Cognitive Behavioral Therapy For Insomnia: A Treatment Guide For Patient S.H.

Goals of Therapy for S.H.

Insomnia is the difficulty faced by a person in falling asleep or staying asleep even when he/she has the scope of sleeping. The inability to sleep leads to consequences such as fatigue, mood swings, failure in concentration, and such other adverse effects. Insomnia is caused due to various reasons, which needs to be treated at the very first instance that would otherwise lead to serious illnesses (Chung et al., 2013). Apart from the pills that are mostly in taken by people who suffer from insomnia, a very effective therapy known as the Cognitive Behavioral Therapy is recommended and used in recent times. The therapy works on the thoughts and behaviors of the patients that gradually enhance their ability to sleep well in the future. The study deals with the effectiveness of the therapy for a patient having insomnia with some related problems such as mood swings and hypertension and aims to provide her with effective solutions to deal with those.

The goal of the Cognitive Behavioral Therapy for Insomnia, commonly known as CBT-I is to help patients replace the thoughts and actions that cause insomnia with behavioral patterns and habits that would enhance sound sleep. The therapy also identifies the other major causes that lead the patients to get insomniac and accordingly connote the various tools to make them regain their sleep. S.H, the concerned insomnia patient has shown a strong disliking for over dosage of medication, which bars her from having medication. The therapy aims to treat her without the usage of pills that has negative impacts on body (Kyle et al., 2015).

Primary insomnia is mostly caused due to emotional, behavioral and psychological interventions (Winkelman, 2015). S.H has been reported to have hypertensions and mood swings that ascribe to the psycho physiologic intervention leading to insomnia. The case does not hint at any serious medical or psychiatric cause for the insomnia in the patient. However, since she has been suffering from the same since years without any prescribed medication, the drug-therapy suggested is a short-term intake of a sedative hypnotic would helps to reduce anxiety and tension (Nami, 2014). This would induce more sleep with the simultaneous use of the CBT-I therapy.

The use of CBT-I shows success with the change in behavioral pattern of the patients (Trauer et al., 2015). Contrary to the sleeplessness that they complain about, the patients tend to spend more time in deep sleep. The therapy also acts as anti-depressant to fight depression and proves to be beneficial in treating bipolar disorder and schizophrenia (Roehrs et al., 2014). The chief parameter of measuring the success of the therapy when used as a treatment by S.H would be the time when she will be able to induce herself into more sleep, getting rid of the tensions and thoughts that makes her insomniac.

The CBT-I therapy is a slow process. Thus, the patients must be properly educated about its functioning. It would be least effective without some basic strictures that the patient must abide by in order to get rid of the problem. It is advisable that one should not oversleep and should take rest as long as he/she feels is necessary. According to the case, it can be assumed that S.H may have some worries that make her feel restless and tensed. It is essential for her to deal with such concerns before going to bed. She must avoid smoking or consuming alcohol before bedtime. Avoiding the use of phones in bed and exercising regularly initiate better sleep.

Drug Therapy for S.H.

The therapy uses some specific techniques to cure the insomniac patients. S.H has been facing the problem for a long time, as is reported in the case. Thus, if she tends to worry about not having proper sleep, the problem of remaining passively awake would bar her from falling asleep. Moreover, she has hypertension that can never make a person sleepy. These eventually would lead to a failure of the therapy as a whole. Though CBT-I has tools such as relaxation training or biofeedback to treat the problems, yet a completely defocused attention would make it unsuccessful. In that case, the therapy needs to be altered.

Pharmacologic therapy is the second-line alternative therapy, alternatively used to treat insomnia. Chemical drugs, herbal or dietary supplements act as the alternatives used to cure short-term insomnia. The drugs show immediate results but should not be considered the only ailments since they have negative impacts on the body as well.

Benzodiazepines and Hypnotics are considered the most effective drugs to be used as short-term treatment for insomnia (Bertisch et al., 2014). Use of these drugs could ensure whether the problem in S.H is long term or short-lived. Studies have shown that regular exercises are equally effective for improving sleep as these drugs. Thus, for S.H., it is recommended to consider the drugs as alternatives, though use of CBT-I is primarily recommended.

S.H. is recommended to have proper food intake and adopt some dietary changes in order to have sound sleep. She should try to include rice, lettuce, almonds, cherry juice and other foods in her diet that induce better sleep. She must also engage herself in regular exercises that reduce insomniac tendencies. In case if she is a smoker or alcohol consumer, S.H is advised not to have these near bedtime.

Drug-drug or drug-food interaction hampers the functioning of the medications as a whole. Due to hypertension and diabetics, S.H has been using medication. She also uses OTC Tylenol pm for self-treatments. Thus, it is advised to her to refrain from using any other chemical drug along the drug for insomnia. The drugs, if she uses any for curing herself from insomnia must also not be consumed with any food or beverages such as alcohol (de Boer, van Hunsel & Bast, 2015). This leads to inactiveness of the body that slows down the reactions of the drugs consumed. Thus, it is advised that in case of any drug intake S.H must always consult a doctor before consuming it.

From the above study and knowing the various therapies that can be used for curing insomnia, S.H is recommended to primarily try CBT-I therapy that is a simple yet beneficial treatment. She can also resort to the drugs to get immediate results but that may cause side effects to the body. Before consumption, S.H is requested to consult a doctor and talk about her problems that are causing insomniac tendencies in her. Apart from all these, she is advised to regularly exercise and maintain a proper diet that would benefit her in the long term.

References:

Bertisch, S. M., Herzig, S. J., Winkelman, J. W., & Buettner, C. (2014). National use of prescription medications for insomnia: NHANES 1999-2010. Sleep, 37(2), 343-349.

Chung, S., Bohnen, N. I., Albin, R. L., Frey, K. A., Müller, M. L., & Chervin, R. D. (2013). Insomnia and sleepiness in Parkinson disease: associations with symptoms and comorbidities. Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine, 9(11), 1131.

de Boer, A., van Hunsel, F., & Bast, A. (2015). Adverse food–drug interactions. Regulatory Toxicology and Pharmacology, 73(3), 859-865.

Kyle, S. D., Aquino, M. R. J., Miller, C. B., Henry, A. L., Crawford, M. R., Espie, C. A., & Spielman, A. J. (2015). Towards standardisation and improved understanding of sleep restriction therapy for insomnia disorder: a systematic examination of CBT-I trial content. Sleep medicine reviews, 23, 83-88.

Nami, M. T. (2014). Chronic insomnia, pharmacotherapy and the cognitive behavioural approaches. J Sleep Disorders Ther, 3(1), 1-4.

Roehrs, T., Gumenyuk, V., Drake, C., & Roth, T. (2014). Physiological correlates of insomnia. In Electrophysiology and Psychophysiology in Psychiatry and Psychopharmacology(pp. 277-290). Springer, Cham.

Trauer, J. M., Qian, M. Y., Doyle, J. S., Rajaratnam, S. M., & Cunnington, D. (2015). Cognitive behavioral therapy for chronic insomnia: a systematic review and meta-analysis. Annals of internal medicine, 163(3), 191-204.

Winkelman, J. W. (2015). Insomnia disorder. New England Journal of Medicine, 373(15), 1437-1444.