Techniques for Treating Insomnia

What is Insomnia?

According to the DSM-5, Insomnia is defined by the following criteria:

1. A predominant complaint of dissatisfaction with sleep quantity or quality, associated with one (or more) of the following symptoms:
   1. 1. Difficulty initiating sleep. (In children, this may manifest as difficulty initiating sleep without caregiver intervention.)
      2. Difficulty maintaining sleep, characterized by frequent awakenings or problems returning to sleep after awakenings. (In children, this may manifest as difficulty returning to sleep without caregiver intervention.)
      3. Early-morning awakening with inability to return to sleep.
2. The sleep disturbance causes clinically significant distress or impairment in social, occupational, educational, academic, behavioral, or other important areas of functioning.
3. The sleep difficulty occurs at least 3 nights per week.
4. The sleep difficulty is present for at least 3 months.
5. The sleep difficulty occurs despite adequate opportunity for sleep.
6. The insomnia is not better explained by and does not occur exclusively during the course of another sleep-wake disorder (e.g., narcolepsy, a breathing-related sleep disorder, a circadian rhythm sleep-wake disorder, a parasomnia).
7. The insomnia is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication).
8. Coexisting mental disorders and medical conditions do not adequately explain the predominant complaint of insomnia.

If you, or a loved one, is experiencing insomnia symptoms–it is imperative that you seek help.  Treating insomnia helps significantly improve physical as well as mental health.  For example, treating insomnia symptoms can reduce symptoms of depression and anxiety as well as strengthen your immune system (Crain, 2015).

Techniques for Treating Insomnia

Dr. Joseph Giardino is a bilingual psychologist who treats insomnia symptoms as a part of his practice, and works with immigrant and non-immigrant populations.  When he provides a New York immigration evaluation, typically he will provide cognitive-behavioral strategies to help treat maladaptive sleeping practices.

Stimulus Control Therapy

• For this approach, the goal of treatment is to reassociate the cues of the bed and bedroom with successful sleep attempts–rather than associating these cues with arousal that perpetuates insomnia.
• To deliver this therapy successfully, patients must do the following:
  • Go to bed only when feeling tired.
  • Establish a consistent wake-up time.
  • Determine sleep-incompatible behaviors that might take place in bed (e.g., worrying, reading, watching TV, eating), and stop engaging in those behaviors.
  • Stop napping during the day.
• This technique can be administered in one visit, but follow up visits that ensure compliance are helpful (Edinger & Means, 2005).

Sleep Hygiene

• Helping patients with their sleep hygiene involves psychoeducation about exercising daily, eliminating substances that prevent proper sleep (e.g., caffeine, alcohol, nicotine), having a light snack before sleeping, and optimally having the bedroom be a quiet, dark, and comfortable place for slumber (Edinger & Means, 2005).
• This is used as a helpful, supplemental technique with other forms of sleep therapy (Edinger & Means, 2005).

Sleep Restriction Therapy

• For this approach, first patients determine the number of hours of sleep acquired on a typical night.  Then, patients are told to only spend that amount of time in bed, and not spend hours lying awake there. Likely a person will get less than the typical number of hours of sleep when he/she does this, so this sleep loss will make that person even more tired at first. Eventually though, the patient will fall asleep faster and wake up fewer times in the middle of the night (American Academy of Sleep Medicine, n.d.).
• Sleep restriction therapy is meant to enable someone to develop a more stable sleep pattern and limit time spent in bed (American Academy of Sleep Medicine, n.d.).