Re-learn the Art of a Good Night's Sleep

[Guest guest]

Re-learn the Art of a Good Night's Sleep

05 Jun 2005 Medical News Today

While sleep may seem like a natural process, it is one that can

easily be taken for granted. A recent poll by the National Science

Foundation found that only 50 percent of Americans get a good night's

sleep a few nights each week.

When interruptions to sleep become a chronic problem, doctors at the

University of Michigan Behavioral Sleep Medicine Program, in the

Department of Psychiatry and affiliated with the U-M Sleep Disorders

Center, can offer patients a multidisciplinary approach to treating

insomnia that teaches them how to sleep.

When lack of good sleep becomes a problem

Jane Heibel, 44, began having problems sleeping about three years

ago.

" On and off, I'd have terrible nights of insomnia where I would fall

asleep easily enough, but then I would wake up on and off and maybe

get three hours of sleep the entire night, " she says.

" I would come to work in the morning so tired that I was nauseated

and I could barely function. I felt like my work was suffering. I was

short with people. I would have to look things over twice or three

times and I'd find mistakes. It just wasn't efficient. "

When Heibel's lack of sleep began to interfere with her daily

activities, she went to J. Todd Arnedt, Ph.D., director of the

Behavioral Sleep Medicine Program, for treatment.

Insomnia, the most common sleep disorder, is characterized by

difficulty falling asleep or staying asleep, waking early with the

inability to fall back asleep, or just waking up feeling tired and un-

refreshed from poor quality of sleep.

" About 33 percent of individuals suffer from some form of insomnia on

an occasional basis at some point in their lives. We estimate that 10

percent to 15 percent are actually chronic sufferers, which we define

as three or more nights per week for six months or more, " Arnedt

says.

Heibel's treatment

Part of learning how to get a good night's sleep is understanding how

environmental factors affect your ability to sleep.

" Medications are the first line of defense against sleep problems.

But when insomnia becomes a chronic problem, there are inevitably

patterns of thinking and behaviors that contribute to the ongoing

problem that medications cannot address, " Arnedt says.

" One of the first things Dr. Arnedt talked to me about was my

routine, " Heibel says. " I would generally go up to bed pretty early

but I would bring my checkbook, taxes, a book to read, whatever it

was that I was working on, even my telephone, so I could make calls.

I was turning my bedroom into a little office. I learned that was an

absolute `no-no,' " she says.

The Behavioral Sleep Medicine Program uses a three-pronged approach

to treatment that includes behavioral strategies, cognitive

techiniques, and sleep education. Treatment takes place in an office

setting, over four to eight sessions. Each session lasts from 40 to

60 minutes. The treatment typically takes anywhere from four to six

months to complete.

" Experts in psychological, behavioral and medical aspects of sleep

problems provide a thorough evaluation to determine each individual's

sleep issues and the factors that contribute to triggering their

sleep problems, " Arnedt says.

Key to the program's approach is targeting poor sleep habits and

maladaptive behaviors that have developed over time and perpetuate

insomnia; targeting patterns of thinking that can lead to frustration

and worry about one's sleep; and teaching individuals new behavioral

strategies.

" In some instances, we are re-teaching people how to sleep properly

by helping to reshape their maladaptive behaviors and to implement

more consistent good sleep practices, " Arnedt says.

" We teach people specific behavioral strategies to help them sleep,

and how to address the cognitive issues that arise in people who have

repeated bad nights of sleep. "

When people repeatedly have difficulty sleeping, they naturally fall

into certain patterns of thinking; like worrying if they are going to

fall asleep, becoming anxious about their sleep, and even becoming

depressed about their sleep, which may perpetuate the problem and

need to be targeted in treatment.

" Research shows that these cognitive behavioral therapies provide

improvement in 70 percent to 80 percent of patients, " Arnedt says.

" I don't bring my work to bed with me anymore. The treatment taught

me to separate the place I sleep from everything else. I sleep much

better now - it's like night and day, " Heibel says. " The best thing

about the treatment was that it wasn't a big investment. I took the

handouts and information I learned from my visits and started

applying what I learned. "

Tips for getting a good night's sleep

Arnedt suggests following the Principles of Sleep Hygiene:

-Go to bed and get up at the same time each day, even on the weekends

-Avoid daytime naps

-Avoid drinking alcohol in the evenings and do not use it to help you

sleep

-Avoid caffeinated products (e.g. coffee, tea, soda, chocolate) after

mid-afternoon

-Eliminate tobacco use, especially close to bedtime and during the

night

-Exercise regularly during the day, but avoid evening exercise

-Use the bedroom only for sleep or marital relations; avoid school

work, business affairs, TV, exercise, or other activities that could

teach you to associate your bedroom with these experiences

-Keep the bedroom dark, quiet and comfortable In addition, it is a

good idea to set aside a 30 to 45 minute period each night to wind

down before bedtime. During this time, engage in a quiet, non-

stimulating activity, such as reading or watching television, dim the

lights, and have a light carbohydrate snack.

If you find yourself lying in bed, unable to sleep, Arnedt also

suggests getting up and engaging in a quiet activity until you feel

sleepy enough to return to bed. This will help to re-establish the

bed as a cue for sleep rather than a cue for wakefulness.

" This program is for people who have chronic sleep problems, are

tired of being frustrated about their sleep and wish to gain a sense

of mastery and control over their sleep. While the program takes

time, the good news is that it really works, " Arnedt says.

University of Michigan Health System

Ann Arbor, MI 48109-2435

med.umich.edu/opm/newspage/reporter.htm