Ending Insomnia - A New Approach
In an intriguing article by Simon Parkin, “Finally, a cure for insomnia?” released on 9/14/18 in the Guardian, the work of South African psychiatrist, Hugh Selsick, and his insomnia clinic located in Bloomsbury, Great Britain are looked at.
Founded in 2009, Dr. Selsick and several other staff members offer a radically diverse way to treat insomnia. Out of approximately 1,000 patients completing the 5-week program, 80% report major improvements and 50% indicate that they’ve been cured.
What makes Dr. Selsick’s program unique? Well, for starters, he treats insomnia as its own disorder and not just as a side effect of another. For example, many depressed people also have insomnia. In the past though, those patients have been provided with anti-depressive medications in the hope and assumption that their insomnia would simply pass as the depression lifted.
Dr. Selsick instead approaches the insomnia head on as its own clinical disorder. He believes it’s highly possible that a depressed person may have suffered from insomnia first and that their depression followed even several years after.
The article reports that many insomniacs have an antagonistic relationship with their bedroom. This is due to the frustrations the insomniac associates with their bedroom and lack of sleep. In short, the bedroom is linked to wakefulness. So, the very act of going to bed produces stress hormones and alertness.
Dr. Selsick’s clinic implements cognitive behavioral therapy, CBT, to break one’s negative associations with their bedroom and replace them with bedroom and sleep. Any and all waking activities done in the bedroom - excluding sex - are discouraged. This includes reading, watching tv, listening to music, talking on the phone, doing bills, writing notes, eating, etc.
In the 5 weeks with patients, the clinic attempts to dispel myths regarding what to do to sleep soundly, as well as how many hours of sleep are optimal. Dr. Selsick has noted that when a patient feels obligated to get the optimal 8 hours of sleep, they may feel pressured, (potentially causing wakefulness) and/or feel like a failure if they don’t get a full-night’s sleep.
Patients are encouraged instead to throw away the shoulds regarding number of sleep hours and to discover the amount of sleep that is correct for them. First things first, steady bedtimes are not endorsed. In fact, Dr. Selsick works with patients initially to spend less time in bed. Within 5 weeks, the same patient who has brought down the number of hours in bed works that number back up. Working the number of hours back up only happens when the patient begins to sleep more. This tactic is referred to as sleep efficiency training.
As an example, patient A goes to bed every night by 11pm. He gets out of bed in the morning for work by 7am. The patient reports being awake from 1am to 4pm every night. In this scenario, the patient is in bed for 8 hours but only sleeping 5. He is exhausted, frustrated and doesn’t know what to do. The insomnia clinic will instruct this patient to always get up at 7am irrespective of how much sleep they’ve gotten or not. Sleep wake up time needs to be consistent 7 days a week.
The patient is also highly discouraged from taking daytime naps. Since fatigue supports sleep, the clinic helps patients to bring their fatigue with them to the evening and to bed at night.
With a stable wake up time and greater fatigue, the number of hours spent in bed is reduced. Rather than going to bed by 11pm because that’s what the patient believes they should do, they are encouraged to stay out of bed until they are actually sleepy. This may mean patient A gets to bed by 1:30am and wakes up at 7. He is now spending 6.5 hours in bed and sleeping approximately 6. Though potentially still tired, the patient’s frustrations begin to ebb since a) they are sleeping more hours and, b) they are not awake for hours at night while hoping to sleep.
When the patient is asleep for 90% of their time in bed for several days, they are then instructed to move their bedtime forward by 15 minutes. In patient A’s cases this means he will wake up at 7am and get to bed at 1:15am. He should only make this switch provided he is feeling sleepy. The calibrated 15 minute bedtime shifts occur until the patient is no longer sleeping 90% of their time spent in bed.
Over several weeks, the patient engaged in sleep efficiency training will find their bedtime will become more naturally consistent. Dr. Selsick maintains that the number of sleep hours needed varies from patient to patient. Some people are fine on 6 hours of sleep, while others thrive on 9 or more. The important thing is to find pleasure again in going to bed and sleeping soundly through the night.
Do you suffer from insomnia? If so, what have you done to improve your ability to get a rewarding and restful night’s sleep?
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Thanks and sweet dreams!