Insomnia is likely to affect all of us at some point during our lives, leaving us bleary-eyed and foggy-headed during the day.
The Centers for Disease Control and Prevention (CDC) estimate that more than a third of American adults aren’t getting enough sleep.
Sleeplessness can result from psychological distress such as anxiety or stress, physical issues like sleep apnea, or neurological conditions such as Alzheimer’s disease.
While sleep medication can help, the medication’s effectiveness can wane over time.
Looking for another way to combat insomnia, Dr. Brandon Peters, a sleep specialist at Virginia Mason Medical Center in Seattle, has written a book called “Insomnia Solved” that uses cognitive behavioral techniques to help people get the rest they need.
This type of therapy is now recommended as the first-line treatment to combat insomnia by the American College of Physicians.
However, Peters, also a clinical faculty affiliate at Stanford University’s School of Medicine in the Department of Psychiatry and Behavioral Sciences, wants to help readers via a six-week therapy course in the book to help improve insomnia symptoms.
We talked to Peters about his book and what we can do to get our sleep back on track.
Can you give an overview to your approach to treating insomnia?
Insomnia is probably one of the more challenging sleep conditions to treat. It can become very frustrating, and a person who experiences [insomnia] will make changes that begin to work against them.
Most folks who present to a physician with complaints of insomnia will be started on a sleeping pill, and those medications can be effective especially over the short term, but may have long-term side effects or just stop working.
One of the motivations for creating this book and putting this information out there is to make it more accessible. The Academy of Physicians of Internal Medicine has in the last year recommended insomnia therapy as the first choice for the management of chronic insomnia.
The problem is it’s just not widely accessible. There aren’t enough psychologists and sleep doctors who are trained to do it.
Can you explain cognitive behavioral therapy and how it’s used to help people with insomnia?
Cognitive behavioral therapy is typically a therapy that is done by psychologists, and it may tackle or resolve a number of different issues. It’s a lot of education, teaching a person about normal expectations for sleep and helping them to address causes of insomnia.
Typically, the person will track their sleep patterns with a sleep log and then use that information to make adjustments to the sleep-wake schedule.
There is a fair bit of training for helping to resolve racing thoughts at night and anxiety that may undermine the ability to sleep.
Often people with insomnia will believe if they don’t go to sleep they won’t be able to go to work tomorrow. It adds to the stress and pressure to sleep.
Part of cognitive behavioral therapy is learning to analyze those thoughts and recognizing those fears never come to pass. They’re able to shut down some of that anxiety that may come at nighttime.
Beyond that, it’s mindfulness and relaxation techniques that may help to disengage the mind at night. In particular, with my program, I emphasize the importance of the circadian rhythm and morning light exposure, and also help people understand that other sleep disorders like sleep apnea may be contributing to their insomnia as well.
I’m sure everyone has had moments where they had trouble getting to sleep, or they’re having one really bad night. But what defines really bad chronic insomnia?
Chronic insomnia is defined as difficulty falling asleep or difficulty getting back to sleep after awakening. Typically, it takes more than 20 or 30 minutes to fall asleep, and more than 30 minutes would be spent awake during the night.
Most people with chronic insomnia are spending hours awake at night, so it’s not unusual for them to wake a quarter of the night, and often they have made changes that make their insomnia worse.
So, if a person isn’t sleeping well, they might start to go to bed earlier, trying to get more sleep. Or they may shut their alarm off in the morning trying to get additional sleep in the morning, and they may try to take naps during the day to catch up on sleep. So, they really begin to unravel their ability to sleep. And those changes begin to work against them.
An insomnia therapy program is really designed to teach what to expect with sleep and give some skills and changes that can be helpful to get a person back on track.
Can you go through some of the most common causes of insomnia? I went through the book and you mention Alzheimer’s disease, which I hadn’t thought of, and also the more common anxiety and stress causes.
Insomnia is understood to have various factors that may cause it to occur, so there’s the baseline which is predisposition toward insomnia. That may be a genetic tendency.
There are triggers — or what we call precipitating factors — and stress or anxiety is one of the most common ones. It may be stress related to an examination in school, a loss of a job, a fight, lots of different things can trigger the ability to sleep.
Those precipitating factors may really prolong the insomnia, that make it become prolonged beyond three months and sometimes even years or decades. [Insomnia] could potentially be perpetuated by unrecognized sleep disorders — most commonly sleep apnea, but restless leg or other conditions may contribute.
The individual factors vary, and part of [therapy] is educating a person on what might be at play and helping them to recognize and diffuse those various triggers that cause the chronic insomnia to persist.
In someone who’s prone to insomnia or had it in the past, what are the triggers that they could be looking out for? When daylight saving time happens and you lose that hour, are those things that people with insomnia need to think about?
There are certain triggers that will always predispose a person to insomnia. They can be environmental, so again light exposure may be part of it.
They can be psychological or psychosocial, so stress related to various things. But the good news with insomnia therapy is that you’re learning a set of skills that will always help you to sleep better.
So, research would tell us that years after someone completes a program, that they continue to sleep normally and they’ve learned what they need to do to help enhance their own natural ability to sleep.
The nice part of insomnia therapy is the education is persistent. With sleeping pills and medication, they ultimately fail. But with insomnia therapy, it seems that people derive benefit, even with triggers that come months or years down the road.
This interview has been edited and condensed.