It relies on the second drive to sleep, in addition to circadian rhythm: progressive sleep deficit (aka, homeostatic drive). The final ingredient in CBT-I is the most challenging for both patient and therapist: sleep restriction therapy. Behavioral techniques include breathing training, simple meditations (eg, this free collection from the UCLA Mindfulness Research Center), and paradoxical intention (remaining passively awake). Now add typical CBT: cognitive techniques include eliciting the typical thoughts your patient will have while lying awake (“I will feel terrible tomorrow,” “If I don’t sleep, I can’t work,” etc), then exploring alternative thoughts and experiments to test them. The first ingredient in CBT-I’s 3-component is still sleep hygiene, so have a good list, like the one from Harvard’s sleep program in the Table. With relatively minimal reading and practice, you can offer a comprehensive psychotherapy for insomnia: CBT-I. Some of them will view it with scorn, thinking it shows you really don’t understand the severity of their insomnia.įortunately, a new smartphone app helps you offer much more than just sleep hygiene. 4īut simply offering patients a list of “sleep hygiene” recommendations is not likely to meet the needs of many patients. 1,2 Sedative/hypnotics (“z-drugs” such as zolpidem and its cousins) also are associated with an increased risk of falls 3 and other hazards. Surely you feel the pressure to reduce the use of benzodiazepines for sleep, because of their linkage with opiates and mortality risk. Once you’re familiar with CBT-I, look for the next article in this series, on the important bipolar extension of this technique. To be prepared to offer CBT-IB, you’ll need to be familiar with plain CBT-I, where the good news is (as shown herein), a remarkable free app can help you provide research-grade therapy with little additional reading or practice. Cognitive behavioral therapy for insomnia (CBT-I) is a major ingredient in a new psychotherapy for bipolar disorder indeed, the latter is called CBT-I B, a bipolar-specific variant of CBT-I. While this article might look like it’s about insomnia, it’s the first in a 3-part series about treating bipolar disorder with as few medications as possible.
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