Dr David Cunnington, specialist sleep physician and co-founder of SleepHub, discusses the prevalence and definitions of insomnia, the importance of taking a history and exam for insomnia, effective interventions for sleep like cognitive-behavioral therapy, the impact of camping on sleep, the limited efficacy of sleep supplements, the role of medication and melatonin in treating insomnia, and recommendations for insomnia resources.
Insomnia is often caused by physical and mental health comorbidities, perfectionistic thinking, and tendencies to worry.
The most common mistake people make with insomnia is going to bed for the sleep they wish they could get night after night and not succeeding.
Treating chronic insomnia can be done effectively with psychoeducation, cognitive behavioral therapy (CBT), and possibly pharmacological interventions like melatonin or low-dose sedatives.
Deep dives
Main Ideas/Key Points/Insights 1
Insomnia is a common sleep disorder that affects 15-20% of adults in Western societies. It is characterized by difficulties with sleep onset or maintenance, lasting for at least three months and impacting daytime functioning.
Main Ideas/Key Points/Insights 2
There are physical and mental health comorbidities that can contribute to insomnia, such as chronic health conditions and mental health disorders. Perfectionistic thinking and tendencies to worry are also risk factors for developing insomnia.
Main Ideas/Key Points/Insights 3
The treatment approach for insomnia often involves a combination of psychoeducation, behavioral interventions (such as sleep restriction and stimulus control), cognitive therapy, and relaxation strategies. Sleep hygiene alone has not shown to be effective in treating insomnia.
Understanding Insomnia and Sleep Studies
The most common mistake people make with insomnia is going to bed for the sleep they wish they could get night after night and not succeeding. Sleep diaries can quickly show the mismatch between desired sleep and actual sleep. Home-based sleep studies are commonly used for diagnosing sleep apnea, but they are not suitable for understanding insomnia. Other options for monitoring sleep include laboratory-based tests, wearables, and similar technologies. Buying a wearable device can be cost-effective as it provides diagnostic and treatment monitoring data.
Approach to Insomnia Treatment
Treating chronic insomnia does not require separate approaches for sleep onset and sleep maintenance. Psychoeducation plays a crucial role in recalibrating sleep expectations and behavior. Cognitive behavioral therapy (CBT) is an effective treatment option. Online CBT programs, supported by healthcare practitioners, have shown equal effects to face-to-face therapy. Supplements and vitamins, except for melatonin, do not have strong scientific evidence supporting their use in treating insomnia. Pharmacological interventions, such as melatonin, and in some cases, medicinal cannabinoids or low-dose sedatives, can be considered for individuals who do not respond to non-drug treatments.
Dr David Cunnington is a specialist sleep physician with qualifications from two Australian Universities and a Fellowship at Harvard Medical School. He is also a Diplomat of Behavioral Sleep Medicine from the US Board of Behavioral Sleep Medicine, serves on the Advanced Training Committee of the Royal Australasian College of Physicians and is the Chair of the Clinical Committee on the Board of the Australasian Sleep Association.
To support this mission he is a co-founder of the website SleepHub, which provides information on sleep, and produces the monthly podcast Sleep Talk.
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