Insomnia? Psychotherapy is better than pills!
The American Family Physician journal has published a revision of approaches to non–pharmacological treatment of chronic insomnia, a condition that affects 10-30% of residents of developed countries.
Studies conducted to date have shown that non-pharmacological treatment of chronic insomnia gives a long-term stable effect comparable to the effect of drug treatment, but its stability is much higher.
Chronic insomnia is defined as a violation of the process of falling asleep and the continuity of sleep or the lack of a feeling of refreshment upon awakening, lasting at least one month and impairing the possibilities of daytime activity. Primary and secondary insomnia are distinguished. The latter is caused by psychiatric or somatic diseases, as well as the influence of chemical substances.
Cognitive therapy of insomnia aims to identify functional disorders of sleep-related behavior, determine their validity and replace them with normal adaptive models.
Cognitive behavior therapy (CTP) is usually conducted in the form of 4-8 weekly sessions, each of which lasts 60-90 minutes. If it acts as the primary method of treatment, then the frequency of classes should be increased. Studies have shown that the positive result of such treatment persists for 12-24 months.
CTP includes cognitive psychotherapy, sleep hygiene, stimulus control, sleep restriction, paradoxical actions, relaxation therapy. The following are the private points of the CTP.
Sleep hygiene includes the following items:Avoiding caffeine and nicotine, especially in the afternoon
- Cessation of pronounced physical activity four hours before the planned bedtime. Physical activity as such improves the quality of sleep, but late physical activity can disrupt it.
- Refusal to eat at night difficult to digest dishes.
- Maintaining a clear schedule of going to bed and waking up.
- Maintaining a comfortable temperature in the bedroom.
- Maintaining darkness in the bedroom.
- Regular evening relaxation with the use of relaxation techniques.
- In the case of external noise – the use of earplugs.
- At least thirty minutes of morning contact with daylight.
Stimulus control is designed to associate the patient's bed with sleep and sex life and exclude other types of activity. Sleep restriction implies an increase in its effectiveness by limiting the time spent in bed.
Paradoxical actions include recommendations to the patient to stay awake, in order to relieve him from the fear of falling asleep.
Relaxation therapy aims to reduce the frequency of awakenings and improve the quality of sleep.
It includes the following items:
- Auto-training: the patient should imagine a peaceful place and comfortable sensations (warmth and heaviness in the extremities, warmth in the upper abdomen, coolness in the frontal part of the head).
- Visual or audio biological feedback training – allows the patient to control specific physiological parameters.
- Hypnosis.
- Therapy with the use of pleasant or neutral images.
- Meditation, lower (abdominal) breathing.
- Measured breathing: a deep breath with a five-second breath delay and exhalation focusing on the sound of breathing is repeated several times.
- Progressive muscle relaxation: tension and relaxation of muscle groups from the foot area to the face area.
- Repetition of focusing on a word, sound, prayer, phrase, muscle activity.
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