Case Example #1

“I have been a poor sleeper all my life and have tried everything there is out there”

This statement is heard by behavioral sleep medicine specialists perhaps more than any other.  Please let us assure you, that you are unlikely to have tried (or even heard of!) most, if not all, of the treatment recommendations that our behavioral sleep provider routinely utilizes.  Each patient is assessed in a wide-variety of domains of functioning to determine the best course of treatment.  The treatment plan contains clinical recommendations that are “tailor-suited” to each specific patient.  Utilizing a personalized treatment plan that takes into account the unique factors involved with each individual patient’s clinical presentation is part of what makes treatment both short-term AND effective.

[References for content and link to related research articles]:
• Taylor, DT, Pruiksma, KE. Cognitive and behavioral therapy for insomnia (CBT-I) in psychiatric populations: A systematic review. International Review of Psychiatry, April 2014; 26(2): 205- 213.  Link
• Okajima I, Komada, Y, Inoue, Y. A meta-analysis on the treatment effectiveness of cognitive behavioral therapy for primary insomnia. Sleep and Biological Rhythms. 2011; 9: 24 34.  Link
Illness – Pediatric – Adult - Childhood

Case Example #2

“I feel like my sleep has never been the same since I started menopause”

Menopause is a time of major hormonal, physical and psychological change for women although menopausal symptoms are variable from woman to woman.  From peri-menopause to post-menopause, women tend to report the most sleeping problems.  Most notably, these include insomnia, hot flashes, mood disorders, and sleep-disordered breathing.  Sleep problems are often accompanied by anxiety and depressive symptoms.

In general, post-menopausal women tend to be less satisfied with their sleep and as many as 61%report insomnia symptoms.  Snoring has also been found to be more common and severe in post-menopausal women.  Snoring, along with pauses or gasps in breathing might be signs of obstructive sleep apnea.

Changing and decreasing levels of estrogen cause many menopausal symptoms including hot flashes, which are unexpected feelings of heat all over the body accompanied by sweating.  They usually begin around the face and spread to the chest affecting 75-85% of women around menopause.  Prior to the hot flash, body temperature rises accompanied by an awakening from sleep.

Hot flashes last, on average, approximately three minutes and tend to fragment and disturb sleep quality.  Most women experience these symptoms for one year, but about 25% have hot flashes for as long as five years.  While total sleep time is unlikely to change, sleep quality can suffer.  Hot flashes may interrupt sleep and frequent awakenings cause next-day fatigue.

Treatment with estrogen (Estrogen Replacement Therapy, ERT) or with estrogen and progesterone (Hormone Replacement Therapy, HRT) has been found to help relieve many menopausal symptoms. We urge you to discuss all potential treatment options with your regular health care provider.  There are alternative approaches for managing your sleep-related menopausal symptoms which may work for you.

The most state-of- the-art theoretical models that explain the development of chronic insomnia recognize that insomnia is caused by a combination of physiological, psychological, sociological and environmental factors.  These factors perpetuate insomnia even in the absence of the original biological changes that started the insomnia phenomenon.With CBT-I, these aforementioned factors and other potential influences are carefully assessed by our behavioral sleep medicine specialist so that they can individually be addressed and treated.

[Reference for content and link to related research article]:

•Attarian, H, Hachul, H, Guttuso, T, Phillips, B (2014). Treatment of chronic insomnia disorder in menopause: evaluation of literature. Menopause: The Journal of The North American Menopause Society. 2014; 22(6). Link

Insomnia – Sleep – Nocturnal - Sickness

Case Example #3

“My Doctor told me they won’t refill my sleep medication prescription!”

While you know your body the best, your primary care physician is the truly the best source of information that there is regarding your medical care.  They are trained to identify specific risk factors about their patients that is an essential and critical skill to them being successful and effective health care providers.

Our behavioral sleep provider is able to work in tandem with your physician.  The treatment process involves an initial clinical aim to improve and/or stabilize a patient’s sleep pattern using CBT-I interventions.  At the start, patients continue to use their current amount of sleep medication.  After that, a slow but methodical tapering process assists patients to achieving their goal of reduced levels of medication.

Reducing or eliminating use of a prescription sleep medication is often a difficult prospect for patients as they are not confident that they can accomplish their goals.  The sleep research literature has consistently reported dramatic increases in success rates when sleep medication tapering is done in conjunction with CBT-I interventions.

Patients can be up to eight times more likely to successfully reduce and/or eliminate their sleep medication usage when their efforts are combined with a course of CBT-I treatment.  If you have tried unsuccessfully to reduce your sleep medication use or if you think that you could use expert therapeutic assistance with the process, please let us help.

[Reference for content and link to related research article]:

•Edinger, JD, Wohlgemuth WK, Radtke, RA, Marsh, GR. Quillian, RE. Cognitive Behavioral Therapy for Treatment of Chronic Primary Insomnia: A Randomized Controlled Trial.JAMA. 2001;285(14):1856-1864. Link

Insomnia – Sleep – Nocturnal - Sickness

Case Example #4

“I was prescribed CPAP over 15 years ago and I couldn’t stand the thing and didn’t wear it, but my health has definitely worsened.”

CPAP was invented by Dr. Colin Sullivan in 1980. It was patented and approved for FDA use in the United States in 1984 and became available for patients by 1985.  The ensuing 30-plus years have borne witness to remarkable technological advances in Positive Airway Pressure (PAP) therapies.

Modern PAP units are small, easily portable and nearly inaudible.  There have been comparable advances in mask and headgear technology.  Researched methods on ways to improve compliance with the device have also improved: behavioral techniques have shown special promise.

For patients that have had any prolonged difficulties tolerating PAP therapy, cognitive and behavioral therapies (CBT) can reduce anxiety and improve adherence to treatment.  These primarily behavioral techniques have been specifically developed and researched since the advent of PAP therapy to help improve compliance and are clinically essential for successful use of PAP use.  Cognitive Behavioral Therapies are effective in improving adherence for all positive airway pressure treatment modalities utilized in the treatment of sleep apnea (e.g. CPAP,BiPAP, AutoPAP and ASV).

[Reference for content and link to related research article]:

• Sawyer, AM, Gooneratne, N, Marcus, C.L., Ofer, D., Richards, KC, Weaver, T.E. A Systematic Review of CPAP Adherence Across Age Groups: Clinical and Empiric Insights for Developing CPAP Adherence Interventions. Sleep Medicine Review. 2011, 15(6): 343-356. Link