Stanford group therapy
program aims to put insomniacs to sleep
BY MITCH LESLIE
For the 30 percent of the
population who have trouble falling or remaining asleep,
nightfall has come to signify the enemy. As the culprit
descends, anxiety mounts, making the nightly struggle to
sleep even harder.
Though insomnia is the
most common sleep disorder, general medical practices and
even sleep clinics rarely provide appropriate treatment,
according to Derek Loewy, PhD, co-director of the
Insomnia Program at the Stanford Sleep Disorders Clinic.
Answering the need for
better diagnosis and treatment, Loewy and his colleague
Rachel Manber, PhD, have launched the first group therapy
program for insomnia in the United States. The
eight-week, outpatient program combines education to
instill healthy sleep habits with counseling sessions
that help patients exorcise negative attitudes about
sleep.
Though more common among
the elderly, insomnia strikes people of all ages. Its
symptoms include difficulty falling asleep, frequent
awakening during the night, or awakening too early in the
morning. The typical insomniac has sought help repeatedly
and unsuccessfully, Loewy said. "Our insomniacs tend
to be those with the thickest medical charts," he
said.
Loewy said the first step
in the treatment involves a thorough examination to rule
out other possible causes for the patient's
sleeplessness, such as depression or other sleep
disorders.
Meeting once a week in
groups of 5 to 7, patients then begin what is called
cognitive-behavioral therapy (CBT), which involves
adjusting behaviors to promote sleep and to alter the
patients' misconceptions about their sleep problem, Lowey
said. This can be difficult, because behaviors that
disrupt sleep are surprisingly common and often seem
sensible. For instance, to compensate for sleep loss or
to remain awake after a restless night, many bleary-eyed
insomniacs try napping, sleeping late and using caffeine
or other stimulants during the day. At night, some people
attempt to sedate themselves with alcohol.
All of these measures are
counterproductive because they distort the body's
sleep-wake cycle, Lowey said.
One of the most common
misconceptions is that insomnia can be beaten through
sheer determination, by stubbornly remaining in bed until
you doze off. Lying awake is one of the worst things you
can do, Loewy said. Failure to sleep breeds frustration
and actually promotes further sleeplessness.
Instead, Lowey counsels,
if you don't fall asleep quickly, get out of bed and do
something relaxing and enjoyable. Reading, knitting and
other quiet activities fit the bill. During these times,
avoid exercise or exposure to bright light, since both
can trigger arousal, he said.
Loewy and Manber also
stress positive actions that can improve sleep, such as
having set times for waking up and going to bed,
something that helps the body's sleep-wake cycle settle
into a regular rhythm.
During the trickier part
of the treatment, Loewy and Manber try to get patients to
talk through some of the worries that often trouble
insomniacs. For some, their inability to sleep becomes so
frustrating that they unconsciously develop negative
associations with their own bed this explains why
insomniacs typically sleep better away from home. For
most people, "the sight of your bed should not be a
source of anxiety," Loewy said.
Loewy and Manber encourage
patients not to worry around bedtime, but to carve out a
"worry time" during the day for fretting. They
also teach breathing exercises that promote relaxation,
and help patients deal with the sleep deficit that
results when they begin adhering to a set wake-up time.
Unlike some past insomnia
treatments, the program shuns drugs. Though sedatives can
induce sleep, they lose their effectiveness as the body
develops tolerance, and addiction remains a possibility,
Loewy said.
The approach used at
Stanford draws on Scottish research and work published in
the March 17 issue of the Journal of the American Medical
Association. That study, conducted by scientists in
Virginia and Canada, found that drug therapy,
cognitive-behavioral therapy and a combination of the two
alleviated insomnia in the short term. But two years
after treatment ended, only the CBT patients reported
that the improvement in their sleep had persisted.
For more information on
the insomnia treatment program, call 724-0181. SR
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