Eli Hendel M.D.
A Medical Corporation

Insomnia Patient

Assessment of the Insomnia Patient

 

Insomnia is the inability to initiate sleep or maintain sleep. Sometimes it's a combination of both issues.

Having insomnia involves many individual features. For this reason, the management and treatment is individualized and not solved simply with a sleeping pill.

Assessing insomnia includes:

  • An examination of the current sleep pattern, and the cognitive and behavioral factors that are causing or perpetuating the insomnia.

  • An examination of lifestyle and environmental factors that may be contributing to the insomnia.

  • Identifying and eliminating medical problems that need to be treated first because they may be contributing to the insomnia (heart disease, asthma, allergies, bladder problem, seizures, thyroid problems, kidney disease, and dementia with sun downing).

  • Evaluating medical conditions specific to women that may contribute to insomnia, like hormonal changes associated with menopause.

  • Identifying mental problems including depression and anxiety which can contribute to sleep issues.

  • Identifying underlying sleep disorders including sleep apnea (obstructive and central), periodic limb disorders, restless legs syndrome and delayed sleep phase disorder

Sometimes resolving the insomnia may only require addressing the precipitating cause of the insomnia.  In other cases where there is no identifiable cause (primary idiopathic insomnia), it may require a lengthier treatment process known as Cognitive Behavioral Therapy (CBT).

Elements of Cognitive Behavioral Therapy include:

Cognitive restructuring – To identify the Negative Sleep Thoughts (NST’s) and replace them with Positive Sleep Thoughts (PST’s).  

Sleep medication withdrawal - To be able to reduce or eliminate sleeping pills by the end of the program.   The approach is to reduce them gradually as they are replaced by learned behavioral techniques that can be safely sustained.

Sleep scheduling - Keeping track of sleep logs in order to achieve a schedule that maximizes sleep efficiency and wakefulness during the day.

Stimulus control - Learning about cues or stimuli in the environment that influence one’s sleep behavior. Identifying those “sleep disruptive” cues and replacing them with cues that will help you to associate with the act of going to bed (feeling drowsy), making it easier to go to sleep.

Relaxation techniques - Stress response propels the brain into a state of arousal and puts us “on the edge,” which is not conducive to falling asleep. Part of this program includes learning how to achieve relaxation so you limit a hyper-arousal state that interferes with the ability to initiate sleep.

Sleep hygiene principles - Learning about regularity or schedules, which will help you to reconcile sleep needs with work and family responsibilities. This phase is an important step that will help to prevent insomnia from recurring in future situations of stress. You will learn to “set yourself up for sleep.”