Treatment of Chronic Insomnia
The busy lifestyle and schedules are the common reason for ignoring sleeplessness. Unawareness about insomnia and its consequences is another leading cause. Due to this acute or transient version of insomnia turns long-term sleeplessness. The big question of ‘how to cure insomnia‘ requires the strategic approach.
Chronic Insomnia Treatment Goals
As discussed earlier, severe chronic insomnia needs multi-prong treatment strategy. Older age, the presence of co-morbid disorders often make it the greater challenge. Ideally, the treatment should consist of following goals:
- Improvement in sleeping difficulties
- Identification and controlling of behaviors which are impacting sleeping
- Enhancing sleep quality
- Improvement in daytime difficulties caused by insomnia
- Improvement in co-morbid disease symptoms hindering sleeping
- Judicious use of medication to avoid side effects
- Improvement in the quality of life
Chronic Insomnia Treatment Strategies
The sleep disorder of insomnia is well known for ages. Hence, we have good and effective treatment options in an alternative science too. However, since our website aims to spread awareness of Homoeopathy, we will be dividing this section into three parts as below:
- Non-Pharmacological Treatment Strategies
- Pharmacological Treatment Strategies
- Homeopathic Treatment for Chronic Insomnia
It is always recommended to identify insomnia in its initial stage. Looking at prevalence, sleep details of each patient visiting clinic should be queried.
The disorder of insomnia impacts patients health as well social life. The patients with chronic insomnia generally suffer from mood swings. They often have lower performance in their routine jobs. Many of them have impaired cognition. Chronic insomnia patients often remain absent or report late to the work. The increasing error by chronic insomnia patient is very obvious. Association between suicidal ideation/completed suicides and severe chronic insomnia is alarming. Additionally, drug abuse, immune dysfunction disorders, often noticed in these individuals. Moreover, the chronic insomnia patient is always accident prone.
Non-Pharmacological Treatment Strategies
The non-pharmacological treatment strategies often aim at sleep education. These strategies also focus on curtailing behaviors or beliefs disturbing sleeping. Generally, these strategies consist of short-term cognitive-behavioral therapies. Not to mention, these technique aids in the efficacy of pharmacological treatments.
The pharmacological approach found helpful for controlling acute insomnia. But cognitive and behavioral interventions are always better for controlling chronic insomnia. Additionally, these cognitive behavioral therapy interventions reduce or eliminate symptoms of co-morbid disorders. Extreme insomnia cases often require multi-prong approach.
Stimulus Control Therapy
Most of the times chronic insomnia patients have anxiety especially when they go to bed. The goal of stimulus control therapy is to reduce anxiety or conditioned arousal. The chronic insomnia patient often faces such situations when he attempts to sleep. The technique consists of a set of instructions. The instructions align bed/bedroom environment with sleeping. Additionally, the instructions ensure consistency in sleep schedules.
- Going to bed only when sleepy
- Getting out of bed when unable to sleep
- Restricting bed/ bedroom only for sleep and sex (nothing else like watching TV)
- Arising at the same time in the morning hours
- Avoiding daytime naps
The person should get out of the bed and go into another room if he fails to initiate sleep. He should return only when he feels sleepy again. The person should maintain regular rising time regardless of previous nights sleep duration. This technique well suited for elderly patients.
Sleep Restriction Therapy
- The individual’s Average Total Sleep Time (ATST) per night
- Restricting the individual to be in a bed each night equal to his ATST
- Establishing a fixed bedtime depending on the desired wake time in the morning
- Do not permit any sleep to occur outside of the sleep window
- Monitor daily sleep efficiency, which is calculated by the Total Sleep Time (TST) / time spent in bed multiplied by 100
- Extend the time spent in bed by 15 minutes when the weekly average sleep efficiency exceeds 90 percent
- Reduce the time spent in bed by 15 minutes when the weekly average sleep efficiency falls below 80 percent
The Average Total Sleep Time can be calculated from the entries made in a Sleep Log or Sleep Diary.
- Progressive Relaxation
- Guided Imagery
- Biofeedback- Assisted Relaxation
- Deep Breathing Exercises
- Autogenic Training
- Yoga/ Pranayama
The relaxation therapies deactivate the heightened arousal system. The choice of a specific technique varies depending on whether physiological or cognitive arousal is targeted for treatment. Some techniques focus on reducing somatic arousals. For example, biofeedback or progressive relation. Some techniques aim at attention focusing. For example, Guided imagery, Yoga etc.
Cognitive Therapy is a part of Cognitive Behavioral Therapies (CBT). The therapy appreciates Cognitive Model. As per this model the thoughts, feelings, and behavior are all connected. And it is possible for an individual to overcome difficulties. The technique pushes an individual to change unhelpful or inaccurate thinking. It also encourages an individual to curtail distressing emotional responses.
The Paradoxical Intention is the deliberate practice of intensifying neurotic habit or thought only to remove it. The counselor purposefully intensifies the sleep-disturbing emotion or thought. He makes the patient understands the irrationality of this emotion or thought and its impact.
Many times chronic insomnia patient suffers from the Universal Principle, “What you resist persists”. The thought or emotion which he is apprehensive about becomes the unintentional hindrance to his sleep. The technique advocates practicing of same emotion or thought under the controlled situation. This results in minimizing attempts of resistance and thereby helps to curtail its persistence.
In conclusion, the Paradoxical Intention is a cognitive restructuring technique to alleviate performance anxiety while sleeping. In fact, there are numerous cases where we can get anxiety about sleeping causing insomnia.
Sleep hygiene is the best practices and habits intended for a good quality of sleep. The sleep is a natural phenomenon to rejuvenate physical and mental activities. A good quality and quantity of sleep improve performance and health. The overall quality of life depends on the healthy sleep.
- Establishing the regular sleep schedule
- Limiting daytime naps
- Exercise to promote good health
- No heavy exercise close to bedtime
- No stressful thoughts close to bedtime
- Avoiding stimulants like caffeine or nicotine close to bedtime
- Cherishing balanced diet
- Limiting worry
- Limiting exposure to light, sound etc. in the hours before sleep
- Getting out of bed if could not sleep
- Restricting bedroom for sleep and sex only
- Comfortable and peaceful bedroom environment