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sleep learning series

Clinical insomnia

At any given time, over forty percent of us report difficulty getting to sleep or staying asleep during attempted sleep periods. Despite the huge numbers that these percentages imply, individuals with clinical insomnia form a much smaller subset of those reporting insomnia. So what about all of those highly frustrated individuals reporting insomnia that do not meet the criteria of a clinical insomnia subclass? It turns out that if they were put through a systematic process, many would show indications of other common sleep disorders in tandem with maladaptive beliefs and behaviors associated with sleep. Some would, indeed, present with clinical insomnia.

rule out disorders

The process of addressing insomnia complaints requires first ruling out other common sleep disorders with overlapping symptoms. This includes obstructive sleep apnea (OSA), restless legs syndrome (RLS), periodic limb movement disorder (PLMD) and MANY others. If ANY of these disorders are suspected they must be addressed as a priority even while continuing the investigative process of identifying OTHER contributions to insomnia, such as medication use, hyperarousal, circadian mistiming, or maladaptive behaviors. In practice— all of the components that contribute to insomnia, including other medical conditions, should be addressed.

treatment options

It is not advised to address insomnia complaints by asking your physician to prescribe a sleep aid for long-term use without addressing the many factors that contribute to delayed sleep onset or poor sleep quality in general. Chronic insomnia complaints should be referred to a board-certified sleep physician (BCSP) to evaluate, or a process that can be taken up by a BCSP, such as The Insomnia Clinic program. A BCSP has at their disposal a much wider range of options and evaluation tools designed to address the multiple components that cause clinically significant sleep disturbances. The key is to treat ALL the components. Interestingly, in 2016, Clinical Guidelines published by the American College of Physicians now recommends that all adult patients receive cognitive behavioral therapy for insomnia (CBT-I) as the FIRST treatment option for chronic insomnia (as opposed to sleeping pills). We will have more to say about CBT-I in other learning series.

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