Text adapted from: "The adult patient with a sleep disorder," in Psychiatry in primary care by Dora Zalai, M.R. Goolam Hussain and Colin Shapiro (CAMH, 2019).
Treatment options
Psychoeducation
Education about normal sleep is an essential part of treating insomnia and other sleep disorders. Discuss the following topics with patients:
- average sleep need and individual variations in sleep need
- change in sleep need with age
- circadian rhythm and its importance in the patient’s ideal regular sleep schedule
- role of napping in compensating for lost sleep and its role in perpetuating chronic insomnia
- importance of sleep quality (versus sleep duration only)
- consequences of sleep deprivation
- effects of caffeine, nicotine, medications and alcohol on sleep.
Cognitive-behavioural therapy (CBT)
According to the cognitive-behavioural model, people with acute insomnia adopt behavioural strategies and cultivate sleep-related anxiety, fueled by unhelpful cognitions about sleep. These are independent of the original cause and perpetuate the condition even after the trigger is no longer present.
CBT-I is a short-term treatment (usually three to six sessions) that is beneficial for more than 70 percent of patients. A shorter, two-session behavioural version can be delivered in primary care settings. Since CBT-I eliminates maladaptive behaviours and cognitions that are at the root of the condition, it yields improvements that endure beyond the termination of treatment.
Ideally, patients participate in individually tailored CBT-I provided by a trained clinician such as a psychologist or, in complex cases, a behavioural sleep specialist. If this service is not available, online CBT-I is an option. There are also CBT-based self-help books and web-based resources that highly motivated patients may find useful. These resources are not equivalent to a full CBT-I program, so if they are not sufficiently helpful, recommend in-person CBT-I. Sleep clinics may have behavioural sleep specialists on site or they can suggest treatment providers. An internet search of psychology clinics may also find clinicians who provide CBT-I.