As a cognitive therapist, helping relieve insomnia requires getting into the thoughts and beliefs that otherwise make sleep impossible. Mind and body are connected; what the mind thinks it ‘translates’ into physical reactions. The body is a captive eavesdropper on the thoughts, worries, regrets, and impulses that criss-cross the mind.
Last week a client made an important decision which would have great influence on her future. Without going into the details if this decision fell in between ‘what-to-order-for-dessert’ (trivial) and ‘who-to-marry’ (super not trivial), this particular decision would fall closer to the who to marry direction. Not surprisingly she complained of sleep difficulties. In this specific case, she was able to fall asleep literally when her head hit the pillow but awakened two hours later and then not be able to fall asleep again.
It didn’t take a rocket scientist or advanced, experienced cognitive therapist to understand why this was: her mind, after a two hour nap, began percolating with activity. The body, ever ready to help out, heard the mind, and threw some coals on the fire. By coals on the fire, I mean acetylcholine, the neurotransmitter of physical activity. It also stopped dumping adenosine, the neurotransmitter of sleepiness, into the blood stream. The result was a body ready to go and buy a dress (oops! I’ve said too much already!).
What we did about however was pretty cool. More on that later.
Reflecting on the common physical causes for insomnia which I encounter with my clients, they all share one common root: disregard for connection between mind and body. It seems that we all live without regard to the body which so cares for us.
So for instance, the amount of artificial light which we fill our living spaces can have cumulative devastating impact on our health (this was brought home to me by some frightening data about breast cancer and light pollution which you can read about here). Yet as much as we read about how important it is to ease the body towards sleep by decreasing exposure to light, we keep the lights on and use our phones, computers, and tablets to stimulate ourselves late into the night.
I mention this disconnection here because for most of our clients, insomnia is another manifestation of their negative relationship with their bodies. While deeply delving into this relationship is not always required, it’s important to at least raise the issue.
The integration of cognitive behavior therapy into the treatment of insomnia has received lots of coverage in the general press as well as in the professional literature. The results reported have been positive regardless if the client was suffering from comorbid depression, anxiety, or addictive disorder or if sleep medication was also used.
The model that I’ll be sharing in coming posts is taken from the protocol developed by the United States Department Of Veterans Affairs. They have an immense amount of experience treating veterans, their families, and their communities for a variety of comorbid disorders.
The protocol has three components. They are:
Psychoeducation about sleep, insomnia, and the conditions that interfere with sleep.
Treatment of environmental, psychological, and physical factors that get in the way of sleep.
Monitoring and follow up of those in treatment.
In following posts, we’ll briefly review what you need to know about sleep (psychoeducation). Then we’ll get into stimulus control, quieting the mind, and relaxation techniques.
In the world of cognitive therapy, upgrading is fundamental. With that in mind, (hopefully!) with today’s post, you’ll notice improvements which will make the content even more exciting and useful. Let me know what you think!
Today’s Tachlis Takeaway: many sleep problems can be helped with the methods of cognitive therapy.
When we think of sleep, we may often think of a necessary evil which we must ‘put up with’. Just look at the coffee section of my local supermarket: there’s a solid eight meters of valuable shelf space devoted to a bitter beverage whose most important redeeming quality is that it can keep us awake. Looking back on my forty year love affair with coffee, I’ve got some serious doubts that I would have been able to start and complete even one degree without the steady drip of stimulants into my veins.
Sleep however gets a bum rap. It’s quite telling that the Bible tells us that Adam was asleep when he was matched up with Eve. Marriage, the most important event in a human’s life; and here a central protagonist was out cold. But it’s not just the Bible that tells us something about sleep; modern science continues to inform us of the many, many blessings of sleep. Or, r’l, the terrible ills that can befall the human mind and body when we don’t sleep enough.
Where we psychotherapists come in is that many of the barriers to the blessings of restful sleep respond to the skills which we offer. In the coming posts we’ll consider some of cognitive therapy techniques which can help our clients (and ourselves) to sleep and to heal.