| Q: |
How are sleep problems treated?
| | A: |
Throughout this content, each sleep problem has been dealt with
in turn and specific treatments have been outlined. Treatments can
include simple lifestyle changes, behavioral changes, talking therapies,
medication, mechanical treatments, surgical treatments, dental
treatments, light therapies, and complementary therapies. Sometimes a
combination of several therapies is necessary.
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| Q: |
What is meant by lifestyle changes?
| | A: |
Making lifestyle changes involves examining the daily patterns of
your life and changing/modifying them if they are not producing the
desired results. Lifestyle includes all the factors that make up your
life and the way you run it, such as diet, exercise, sleep-wake routine,
work, leisure, and relationships.
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| Q: |
What is meant by behavioral approaches to treating a sleep problem?
| | A: |
Behavioral techniques used to modify or change sleep behavior
(usually in the treatment of insomnia) include sleep hygiene, relaxation
exercises, and techniques for reducing recurrent and persistent
thoughts during sleep. These include cognitive focusing, sleep
restriction therapy, and systematic desensitization.
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| Q: |
What is cognitive focusing?
| | A: |
This is the technique of focusing on pleasant thoughts and images
when awakening at night. It is useful in the treatment of insomnia,
especially in situations where the person wakes up during the night with
negative thoughts that prevent him or her from getting back to sleep
again.
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| Q: |
What is sleep restriction therapy?
| | A: |
This is one treatment that can be of use in insomnia, when too
much time is spent in bed but not enough of that time is spent asleep.
People with this problem often end up going to bed early on some nights
and late on others with the result that they end up with a very
disrupted and inefficient sleeping pattern. The treatment involves
reducing the amount of time spent in bed by an hour or more initially
and going to bed at set times and getting up at set times. This helps
consolidate sleep and strengthen circadian rhythms.
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| Q: |
What is systematic desensitization?
| | A: |
This technique is very useful in people whose insomnia is related
to anxiety and who associate negative thoughts with their bedtime
routine. The person is asked to make a list of the negative thoughts and
experiences associated with getting to sleep. The person then
concentrates on associating pleasant ideas with the bedtime routine
until it no longer becomes anxiety-inducing.
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| Q: |
Which medications are commonly prescribed for sleep disorders?
| | A: |
The type of medication prescribed for your sleep disorder will
differ depending on whether the problem is acute or chronic and whether
it is potentially medication-responsive or not. There are many different
classes of drugs that act on very different pathways in the brain.
Probably the most commonly prescribed drugs are sedative drugs from the
benzodiazepine and related classes. Some of the other drugs listed in Commonly prescribed medications for treating adult sleep disorders
are used exclusively for the treatment of excessive daytime sleepiness,
such as modafinil, while others are used to treat a variety of
disorders such as depression and anxiety (tricyclic antidepressants),
and L-dopa is used to treat Parkinson’s disease as well.
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| Q: |
What does the term “talking therapies” encompass?
| | A: |
Talking therapies involve counseling using techniques ranging
from psychodynamic psychotherapy to cognitive-behavioral therapy (CBT).
CBT is one of the most effective forms of psychotherapy, and deals
specifically with issues that are causing problems in the patient’s life
such as self-esteem, anxiety, problems with coping, low mood, or
self-defeating behavior. CBT involves the patient identifying the
behavior, rating how he or she feels about it (anxious, stressed,
depressed), and then challenging that feeling with rational thought.
Once the feeling is challenged and more realistic alternative viewpoints
are brought into play, the patient is then asked to again rate feelings
again about coping with the situation.
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| Q: |
What is meant by mechanical treatments for sleep disorders?
| | A: |
Mechanical treatment of sleep disorders encompasses the use of
continuous positive airway pressure (CPAP) for sleep-disordered
breathing or bilevel ventilation devices in patients with respiratory
failure .
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| Q: |
How applicable are dental and surgical treatments to sleep disorders?
| | A: |
Surgery may help patients with sleep apnea who have a correctable
facial, jaw, or tongue abnormality. Dental treatments for sleep apnea
and snoring are mandibular repositioning devices or mouthguard devices
that are fitted to the upper and lower jaws. Mouthguards are useful in
the treatment of bruxism or tooth-grinding during sleep.
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| Q: |
How do I undertake light therapy?
| | A: |
Light therapy is used to treat both circadian rhythm disorders and SAD .
It involves exposure to a lightbox at 10,000 lux for 30–60 minutes
depending on the strength of light. Lightboxes can be bought easily,
especially online.
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| Q: |
Are complementary therapies effective in the treatment of sleep disorders?
| | A: |
Personal anecdotes suggest that herbal, homeopathic, and other
complementary therapies such as reiki and hypnosis may be useful at
times or even as adjuncts to other forms of therapy in the treatment of
sleep problems. They are probably the most helpful when it comes to
lifestyle problems involving the reduction of stress and anxiety levels.
They may have a small role to play in dealing with insomnia. However,
there is very little evidence from properly conducted trials on their
true efficacy.
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Commonly prescribed medications for treating adult sleep disorders
A large number of
medications are used in the treatment of a variety of sleep disorders.
They are listed , but they must be prescribed by your doctor.
Table | Sleep problem | Medication | Drug class |
|---|
| Cataplexy; depression | Imipramine | Tricyclic antidepressant | | Enuresis | Desmopressin | Hormone (ADH) analog | | Parasomnias; seizures | Clonazepam | Benzodiazepine | | Sedation | Lorazepam | Benzodiazepine | | Sedation; phase advance | Melatonin | Hormone | | Sedation | Zaleplon | Nonbenzodiazepine | | Sedation | Zolpidem | Nonbenzodiazepine | | Sedation | Zopiclone | Nonbenzodiazepine | | Sedation | Temazepam | Benzodiazepine | | Narcolepsy | Modafinil | Stimulant | | Narcolepsy | Dexamphetamine | Stimulant | | Narcolepsy | Methylphenidate | Stimulant | | Cataplexy | Clomipramine | Tricyclic antidepressant | | Depression; cataplexy | Sertraline | Selective serotonin reuptake inhibitor (SSRI) | | Depression; cataplexy | Fluoxetine | SSRI | | Restless legs syndrome | Codeine | Opioid analgesic | | REM-behavior disorder; Parkinson’s disease | L-dopa | Dopamine agonist | | Restless legs syndrome | Ropinirole | Dopamine agonist |
Relaxation techniques for getting to sleep
There are
many different relaxation techniques and you should choose one that
suits you. Some people find meditation useful, while others enjoy yoga
or tai chi. People with very high muscle tension may find it useful to
do the progressive relaxation exercise first described by Edmund
Jacobsen in 1983.
This exercise is
intended to relax step-by-step all the different groups of muscles in
the body. It involves lying on the floor on your back with legs
uncrossed and out straight, and arms down by your sides. Your eyes
should be closed. The exercises should last about 30–60 minutes,
depending on the degree of muscle tension present, but can be
abbreviated. Each muscle group in turn is tensed, then suddenly allowed
to go limp, followed by relaxation for a couple of minutes. Start at
your feet and gradually work up your body, tensing and relaxing each
large muscle group in turn until you reach your head.
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