Medium 9781782203452

Teaching the World to Sleep: Psychological and Behavioural Assessment and Treatment Strategies for People with Sleeping Problems and Insomnia

Views: 210
Ratings: (0)

Sleep problems are ubiquitous in the modern world, significantly impacting on quality of life, mental health, and performance at work and at home. More significantly, sleep problems accompany almost every mental health condition and are a significant driver in the development and maintenance of poor mental health. This book describes the current state of knowledge on the science of sleep, covering the various forms of insomnia and parasomnia that abound, before discussing the variety of assessment and treatment options available to the healthcare practitioner. Further discussion of psychological and behavioural interventions is made with particular reference to a new, second-generation Cognitive Behavioural Therapy for insomnia, how this is an effective treatment modality, and how it can be applied with clients presenting with more complex physical and mental health conditions. The final chapter presents the range of theories as to the purpose and function of dreams and dreaming, and how 'dream-work' has been applied in the therapeutic setting. The aim of this book is to empower healthcare professionals with new up-to-date knowledge on the assessment, treatment, and management of sleep problems (an area so often neglected in every health-related training course), and to assist them with their clients who do not sleep well. The book is also written for the interested insomniac, to help them with their own sleep, or the sleep of their loved-ones. The purpose of this book is to spread the word about sleep and how it can be improved and optimised: to teach the world to sleep.

List price: $25.99

Your Price: $20.79

You Save: 20%

Remix
Remove
 

7 Slices

Format Buy Remix

Chapter One: The Science of Sleep

ePub

There have been many books written about sleep, the varying theories about its nature and purpose, informed from multiple angles (adults, infants, animals, and even plants!) over many decades. As stated in the introduction, the purpose of this book is to deliver information that is current and state-of-the-art: to people with insomnia to help improve their sleep experience; and to healthcare practitioners in order to inform and enhance their practice. As a result, this chapter will not engage in a lengthy repetition of the evolving theories as to the purpose of sleep over the years, but will describe where we are at the moment and how this can be of use to the individual with a sleep problem and the practicing healthcare professional, restricting its range to human sleep in health and “disease”. This chapter is subdivided into sections that will examine our current knowledge about sleep from different perspectives. After an initial examination of the various states of consciousness, we will look at circadian rhythms, sleep stages, current ideas about memory, how sleep changes as we age, the influence of light on our sleep, tiredness, how social cues impact on our sleep, and then how physical and psychological insults can reduce the quality and quantity of our sleep. This chapter will then conclude by pulling all these elements together to explain the complex and dynamic nature of sleep. After reading through this chapter it is anticipated that the reader will have a good base-knowledge about the science underpinning what it is to sleep in health and in poor health, so providing them with a good foundation on which to introduce therapeutic interventions to help improve sleep in themselves, and for their families, friends, and clients.

 

Chapter Two: Insomnias and the Parasomnias

ePub

The previous chapter examined the “science of sleep” in relation to the various physiological, psychological, and sociological influences on sleep. This examination culminated in Figure 10 which summarised the complexity of what, and how, it is to sleep; showing the various controlling, moderating, and mediating factors that can influence our sleep. We will return to many of these elements in further chapters of this book, but before that a description of the various types of insomnia and how we assess sleep problems is warranted. This is crucial from the perspective of the therapist: a good formulation is essential for an effective treatment.

A definition of insomnia

There are various bodies and institutions around the world whom define diagnostic criteria for the whole gamut of human conditions, both physical and psychological. Insomnia is variously defined by many of these bodies and institutions (e.g., the World Health Organization, The ICD–10 (the International Statistical Classification of Diseases and Related Health Problems), DSM-V (the Diagnostic and Statistical Manual of Mental Disorders), and the International Classification of Sleep Disorders published by the American Academy of Sleep Medicine). Although there is some variation on the exact definitions of the insomnias, there is broad agreement on the key criteria for these conditions which we will examine below. Insomnia is a significant problem with four–twenty-two per cent of the general population (proportions depending on the exact criteria used) reporting significant problems with sleep, proportions that increase with advancing age (Roth et al., 2011) and precipitate huge costs to society (Sivertsen & Nordhus, 2007). For the remainder of this chapter and book we will refer to the DSM-V criteria, as these are the most recently updated at the time of writing, and tend to be the criteria most commonly referred to and so potentially the most useful from a therapeutic perspective.

 

Chapter Three: The Assessment of Sleep

ePub

The previous chapter examined the multifaceted nature of poor sleep and presented a selection of the more popular psychological models for the development, progression, and maintenance of insomnia. There are multiple methods for identifying the various insomnias and parasomnias, the most informative, as with most things, is to ask the person directly what they are experiencing and how they feel about their experience(s). There are of course other, perhaps more objective methods for examining a person's sleep and these will be the focus of this chapter.

Electrodes and sleep laboratories

The traditional, and gold-standard, method of assessing an individual's sleep is that of polysomnography (or PSG). This method involves the placing of electrodes onto the test subject's scalp in order to measure the electrical activity of their brain, the so-called electroencephalograph (or EEG), and other electrodes to record other physiological functions such as eye movements, cardiac activity, respiration rate and depth, and limb movements. These “many” electrodes, recording EEG and other physiological functions, provide the “poly” in polysomnography. You may recall in Chapter One in the section examining the different waveforms of sleep that REM sleep “looks” like the waking EEG, in order to definitively confirm that a person is experiencing REM sleep and not wakefulness, we require the assistance of other electrodes to confirm: (1) atonia of the skeletal muscles; and (2) the characteristic rapid eye movements of REM sleep. Furthermore, in order to effectively diagnose conditions of apnoea, we require electrodes attached to the chest area to confirm the absence of breathing, and in periodic limb movement disorder and restless legs syndrome we require electrode feedback from the limbs. Figure 14 shows the typical electrode placement for the polysomnographic procedure.

 

Chapter Four: The Treatment of Sleep Problems and Insomnia

ePub

So far we have examined the science of sleep (Chapter One), types of sleeping problem (Chapter Two), and assessment techniques for the diagnosis of the various sleep disorders (Chapter Three). This chapter will now describe the range of treatment strategies available to the healthcare professional in the treatment and management of poor sleep. These can be broadly divided into the pharmacological and non-pharmacological approaches. So this chapter will begin by describing the various drug treatments available, before going on to explore the range of psychobehavioural and cognitive approaches for the treatment and management of the person with insomnia. One caveat though before commencing, and that is that the focus of this book is the psychological and behavioural treatment and management of insomnia. With that in mind the first section of this chapter on drug treatments will be brief, although it is anticipated that this will be enough to cover the main issues. Finally, a disclaimer, the author is not a pharmacologist and cannot speak with great authority on the mechanisms of various drugs. He is also very concerned about the over-prescription of sleeping medications. Although there are certainly circumstances and situations whereby the prescription of sleeping medications may well be warranted, there is most certainly an over-reliance on their use, both historically and contemporaneously. Part of the mission of this book is to promote non-drug methods for the treatment and management of insomnia and, as a result, the first section of this chapter will not be unbiased.

 

Chapter Five: The Rest Programme

ePub

As discussed in the previous chapter, although psychobehavioural treatment strategies for insomnia are known to be highly effective, and that CBTi is now recognised as the treatment of choice for a whole range of sleeping problems, there are some limitations to this approach. As a result, the REST programme has been developed as a second generation CBTi treatment approach, incorporating the elements of CBTi which have known efficacy, but with the added benefit of allowing practitioners to use the programme flexibly with their clients, tailoring treatment to the client in such a way as to:

These considerations can be achieved by making an in depth assessment of the client before developing their targeted and tailored treatment programme from the elements of the REST programme which are appropriate for them.

The REST acronym stands for Routine, Environment, Stimulation control, and Thinking, and we shall examine each of these elements in turn in the following sections.

 

Chapter Six: Considerations for Vulnerable Groups

ePub

The previous chapter detailed the REST programme, which, based on well-evidenced CBTi approaches, can be highly effective at the treatment and management of insomnia in people who are otherwise in good health. There are, however, considerations which need to be made for people who have more complex needs, based on their age and/or any accompanying medical or psychological comorbidities.

As a general rule, the principles outlined in the REST programme in Chapter Five of this book are known to be effective for certain groups (especially adults with poor sleep, some older people, children, those living with depression, anxiety, or chronic pain), and there is emerging evidence for some other conditions as well, such as people living with dementia, trauma, and those who have had a head injury. In these more vulnerable groups, the REST programme may well need some adjustment to suit the requirements of the person depending on their situation and that is the focus of this chapter, beginning with adjustments and considerations for older and then younger people, before examining alterations that might be appropriate for people living with specific medical or psychological conditions. The list is not exhaustive, but has been written in such a way as to capture the majority of the more common presentations; and to signpost the way in which the approach can be tailored for others not specifically mentioned here. For those clients not specifically mentioned in this chapter, then adjustments which are made sensibly, inline with those described here, and with keeping the individual and their requirements in mind, are a useful starting point. However, if there is any uncertainty then one should always proceed gradually and with caution, and also seek the advice of a more experienced professional where necessary. This is certainly the case when working with children, those who lack capacity, or those who are particularly vulnerable due to an extremely pronounced psychological or medical condition, for example those living with brain injuries, dementia, or psychosis.

 

Chapter Seven: Dreams and Dreaming

ePub

The final chapter of this book departs from the science of sleep, insomnia, assessment, and treatment strategies; and concludes with an examination of dreams and dreaming. The historical context and current theories as to the purpose and meaning of dreams and dreaming is made in the following sections, before this chapter and book concludes with the application of “dreamwork” in the therapeutic setting.

Background and beginnings in psychotherapy

The origins of dreamwork in psychotherapy begin with Sigmund Freud at the turn of the last century. His famous text The Interpretation of Dreams (Freud, 1900) introduced his theory of the unconscious mind through the interpretation of his own, and other people's dreams. Freud regarded dreams as wish fulfilment, in that their purpose is an attempt by the unconscious mind to resolve some conflict or other, either recent or even a long time in the past. He argued that information that is stored in the unconscious mind can be disturbing and potentially destabilising to the conscious mind and that we have a “preconsciousness”, which intervenes and prevents such unconscious information breaking through into the consciousness.

 

Details

Print Book
E-Books
Slices

Format name
ePub
Encrypted
No
Sku
BPE0000186800
Isbn
9781781816844
File size
1.75 MB
Printing
Allowed
Copying
Allowed
Read aloud
Allowed
Format name
ePub
Encrypted
No
Printing
Allowed
Copying
Allowed
Read aloud
Allowed
Sku
In metadata
Isbn
In metadata
File size
In metadata