Treating Insomnia in 10 MinutesDr Hugh SelsickInsomnia ClinicRoyal London Hospital for Integrated Medicine/UCLH

How We Treat Insomnia 30 minute assessment. Possibly blood tests and overnight sleep

studies. Five 60 – 90 minute group sessions of

Cognitive Behaviour Therapy for Insomnia.

One or two 30 minute follow up sessions. If on medication will then have ongoing

monitoring sessions.

Don’t: Waste time on sleep hygiene. Sleep

hygiene has been shown not to work and is often used as the control when testing insomnia treatments.

Assume that the insomnia is simply a sign of depression. Insomnia frequently causes depression, is a common residual symptom when depression lift and predisposes the patient to relapse.

Minute 1 Take their insomnia seriously. Insomnia has a similar impact on quality

of life to depression and congestive heart failure (Katz, 2002).

Insomnia leads to increased health resource utilization (Hatoum, 1998).

Minute 2 Reassure them that,

despite being a serious illness, insomnia will not kill them.

People with insomnia don’t die any younger that people without insomnia.

Remind them that the scare stories they read in the papers are often over-extrapolations from limited data and even then they are almost always talking about sleep deprivation.

Minute 3 Discard the myth of the 8 hour sleep. The average sleep time in adults in the

Western world is about 7.5 hours. But there is variation either side of that

mean. Naturally short sleepers are at risk of

developing insomnia when they try to strive for the 8 hour ideal and fail.

Explain that the right amount of sleep for them at the moment is the amount that makes them feel alert most of the day most days.

Minute 4 Don’t tell them to go to bed at the same

time every night. This often makes insomnia worse.

Tell them to get up at the same time every morning, seven days a week, whether they have slept well or slept badly, whatever time they went to bed.

This way they start accumulating tiredness at the same time each day and will gradually come to feel sleepy around the same time each day.

Minute 5 Discourage napping. If fatigue is the fuel that drives sleep,

then every nap is like stealing some of that sleep fuel from the night.

It is better to push through the sleepy periods during the day and save that fatigue for the night.

Once their sleep improves it will be easier to avoid napping.

Minute 6 Tell them never to go to bed until they

are sleepy. If they go to bed when they are not

sleepy they will just lie in bed waiting to get sleepy. This will reinforce their belief that their sleep is “broken”.

If they go to bed when sleepy they have a better chance of falling asleep quickly and staying asleep.

Minute 7 Tell them to spend less time in bed, not

more. They should set an earliest bedtime and

should not go to bed until they have reached that bedtime and they are sleepy.

Each week the earliest bedtime is moved 20 minutes later.

When they are falling asleep within 20 minutes and sleeping fairly solidly through the night they can reverse the process and start moving their earliest bedtime 20 minutes earlier each week.

Minute 8Things Allowed in the

BedroomSleepSexGetting dressed and undressed.

Things Not Allowed in the Bedroom

TV/RadioComputerTalking on phoneTextingExerciseIroningStudyingPaying billsReading!!MeditatingArguingEtc, etc, etc

Minute 9 If they go to bed, or wake up in the middle

of the night, and they are not asleep within about 20 minutes, they should get up, get out of the bedroom, and do something relaxing and enjoyable e.g. watch TV, read, listen to a podcast.

When they are sleepy they can go back to bed.

If they aren’t asleep within another 20 minutes, repeat above.

Minute 10 Explain that these techniques work, but

they work slowly. They will not sleep better straight away and,

in fact, may sleep worse initially. But the payoff for the reduced sleep in the

short term is better sleep in the long term. Teach them the mantra: I am not doing this

tonight to sleep better tonight. I may actually sleep worse tonight. I am doing this to sleep better in a month.

A Final Word Do not dismiss the possibility of using

medication out of hand. Hypnotics carry certain risks. So does insomnia. Therefore, the risks and benefits of

medication should be weighed up in each individual case, with the patient’s input, before deciding whether to prescribe or not prescribe hypnotics.