OT?? Interesting links on insomnia

[robysue]

For those with insomnia issues, the following links may be of interest---particularly if you are interested in non-drug based approaches to treating insomnia:

From Feb 2012: Overnight treatment for chronic insomnia by P.J. Skerrett posted on the Harvard Health Blog, which are part of the web pages associated with Harvard Medcical School.

A link to the original paper cited in the above link: INTENSIVE SLEEP RETRAINING FOR CHRONIC INSOMNIA A Randomized Controlled Trial of Intensive Sleep Retraining: A Brief Conditioning Treatment for Chronic Insomnia (ISR) published in the January 2012 issue of SLEEP.

And for those of you who read these two links and wonder what the heck Stimulus Control Therapy (SCT) for insomina that is mentioned in the previous links entails, here's a decent description written for a mass auidience from 2009 published in Psychology Today: Cognitive Behavioral Therapy for Insomnia Part 2: Stimulus Control by John Cline, Ph.D. It's part of a series of articles by Cline published in Psychology Today. They include:

Cognitive Behavioral Therapy of Insomnia
Cognitive Behavioral Therapy for Insomnia Part 1
Cognitive Behavioral Therapy for Insomnia Part 2: Stimulus Control
Cognitive Behavioral Therapy for Insomnia Part 3: Cognitive Restructuring

Please note: I know that CBT is NOT for everyone. Many people have no problems with the idea of taking sleeping pills. But if you are interested in what kinds of things fall into the broad category of "CBT for insomnia", these links make for some interesting reading.

[napstress]

Thanks, Robysue, for these articles. I read and applied the techniques from Jacobs' book in April and had immediate success. The most helpful for me were 1) learning that if I at least got core sleep (5.5 hours), I would still be able to function the next day (however irritably). However, they do not distinguish between consolidated and fragmented hours. Are 5.5 hours broken into 2- and 3-hour fragments the same as 5.5 uninterrupted ones? I'd be interested in knowing more about that. 2) cognitive restructuring (combined with touching my thumb and forefinger together, breathing, and holding an image of nature in mind). It got the the point where I'd wake up, touch my thumb and forefinger together, and say to myself, "I know I say and think something helpful at this point but I can't remember what it is" and I'd fall asleep immediately

My sleep is so hygienic you could eat off it, and has been for a long time, so no changes there.

I have a couple of obstacles to the going into another room if awake for more than 20 minutes, but I can easily remove them. I'm glad they mentioned that subjective time is sufficient. It made me crazy that they would say "Don't look at the clock," but then have some time-dependent activity to do!

The only items I take issue with are the sleep restriction and the elimination of naps, in an effort to "increase sleep drive." When I read this, I want to cry. My sleep drive is so high that I risk having the kind of meltdown 2-year-olds have when sleep deprived. During vacation I would sleep an average of 7.5 hours a night straight through, wake up tired, have a morning nap, wake up tired, have an afternoon nap, wake up tired, and not be able to keep my eyes open watching TV early in the night. For 3 weeks. (Jacobs permits naps under 45 mins and not too late in the day; mine are about 15-20 minutes). Also, during work weeks, I don't nap during the day, and am consistently awake for 2 hours per night, averaging 5.5-6 hours of sleep per night. I think this last piece is more about stress for me than sleep drive. Looking at my sleep consolidation on SH, you can tell when my vacations are: solid bars starting around December 20 and May 20; Swiss cheese starting mid-August and mid-January.

[taylor12]

I went through all the links you have shared on this post and found it very interesting as well as helpful to read. I must thank you robysue for sharing so many useful links online. I am sure many people would benefit from this.

[lazer]

Thanks RobySue... Lots of info here to check out

[patrissimo]

For those with insomnia issues, the following links may be of interest---particularly if you are interested in non-drug based approaches to treating insomnia:

From Feb 2012: Overnight treatment for chronic insomnia by P.J. Skerrett posted on the Harvard Health Blog, which are part of the web pages associated with Harvard Medcical School.

A link to the original paper cited in the above link: INTENSIVE SLEEP RETRAINING FOR CHRONIC INSOMNIA A Randomized Controlled Trial of Intensive Sleep Retraining: A Brief Conditioning Treatment for Chronic Insomnia (ISR) published in the January 2012 issue of SLEEP.

Now that is wacky. To cut to the chase on what ISR is:

On the night prior to attending the laboratory, participants undergoing ISR treatment were required to restrict their bed period to a total of 5 h, with the aid of an alarm clock, in an attempt to increase homeostatic sleep drive for the treatment period. Treatment then started with an arrival to the sleep laboratory on night 1 at 21:00. Following an explanation, the signing of an informed consent form, electrode application, and a quiet settling period, treatment began at 22:30. Treatment trials were conducted every half hour, finishing after 23:00 on night 2. Thereby, the ISR treatment routine allowed a series of 50 half-hourly sleep onset opportunities. Prior to the beginning of each trial, participants completed the Stanford Sleepiness Scale (SSS)17 in order to gauge subjective sleepiness throughout treatment. Within each treatment trial, the opportunity for sleep onset was limited to a 20-min period, with the trial stopping if sleep onset had not occurred by this time. For those trials in which sleep was initiated, 3 consecutive minutes of sleep were permitted, prior to being awoken. Upon awakening, treatment participants first rated their perception of whether sleep onset had occurred (on a Likert scale of 1 “No, definitely not” to 7 “Yes, definitely”). Following this response, participants were provided with information as to whether sleep onset had or had not occurred.

Participants then arose from bed following each treatment trial, to maintain quiet alertness in a bedside chair, undertaking activities such as reading or watching DVD movies. At the culmination of the treatment session, participants were provided with detailed treatment feedback regarding the number of treatment trials, their sleep status for each trial, perceived sleep attainment, sleep onset latencies, and total sleep time for each trial. Participants then traveled home via a taxi, in order to have a recovery night's sleep (with a maximum of 8 h in bed). Following this weekend component of treatment, participants were booked to attend a series of 5 further treatment sessions, involving sleep hygiene alone or in combination with SCT. In order to create a degree of experimental treatment blindness, the SCT/sleep hygiene therapist was blind to the presence or absence of the ISR treatment component.

So for 25 hours, every half hour you try to fall asleep, if you do you get woken up after 3 min, and get a pop quiz on whether you can tell that you had been asleep. Then you're awake the rest of that half hour. Guess it would make people really familiar with the feeling of slipping into sleep, and good at knowing that they had been asleep (which would be psychologically reassuring)?

[49er]

For those with insomnia issues, the following links may be of interest---particularly if you are interested in non-drug based approaches to treating insomnia:

From Feb 2012: Overnight treatment for chronic insomnia by P.J. Skerrett posted on the Harvard Health Blog, which are part of the web pages associated with Harvard Medcical School.

A link to the original paper cited in the above link: INTENSIVE SLEEP RETRAINING FOR CHRONIC INSOMNIA A Randomized Controlled Trial of Intensive Sleep Retraining: A Brief Conditioning Treatment for Chronic Insomnia (ISR) published in the January 2012 issue of SLEEP.

Now that is wacky. To cut to the chase on what ISR is:

On the night prior to attending the laboratory, participants undergoing ISR treatment were required to restrict their bed period to a total of 5 h, with the aid of an alarm clock, in an attempt to increase homeostatic sleep drive for the treatment period. Treatment then started with an arrival to the sleep laboratory on night 1 at 21:00. Following an explanation, the signing of an informed consent form, electrode application, and a quiet settling period, treatment began at 22:30. Treatment trials were conducted every half hour, finishing after 23:00 on night 2. Thereby, the ISR treatment routine allowed a series of 50 half-hourly sleep onset opportunities. Prior to the beginning of each trial, participants completed the Stanford Sleepiness Scale (SSS)17 in order to gauge subjective sleepiness throughout treatment. Within each treatment trial, the opportunity for sleep onset was limited to a 20-min period, with the trial stopping if sleep onset had not occurred by this time. For those trials in which sleep was initiated, 3 consecutive minutes of sleep were permitted, prior to being awoken. Upon awakening, treatment participants first rated their perception of whether sleep onset had occurred (on a Likert scale of 1 “No, definitely not” to 7 “Yes, definitely”). Following this response, participants were provided with information as to whether sleep onset had or had not occurred.

Participants then arose from bed following each treatment trial, to maintain quiet alertness in a bedside chair, undertaking activities such as reading or watching DVD movies. At the culmination of the treatment session, participants were provided with detailed treatment feedback regarding the number of treatment trials, their sleep status for each trial, perceived sleep attainment, sleep onset latencies, and total sleep time for each trial. Participants then traveled home via a taxi, in order to have a recovery night's sleep (with a maximum of 8 h in bed). Following this weekend component of treatment, participants were booked to attend a series of 5 further treatment sessions, involving sleep hygiene alone or in combination with SCT. In order to create a degree of experimental treatment blindness, the SCT/sleep hygiene therapist was blind to the presence or absence of the ISR treatment component.

So for 25 hours, every half hour you try to fall asleep, if you do you get woken up after 3 min, and get a pop quiz on whether you can tell that you had been asleep. Then you're awake the rest of that half hour. Guess it would make people really familiar with the feeling of slipping into sleep, and good at knowing that they had been asleep (which would be psychologically reassuring)?

That makes about as much as sense as a diabetic eating a high sugar diet. Sheesh, sometimes you wonder on how these studies develop.

Somehow, I don't get the feeling that folks like Barry Krakow, who understand sleep issues based on his own previous problems, would come up with studies like this.

49er

[eeckel]

Thanks for the links. I have the day off and enjoyed them with a cup of coffee. I've been reading about the history of attitudes towards segmented sleep and the impact of artificial lighting on sleep patterns. http://www.bbc.co.uk/news/magazine-16964783 The Roger Ekirch book was a good but long read. It contained a section on the history of segmented sleep. http://www.amazon.com/At-Days-Close-Nig ... ger+ekirch

[Eddy]

ISR sounds pretty out there, but it seemed to work. And fast. I go around and around with the Ambien pills and melatonen because they usually work fast! But I have to switch occasionally. I'd be willing to try this ISR thing, I don't sleep much anyways. Is there a way to do it at home or does my doctor have to order it?

Thanks,

Ed

[49er]

ISR sounds pretty out there, but it seemed to work. And fast. I go around and around with the Ambien pills and melatonen because they usually work fast! But I have to switch occasionally. I'd be willing to try this ISR thing, I don't sleep much anyways. Is there a way to do it at home or does my doctor have to order it?

Thanks,

Ed

Hi Ed,

What about simply finding a good CBT Therapist for insomnia?

If you do a google search, you can also do this therapy online.

49er

[Eddy]

Thanks 49er. Yeah I've seen some, but thought this ISR thing might be a fast fix. I'm willing to do anything if it works! Lots of counseling doesn;t sound like its for me though.

Ed

[blueh2o]

Exclusion criteria were other sleep disorders (e.g., obstructive sleep apnea, delayed sleep phase disorder, periodic limb movement disorder),

[quote Overall, this classification of response resulted in 40% to 45% of participants showing a clinically significant response. These data indicate the greatest number and percentage of “responders” in the combination ISR+SCT treatment group, with over 60% achieving a clinically significant change.][/quote]

Couple of comments; love to see a study with participants who's insomnia was apnea induced. And it seems like the "success" percentages aren't really that high? I find it difficult to determine how much of my sleep problems are insomnia related vs. physiologically related.

[Eddy]

Yeah I know. Sleep apnea seems pretty bad too. I guess some success is better than nothing. Especially with no pills! If anyone tries this sleep training thing please share experience!

[Eddy]

So if I try to fall asleep over and over again, that might be like the research study? I dont snore so I dont think I have breathing problems like apnea/CPAP. Appreciate the advice /feedback here! thanks everyone. Ed