(This page contains details on the treatment methods used by Northern Colorado Sleep Consultants, LLC. It is intended mainly for healthcare professionals because of the somewhat technical language. It provides an overview of our approach to treating insomnia and other sleep problems.)
Northern Colorado Sleep Consultants, LLC use behavioral therapies for treatment for insomnia and nightmares. The treatments for insomnia that we use are CBT-I (Cognitive Behavioral Therapy for insomnia) or GMATI (Guided Mindfulness with Acceptance Treatment for Insomnia) depending on the nature of the client’s insomnia. Problematical nightmares respond well to IRT (Imagery Rehearsal Therapy).
There has been a convergence of evidence indicating that these sets of non-drug treatments produce reliable and durable improvements in sleep and significant reduction of the severity and frequency of nightmares. CBT-I and IRT aim at making specific changes in behaviors and cognitions related to sleep and nightmares. As such, they are a specialized subclass of the more general cognitive-behavioral therapy frequently used in psychology. They have been shown to be more effective than general psychotherapy for treatment of insomnia and nightmares (Backhaus, Hohagen, Voderholzer, & Riemann, 2001; Krakow, Kellner, Pathak, & Lambert, 1995). They are generally well tolerated and acceptable to many insomnia and nightmare patients.
GMATI is a newer approach to helping people with insomnia that we have been developing over the last several years. We are currently writing a book about this method for Newharbinger press. Rather than trying to directly improve poor sleep, GMATI focuses on learning to simply observe and accept the way one’s sleep is. This treatment results in less emotional arousal and less energy expended during nights when sleep is difficult to obtain. The paradoxical result is that sleep quality and sleep duration improve.
There are four domains to CBT-I:
1. Changing behaviors through sleep hygiene education, stimulus control, and Sleep Scheduling Treatment (often miscalled Sleep Restriction).
2. Changing cognitions in order to reduce arousal and increase compliance with behavioral components.
3. Modulating the arousal system through somatic and mental relaxation training and by applying methods to decrease racing thoughts and cognitive arousal.
4. Adjusting, when necessary, the circadian rhythm for sleep, including proper timing of sleep-wake behaviors and light/dark exposure.
The target thoughts and behaviors for change in CBT-I are those that are incompatible with sleep. These include thoughts and behaviors that increase physiologic and cognitive arousal and behaviors that disrupt the sleep-wake rhythm. In an attempt to control sleep, many people engage in behaviors that tend to perpetuate, rather than solve, the problem. These behaviors often increase frustration and arousal and may weaken the homeostatic and circadian sleep rhythm, thus perpetuating a vicious cycle of insomnia. CBT-I aims at reversing this.
Additional advanced but compatible methods may supplement the above treatments. A session of hypnosis followed by instructions on self-hypnosis can be effective and is used when appropriate if the person is comfortable with it. People who are dependent on sleeping pills may be given a taper schedule specially designed to gradually but effectively reduce then eliminate the need for sleeping pills. Newer techniques and approaches developed by Barry Krakow, MD (Krakow, 2007) can be added as necessary. These include helping clients eliminate clock checking when they are having trouble sleeping, helping clients bring closure to their busy day life so they can seep peacefully at night, helping clients bring closure to their busy day life so they can sleep peacefully at night, helping clients eliminate out-of-control thoughts and other mental content that keeps them awake, helping clients reduce over-reliance on logical thought when it interferes with their sleep at night.
(For information about how Northern Colorado Sleep Consultants, LLC can use one of these approaches to help with your insomnia click here.)
GMATI – A New Alternative for the Treatment of Insomnia
Some people who suffer from chronic insomnia often describe their condition as a ”vicious cycle.” They find that the increasing effort and desire they put into trying to improve their sleep only seems to make it worse. This is because their struggles with unwanted thoughts, emotions, and physical sensations associated with not sleeping increase arousal levels that perpetuate sleeplessness. The result is frustration and anxiety that make their sleep even worse. Directly trying to change their sleep just does not work for such people. Instead, they need to let go of trying to “fix” their sleep.
Fortunately, GMATI is a newer, more indirect approach that can eventually be successful for them. It is more effective to teach them how be more accepting of what they experience when having difficulty sleeping. The greater willingness to experience poor sleep results in fewer struggles, less arousal, and, paradoxically, greater levels of calm, beneficial sleepiness. Eventually they find they are getting more and better sleep.
This innovative, cutting edge approach, emphasizes changing the relationship that a person with insomnia has with their sleep using guided mindful meditation as a way to accept their sleep as it is. As they change this relationship they will notice an improvement in the quality and quantity of their sleep. They will also find that they have more alertness and energy during waking hours. This can usually be accomplished in a matter of weeks if the person is diligent on working on it.
In fact, this approach is psychologically and physiologically more consistent with the natural process of falling asleep that occurs in people without insomnia. They don’t struggle with their sleep, rather they just accept it as it is.
To summarize, GMATI is particularly useful in reducing the distress and emotional reactivity associated with chronic insomnia and thereby improving sleep and waking life. The results can provide lifelong benefits.
(For information about how Northern Colorado Sleep Consultants, LLC can use this approach to help with your insomnia click here.)
IRT has two domains:
Reducing the frequency and intensity of nightmares and changing the attitude of the nightmare sufferer toward their nightmares.
People can be taught to take control of their nightmares and disturbing dreams by changing them into new, less threatening scenarios. This is done by repeated rehearsal when awake plus positive thinking about what they can do with their disturbing dreams and nightmares as they go to sleep.
Also, people vary in their attitudes toward their disturbing dreams and nightmares. Some people are indifferent to their nightmares while others, with nearly identical nightmare intensity, are extremely disturbed by them. It has been shown that people can change their attitudes toward their nightmares, which is also therapeutic.
The approach to treating nightmares in children depends on the child’s age and the severity of the nightmares and the degree of distress caused by them. Nightmares in younger children that are not very frequent, intense, and distressing are typically not treated and allowed to remit by themselves. With older children and teenagers with more severe nightmares, techniques similar to those used with adults can be used with age-appropriate modifications. Younger children with severe nightmare problems often require different, simpler techniques.
(For information about how Northern Colorado Sleep Consultants, LLC can use this approach to help with your nightmares click here.)
These behavioral and cognitive changes are often not easy, especially when attempted without professional guidance. Sometimes people can benefit from books and articles that give some steps for behavioral changes to improve sleep. Likewise websites and aps may help some. But when these sources do not fully produce the desired results, a sleep doctor who can provide individualized firm support, close monitoring, frequent follow-ups, and continued direct discussion of compliance problems are important for success. To increase compliance, it is important to address the individual’s worries and to explore potential obstacles to the implementation of the requisite behavioral changes. Also, having a sleep expert who can decide which components are appropriate for each individual client and in what order is critical.
To obtain free, additional information about insomnia click here.
Backhaus, J., Hohagen, F., Voderholzer, U., & Riemann, D. (2001). Long-term effectiveness of a short-term cognitive-behavioral group treatment for primary insomnia. European Archives of Psychiatry and Clinical Neurosciences, 251, 35-41.
Krakow B, Kellner R, Pathak D, & Lambert L (1995). Imagery rehearsal treatment for chronic nightmares. Behaviour, Research and Therapy, 33, 837-843.
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