Insomnia Treatment in Seattle

Insomnia is a common sleep disorder in which someone has trouble falling or staying asleep. This results in a lack of quality sleep that leaves one feeling unrested. Insomnia can range from mild to severe, and acute (short-term) to chronic (long-term). Chronic insomnia means having symptoms at least 3 nights a week for more than a month. 1 in 3 adults will sometimes have insomnia. 1 in 10 adults has chronic insomnia.

Negative daytime consequences occur in the form of fatigue, lack of concentration, and mood problems.  The prevalence of chronic insomnia is about 10% of the adult population, with a higher rate among women, geriatric populations, and those with medical problems.

Treatments can include medication, cognitive-behavioral therapy, and sleep hygiene.

Medications for Insomnia

Sleep Hygiene

Lifestyle changes often can help relieve acute insomnia. This is referred to as developing good “sleep hygiene”. Helpful steps may include avoiding substances that make insomnia worse (caffeine), adopting good bedtime habits (not watching television in bed), and going to sleep and waking up around the same time each day.

Sleep Diary:  Upon waking up in the morning, review of the last night’s bedtime, time spent asleep, and time you wake up can reveal patterns that might not otherwise be detected.  This information can be used to track progress as well.

Sleep Consolidation:  This technique is sometimes called sleep restriction, because it involves limiting the amount of time in bed.  It involves waking up at a “fixed” time, regardless of what time you go to sleep.  This helps set a regular circadian rhythm.

Stimulus Control:  This technique is designed to break the negative associations that develop around sleeping and the bed.  It involves keeping all non-sleeping activities away from the bed and waiting until sleepiness occurs before going to sleep.  If lying awake in bed for more than 15 minutes, you should go to a quite area and engage in a relaxing activity until you are sleepy enough to return to bed.

Cognitive Behavioral Therapy for Insomnia

Cognitive-Behavioral Therapy (CBT) for insomnia targets the thoughts and actions that can disrupt sleep. This treatment encourages good sleep habits and uses several methods to relieve sleep anxiety.

For example, relaxation techniques and biofeedback are used to reduce anxiety. These strategies help you better control your breathing, heart rate, muscles, and mood. CBT also aims to replace sleep anxiety with more positive thinking that links being in bed with being asleep. This method also teaches you what to do if you’re unable to fall asleep within a reasonable time.

CBT also may involve talking with a therapist one-on-one or in group sessions to help you consider your thoughts and feelings about sleep. This method may encourage you to describe thoughts racing through your mind in terms of how they look, feel, and sound. The goal is for your mind to settle down and stop racing.

CBT also focuses on limiting the time you spend in bed while awake. This method involves setting a sleep schedule. At first, you will limit your total time in bed to the typical short length of time you’re usually asleep. For people who have insomnia and major depressive disorder, CBT combined with anti-depressant medicines is an effective treatment strategy

Diagnosing Insomnia

Sleep Study Tests

Many tests are available to assess the quality of an individual’s sleep, and a discussion of each is beyond the scope of this course. However, the most commonly used tests are polysomnography and the multiple sleep latency test (MSLT), both of which are used in the evaluation of many sleep disorders.

Polysomnography is preferably conducted by a certified sleep technologist at an AASM-accredited facility. This test monitors many physiologic parameters, including electrocardiogram, EEG, eye movements (electrooculogram), chin EMG, airflow, oxygen saturation, respiratory effort, and heart rate.

A technician will note if snoring is present and, if so, the degree (i.e., mild, moderate, or severe). Body position and leg EMG derivations are also recommended.

One full-night study is typical, but split-night studies (i.e., polysomnography followed by continuous positive airway pressure [CPAP] titration) may be used when initial monitoring shows a high apnea-hypopnea index (AHI) score.  Polysomnography can help rule out the possibility of sleep disorders, and it will also show if the patient’s sleep cycle is normal or if REM sleep occurs at unusual times.

Portable monitor testing has a known likelihood of producing false-negative results; therefore, it is considered inferior to overnight sleep lab polysomnography. Airflow, blood oxygenation, and respiratory effort are the minimum test parameters needed for a complete at-home study. The sensors are similar or identical to those used for polysomnography and will either be placed by a sleep technologist, other trained professional, or the patient following detailed instruction.

The MSLT is a daytime test that can determine if REM sleep patterns occur during wakefulness and monitor the amount of time it takes for the patient to fall asleep normally during the day. For example, sleep latency periods (i.e., the time it takes to fall asleep) are typically 8 minutes or less in narcoleptic patients, but healthy individuals usually take 12 or more minutes to fall asleep during the daytime.

The American Psychiatric Association’s diagnostic criteria for Insomnia Disorder

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5):

A.  A predominant complaint of dissatisfaction with sleep quantity or quality, associated with one (or more) of the following symptoms:

  1.  Difficulty initiating sleep.
  2. Difficulty maintaining sleep, characterized by frequent awakenings or problems returning to sleep after awakenings.
  3. Early-morning awakening with inability to return to sleep.

B.  The sleep disturbance causes clinically significant distress or impairment in social, occupational, educational, academic, behavioral, or other important areas of functioning.

C.  The sleep difficulty occurs at least 3 nights per week.

D.  The sleep difficulty is present for at least 3 months.

E.  The sleep difficulty occurs despite adequate opportunity for sleep.

F.  The insomnia is not better explained by and does not occur exclusively during the course of another sleep-wake disorder (e.g. narcolepsy, a breathing-related sleep disorder, a circadian rhythm sleep-wake disorder, a parasomnia).

G.  The insomnia is not attributable to the physiological effects of a substance (e.g.a drug of abuse, a medication).

H.  Coexisting mental disorders and medical conditions do not adequately explain the predominant complaint of insomnia.

Insomnia Books

Peer-reviewed Research on Insomnia