Everyone has trouble sleeping from time to time. Chronic insomnia is something which happens more regularly and interferes with daytime functioning in some way or another (the technical definition is having 3 nights or more per week of poor sleep for at least a month or more). Insomnia is more frequent in women, particularly those in menopause or peri-menopause. Primary insomnia- simply not being able to fall asleep without any contributing medical factor (e.g. pain) or mental health factor (e.g. anxiety/stress/depression) is a rare bird. It’s often less of a singular disorder and more a symptom of other things going on in your life: stress, grief, chronic pain, etc.
Conventional medicine still looks to pharmacologic treatments for insomnia, despite the fact that another approach (CBT-I) has more documented efficacy and far fewer side effects. It hardly ever considers the broader picture of what’s driving the insomnia during the daytime hours or what’s on the patient’s mind as they lay in bed each night. What is CBT-I? You may have heard of it’s mother: Cognitive Behavioral Therapy (CBT). The ‘I’ simply means it’s a specific approach for insomnia. In many cases of insomnia, one has effectively taught their mind/body how not to sleep. CBT-I is an unlearning, a resetting. There are two components: cognitive and behavioral. Most people think just of the cognitive part, the learning to change what you think, which is certainly key. But I’d argue the behavioral part (which involves some pretty scary and paradoxical prescriptions such as further sleep restriction) is just as crucial.
For the cognitive component, a patient learns to shift the self-defeating narrative that they are doomed to another night (or year) of poor sleep. But sometimes you can tell yourself something, know it to be true in theory, and still not believe it with your body. That’s where the behavioral changes come in. If indicated, one may be asked to actually deliberately restrict your sleep for the first few days or week. It sounds bonkers – asking someone who already isn’t sleeping to not even let themselves try to sleep until say 3 AM. But sometimes it’s a necessary step to shift your sleep homeostat (the biochemical driver in each of your cells which regulates sleep and wake). CBT-I is provided by a qualified Behavioral Sleep Medicine Specialist.
Where we come in: our approach at Integrative Alchemists is to provide Clinical Sleep Health Education to the whole person, taking into account their whole state of health and wellness. Poor sleep hardly ever occurs in a vacuum, so why should it be treated as such? We can work with your sleep physician, CBT-I provider, and/or therapist to help you reach your goals and follow through on the treatment recommendations you have been given but may be struggling to stick with.
There is rarely a quick fix for many sleep disorders. Internal motivation is key. When you are ready to take the first step, we are ready to talk.