How to treat Chronic Insomnia A self help manual Dr. Antonio Ambrogetti Sleep Medicine How to treat Chronic Insomnia A self-help manual Dr. Antonio Ambrogetti Contents Preface ........................................................................................................................................................... 4 What is insomnia. .......................................................................................................................................... 5 How much sleep a person needs. ................................................................................................................. 6 Insomnia as a symptom not a disease........................................................................................................... 6 Insomnia is a symptom of poor function during the 24 hours not just a bedtime or nighttime problem. .. 7 People with insomnia who are sleepy during the day and people with insomnia who are not sleepy. ....... 8 Psycho-physiological ‘insomnia’ (learned insomnia). ................................................................................... 9 Individual body clock. .................................................................................................................................... 9 A different understanding of sleep. ............................................................................................................10 Insomnia: Assessment and Management ...................................................................................................12 Assessment ..................................................................................................................................................12 Daytime Function ....................................................................................................................................13 What do you mean for tiredness? ...........................................................................................................13 Do you fall asleep during the day? ..........................................................................................................13 Hyper-arousal. .........................................................................................................................................14 Assessing your emotions .........................................................................................................................14 Treatment strategies. ..................................................................................................................................15 Do you have any of the following:...........................................................................................................15 Re-framing the problem of insomnia. .....................................................................................................15 Daytime issues. ........................................................................................................................................16 Self and Family ........................................................................................................................................16 Work and social environment .................................................................................................................17 Use of meditation/relaxation. .................................................................................................................17 To summarize: .........................................................................................................................................18 Bedtime advice. ...........................................................................................................................................18 Sleep depends on prior wakefulness. .....................................................................................................18 Problems with restriction of time in bed. ...............................................................................................19 ‘C’ for body clock’. ...................................................................................................................................20 Use of light for insomnia. ........................................................................................................................22 ‘M’ for meditation-relaxation and medication .......................................................................................23 Use of Melatonin .....................................................................................................................................23 Side effects of melatonin. ....................................................................................................................23 Timing of melatonin administration. ...................................................................................................24 The use of sleeping tablets. .....................................................................................................................24 Risk associated with taking sleeping tablets. ......................................................................................26 Over the counter sleep aides. .................................................................................................................27 ‘Natural’ products................................................................................................................................27 Primary insomnia (learned insomnia) .........................................................................................................30 Insomnia due to difficulty adjusting to a new situation ..............................................................................32 Insomnia due to body clock problems ........................................................................................................33 Insomnia due to “body clock” problem (delayed sleep phase syndrome) .............................................33 Insomnia due to “body clock” problem (advanced sleep phase) ............................................................35 Insomnia and the menopause (a challenging condition) ........................................................................36 Insomnia due to chronic medical conditions ..........................................................................................38 Insomnia and substance abuse ...............................................................................................................40 Insomnia, anxiety and panic attack .........................................................................................................41 Paradoxical insomnia (sleep mis-perception) .........................................................................................43 Insomnia and depression ........................................................................................................................45 Insomnia and sleep apnea .......................................................................................................................46 Insomnia and restless leg ........................................................................................................................47 Insomnia and non-restorative sleep .......................................................................................................49 Practical Advices ..........................................................................................................................................51 Implementing restriction of time in bed .................................................................................................51 The importance of maintaining regular bedtime and get up time .........................................................51 Use of light in insomnia ...........................................................................................................................52 Physical exercise ......................................................................................................................................52 The use of a sleep diary ...........................................................................................................................53 What about sleep hygiene and stimulus control?...................................................................................53 Sleep hygiene and stimulus control ....................................................................................................53 The essence of chronic insomnia treatment ...........................................................................................55 Appendices ..................................................................................................... Error! Bookmark not defined. DASS (Depression, Anxiety and Stress Score)..........................................................................................56 Body clock type .......................................................................................... Error! Bookmark not defined. Specific Disorders of Sleep. ....................................................................................................................... 3 Preface The purpose of this book is to provide a management frame work that any person can use for treating chronic insomnia successfully. It is based on clinical experience; that is on practical interaction with patients and focusing on what to do and how