer from insomnia, however obstructive sleep apnea is also common. Sleep problems may contribute to an increased risk of developing depression and reduce the effectiveness of depression treatment. Depressed individuals with sleep disturbances are also more likely to think about suicide and die by suicide than depressed patients who are able to sleep normally. Bipolar Disorder: Sleep problems are common among bipolar patients; some report experiencing insomnia while others report hypersomnia (excessive sleep). Insomnia may worsen during manic episodes and may also contribute to the occurrence of these episodes. Anxiety: Sleep problems affect individuals with generalized anxiety disorder, post-traumatic stress disorder, panic disorder, obsessive compulsive disorder and phobias. Insomnia may be a risk factor for developing anxiety and may worsen anxiety symptoms and prevent recovery. Management and Treatment In cases of acute insomnia, the need for treatment is based on the severity of a patients daytime symptoms, duration of insomnia episodes, and predictability of episodes. Acute insomnia may require treatment if a patient becomes significantly sleepy during the day after losing sleep on one or more nights. Acute insomnia which is left untreated may develop into a more chronic condition. In cases of chronic insomnia, multiple treatment approaches may be necessary. If there is an underlying psychiatric medical or psychiatric condition, this condition should be treated first. In the case that the insomnia is primary and persists beyond treatment of the underlying condition, there are multiple treatment options, including behavioral treatment approaches and pharmacological treatment approaches. Behavioral treatment approaches: Lifestyle changes: avoid caffeine, nicotine and alcohol (especially before bedtime) Regular physical activity: helps people fall asleep faster, spend more time in deep sleep and awaken less during sleep Relaxation therapy: meditation, guided imagery, deep breathing exercises, progressive muscle relaxation Cognitive therapy: identify dysfunctional beliefs and attitudes about sleep and replace them with more adaptive thoughts Sleep Hygiene Tips: 1) The right space. It is very important that your bed and bedroom are quiet and comfortable for sleeping. A cooler room with enough blankets to stay warm is best, and make sure you block out early morning light and consider earplugs if there is noise outside your room. 2) Bed is for sleeping. Try not to use your bed for anything other than sleeping and sex, so that your body comes to associate bed with sleep. Avoid being in bed to watch TV, eat, read, work on your laptop, pay bills, and other things,. 3) Sleep when sleepy. Only try to sleep when you actually feel tired or sleepy, rather than spending too much time laying awake in bed. 4) Establish a bedtime ritual. Establishing pre-sleep habits/rituals helps train the body that it is time to sleep. Whether it be relaxing stretches or breathing exercises, or reading calmly for a few minutes, a routine can be helpful. 5) Get up & try again. If you are not sleeping after about 20 minutes or more, get up. Do something calming or boring until you feel sleepy, then try again. Sit quietly on the couch with the lights off (bright lights and electronic screens will awaken your brain), or read at low light. 6) Avoid caffeine & nicotine in the late afternoon and evening. Any caffeine (in coffee, tea, cola drinks, chocolate, and some medications) or nicotine (cigarettes) may act as stimulants and interfere with the ability to fall asleep. 7) Avoid alcohol. It is also best to avoid alcohol for at least 4-6 hours before bed. While alcohol may help someone get to sleep, it actually interrupts the quality of sleep and leads to frequent awakening. Pharmacological treatment approaches: When nondrug interventions are insufficient in treating sleeping disorders, treatment with medication is an additional option. An algorithm for treatment of chronic insomnia is provided (page 6). Further, a list of pharmaceutical therapy options is provided (page 7). Care should be taken to ensure patients with comorbid psychiatric conditions are treated appropriately; while some medications for insomnia can be used to treat a co-occurring psychiatric conditions, other insomnia medications may exacerbate psychiatric symptoms. About the Virtual Guidance Program JPS Health Network is proud to offer a new behavioral health clinical guidance resource to all primary care providers in our region. The JPS Behavioral Health Virtual Resource service offers: Telephone consultation with a behavioral health clinical team member Referral to community resources benefiting behavioral health patients Online reference library of behavioral health education materials Educational opportunities to increase provider understanding and comfort level in treating behavioral health conditions.

2 Diagnostic Criteria

3 Adult Insomnia: Assesment to Diagnosis. February Revised February 2007.

4 Treatment Algorithm for Sleeping Disorders

5 Schutte-Rodin S; Broch L; Buysse D; Dorsey C; Sateia M. Clinical guideline for the evaluation and management of chronic insomnia in adults. J Clin Sleep Med 2008;4(5):

6 Sleep Diary

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