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Low Intensity Treatments > Insomnia > Flashcards

Insomnia Flashcards

1
Q

INSOMNIA: IS IT A PROBLEM?

Who has slept poorly at least once?

Who sleeps poorly regularly?

Who has a sleeping problem?

A

Who has slept poorly at least once? 95% of the population

Who sleeps poorly regularly? 30% of the population

Who has a sleeping problem? 10% of the population

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2
Q

WHY DO WE NEED SLEEP?

A

We still don’t really know

We know what happens if you don’t sleep:

> Physical: Inflammation processes are disturbed

> Cognitive: Poor memory

> Emotional: Mood swings + irritable

> Ultimately: death

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3
Q

HOW MUCH SLEEP DO WE NEED?

A
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4
Q

WHAT IS SLEEP?

A

5 fases = 1 cycle = about 1,5 hr Every night: 4 a 5 cycles

Start of the night: most of the deep sleep

the phases are: awake, REM-sleep, snooze, light sleep, moderate deep sleep and deep sleep

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5
Q

WHAT MAKES US SLEEP?

A

2 mechanisms

  1. Circadian rhythm (C)
  • Regulates hormones in our body (e.g. melatonine)
  • Normally slightly longer than 24hrs
  • Regulated by cues = “zeitgebers” e.g. light
  • Also regulates appetite, core body temperature etc.
  1. Homeostatic sleep process (S)
  • Accumulation of sleep inducing substances in the brain during waking hours
  • The longer you are awake à the more tired
  • During sleep you break down the substances
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6
Q

WHY DO WE NOT SLEEP? (hyperarousal)

A

Hyperarousal

Impossible to ‘switch of’

During acute stress periods

Or chronic stressors:

  • Too busy during the day
  • Ruminating too much
  • Then: Ruminating about sleep
  • Develop bad sleep habits: Circle!
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7
Q

Likelihood of sleep disturbance (types of insomnia)

A
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8
Q

WHY DO WE NOT SLEEP?

  • individual vulnerability
  • precipitating factors
  • perpetuating factors
A

In summary:

Individual vulnerability > Biological, personality

Precipitating factors > Stress and life events

Perpetuating factors > Dysfunctional sleep habits: going to bed early (or very late), to lie in in the morning, take a nap etc

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9
Q

INSOMNIA: WHEN IS IT A DISORDER?

A

DSM-IV: sleep disorder

DSM-5: sleep- wake disorder

DSM-5: Insomnia Disorder:

  1. Difficulty initiating or maintaining sleep (at least 30 minutes per night)
  2. At least 3 nights a week
  3. At least 3 months
  4. Causes clinically significant distress or impairment in daytime functioning
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10
Q

Other sleep disorders:

A
  • Sleepapnea = breathing stops §
  • Restless legs
  • Circadian rhythm disorders=sleep at the wrong moment §
  • Parasomnia = nightmares
  • Hypersomnolence=excessive sleepiness (during day)
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11
Q

How (with what) do you measure sleep/insomnia?

A

Objective:

  • Polysomnography: gold standard
  • Actigraphy: NB not Fitbit etc

Subjective:

  • sleepdiary

Various sleep estimates:

  • Sleep Onset Latency – time to fall asleep
  • Totale Sleep Time
  • Sleep Efficiency - % asleep of total time in bed
  • Wake After Sleep Onset
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12
Q

INSOMNIA: HOW DO YOU MEASURE IT?

(Objective v. subjective)

A

Objective ≠ subjective

Good sleepers: overestimate hours of sleep

Poor sleepers: underestimate hours of sleep

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13
Q

INSOMNIA: HOW DO YOU MEASURE IT? (Questionnaire)

A

Questionnaire: Insomnia Severity Index

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14
Q

INSOMNIA: CONSEQUENCES

A
  • Tired
  • Mood swings
  • Poor concentration
  • Absence school / work
  • More use of health care
  • Higher risk on other disorders > Depression > Anxiety > Cardiovascular > Mortality
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15
Q

TREATMENT: MEDICATION

A

Sleep medication (called hypnotics): OK, if it is every now and then

  • If long-term: > dependent > Not alert > Chance on accidents

Antidepressants

  • More and more used
  • Currently trials in NL (amitryptiline)

Melatonine

  • Only effective in jetlag
  • Might enhance insomnia
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16
Q

TREATMENT: MANY APPS AVAILABLE

A

Mostly based on:

  • Relaxing music or noise
  • Relaxation exercices
  • Measuring sleep (phases)

However: No proof at all that this is effective

17
Q

TREATMENT: PSYCHOLOGICAL

A

CBTi

  1. Psycho-education
  2. Sleephygiene
  3. Stimulus control
  4. Sleeprestriction
  5. Cognitive therapy
  6. Relaxation exercices
18
Q

§ Psycho-education

A

Psycho-education:

Information about sleep & sleep disorders

  • e.g. sleep phases, number of hours
19
Q

Sleephygiene

Behavior that can promote sleep:

A

Behavior that can promote sleep:

  • No coffee
  • No alcohol
  • Relaxation during the day
  • Bedroom (noise, light)
  • Not looking at alarm clock etc
20
Q

Stimulus control

A
  1. “Conditioning’ on sleep
  • Slowing down the day
  • bedroom only for sleep (and sex)
  1. Create 24 hours rhythm
  • Fixed times to go to bed
  • Fixed times to get up
  • No sleep during the day
21
Q

Sleeprestriction

A
  1. Restrict number of hours in bed (to average hours of sleep)
  2. When sleeping through: slowly increase hours

Rationale: In bed for many hours -> many hours awake

Less hours in bed

  • Building sleep ‘sleep debt’
  • Increases chance on sleeping through
  • People feel much better
22
Q

Cognitive therapy:

A

Usually aimed at:

  • Disfunctional thoughts about sleep

E.g.: “I need 8 hours of sleep to function well”

“I avoid commitments (social, family) after a bad night”

23
Q

Relaxation exercises (TREATMENT: PSYCHOLOGICAL)

A

Audio fragments or book

Is a skill you need to practice!

Practice during the day

24
Q

Effectiveness

CBTI: meta-analyses

(Van Straten et al. Cognitive and behavioral therapies in the treatment of insomnia: a meta-analysis. Sleep Medicine Reviews. 2017. 87 randomised controlled trials; ca. 6.000 patients § Effects of (elements of) CBTi compared to no treatment / waitlist)

A

Effects:

  • Not: sleeping more hours
  • But less wakenings
  • With circadian rhythm
  • Feeling more rested
  • More in control of sleep problem
  • Less anxious and depressed
25
Q

ONLINE TREATMENT

A
  • Consensus about treatment components
  • Relatively easy to translate to online (e.g. iSleep)
26
Q

ONLINE TREATMENT (iSleep)

A

5 lessons:

  1. Sleep and habits
  2. Improving sleep pattern
  3. Less ruminating, more relaxation
  4. Changing disfunctional beliefs
  5. The future

Every lesson:

  • Sleepdiary
  • explanation
  • Video clips expert & patient
  • Homework

Online feedback after every lesson by coach

27
Q

I-SLEEP effectiveness

A

Internet CBT voor insomnie is effectief

28
Q

TAKE HOME MESSAGE VANDAAG

A

Insomnie = volksgezondheidprobleem Goed te behandelen met CGT Ook online

29
Q

treatment: many apps available

A
30
Q

Cognitive therapy (How to stop ruminating)

A

Stop rumination

Alternative thoughts
Without emotional content
e.g.

  • Rehearsing capitals
  • Telefone alphabet
  • Counting sheep!

Low Intensity Treatments (9 decks)

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