Insomnia and Symptoms
70% of depression cases include insomnia symptoms
34% of women and 22% of men cite stress as a factor in their insomnia
53% of night shift workers fall asleep at work on a weekly basis
22% of secondary insomnia results from pain or discomfort
17% of women and 5% of men blame their insomnia on their partner's snoring
20% of cases of insomnia are due to excessive light, noise or temperature
Everybody with anxiety related disorders experiences insomnia symptoms
Primary Insomnia makes up 20% of insomnia cases and is unrelated to other medical conditions (i.e., there is no underlying cause detected, stress is a factor).
Secondary Insomnia makes up 80% of insomnia cases where underlying causes of sleep disturbances can be detected. Insomnia can be acute, intermittent, or chronic.
Sleep Complaints and Daytime Impairments
- Difficulty falling asleep
- Difficulty staying awake
- Waking too early
- Poor Quality
- Interrupted sleep
- Non-restorative sleep
- Daytime sleepiness
- Reduced Motivation/energy/initiative
- Mood disturbance/ irritability
- Social/vocational problems, poor school performance
- Attention, concentration, or memory impairment
- Proneness for errors/accidents at work or driving;
- Tension, headaches, and/or GI symptoms
- Sleep Apnea
- Hot flashes
- Restless Legs
- Poor sleep habits
- Exercise Schedules
Mental health issues:
- Major life events like job loss or change, death, divorce, moving
- Chronic stress
- Substance use
- Improvements in sleep quality, sleep latency, total sleep, and sleep efficiency
- Improvements in vitality and physical and mental health
- Improvements in insomnia related daytime impairments
- Sleep environment
- Sleep habits
- Daytime function
- Medication use
- Medical & psychiatric history
- Alcohol/drug use
- Assessment of goals
- Compensatory strategies
- Introduction, education, sleep logs, sleep history, screen for psychiatric disorders (depression, anxiety, PTSD, Alcohol)
- Sleep Restriction Procedures (Optional) involves controlling time in bed (TIB) based upon the person's sleep efficiency.
- Stimulus Control Procedures aimed at associating the bed with sleeping and limit its association with stimulating behavior.
- Relaxation Training (e.g., meditation, PMR, imagery, entrainment, breathing)
- Cognitive Therapy focuses on education about sleep in order to target dysfunctional beliefs/attitudes about sleep (use DBAS), catastrophic thinking, consequences, worries, expectations, medication.
- Sleep Hygiene aimed at controlling the environment and behaviors that precede sleep.
- Review, Answer Questions, Resistance, Titration, Problem Solving
- Relapse Prevention
- Start by going to bed and getting up at the same time each day
- Go to bed only when tired
- Restrict activities in bed to sleep and sex
- Avoid stimulating activities like TV, computer games, action-packed books
- Avoid being around bright lights before going bed
- Get moderate exercise during the day but not before bedtime
- Avoid taking naps during the day
- Don’t eat a heavy meal late in the day
- Sometimes a light bedtime snack, such as milk or peanut butter helps
- If you don’t fall asleep within 10 minutes, get up and go to another room and do something calming until sleepy.
- Avoid substances like caffeine, nicotine, alcohol, and other street drugs that can interfere with proper sleep, especially within 4–6 hours of going to bed.
- If you tend to worry before bed, try making a to-do list.
- Keep the bedroom dark, quiet, and comfortably cool.
- Engage in a relaxing routine before going to bed, such as reading, writing, listening to calming music, taking a bath, meditation, progressive muscle relaxation, or calming breath exercises.