ebook img

End the Insomnia Struggle: A Step-by-Step Guide to Help You Get to Sleep and Stay Asleep PDF

234 Pages·2016·24.18 MB·English
Save to my drive
Quick download
Download
Most books are stored in the elastic cloud where traffic is expensive. For this reason, we have a limit on daily download.

Preview End the Insomnia Struggle: A Step-by-Step Guide to Help You Get to Sleep and Stay Asleep

“I’m impressed. This is easily the most comprehensive and practical approach I’ve ever read on how to treat insomnia. I thought I had a pretty good handle on this topic, but was surprised to find large gaps in my knowledge, and quite a number of erroneous beliefs (don’t tell anyone, please!). The authors expertly synthesize acceptance and commitment therapy (ACT) and cognitive behavioral therapy (CBT) (which is no easy feat) to offer effective treatment for a wide range of sleep difficulties across the whole spectrum of DSM disorders. So, if you want to help your clients to sleep better without drugs, you need this book.” —R uss Harris, author of The Happiness Trap and ACT Made Simple “This fantastic toolkit is like getting to have two of the smartest, most empathic insomnia treat- ment experts in the world be your doctors. Clear instructions and flexible, doable steps transform the highest-q uality treatment into a do-i t-y ourself plan that will make it possible to get a good night’s sleep again.” —K elly Koerner, PhD, Evidence-B ased Practice Institute, Seattle, WA “For those of us who lie awake at night wondering when sleep is going to arrive and what tomorrow will be like without it, End the Insomnia Struggle offers hope. In this well-w ritten and accessible manual, Colleen Ehrnstrom and Alisha Brosse, two experienced clinical psychologists, take us through the reasons that people can’t sleep, and the behavioral and cognitive strategies that help them overcome insomnia. Readers will appreciate the handouts for recording one’s progress in the program and the many recommendations on how to troubleshoot one’s sleep plan. The one-s ize- fits-a ll approach of many cognitive-b ehavioral manuals is replaced here with acceptance, mindful- ness, and commitment strategies to help you individualize behavioral sleep tools. A must-r ead for people with insomnia and the clinicians who work with them.” —D avid J. Miklowitz, PhD, professor of psychiatry and behavioral sciences at the UCLA School of Medicine, Los Angeles, CA; and author of The Bipolar Disorder Survival Guide “End the Insomnia Struggle is a wonderful and much-n eeded book. Ehrnstrom and Brosse not only provide clear descriptions of the core tools needed to help promote healthy sleep, they also pour into each page their wealth of expertise working with people struggling with insomnia. The result is that they are there with you, as the reader, every step of the way, guiding you clearly, firmly, and gently along the path to better sleep.” —S ona Dimidjian, PhD, associate professor in the department of psychology and neuroscience at the University of Colorado Boulder “End the Insomnia Struggle is a must-h ave for anyone struggling to sleep well. Clinical science has validated a number of very effective strategies for insomnia, but unfortunately, these strategies are very challenging to put into action. The authors have put their combined forty-p lus years of clini- cal experience into providing a comprehensive program in a very straightforward way that a moti- vated person can actually do on their own, or that counselors could readily use to guide their clients. The book is user friendly, and addresses all the possible excuses and roadblocks that might get a person off track. Their distinction between worry (future-o riented) and rumination (past- oriented) is particularly helpful. I have already made a list of family and friends to send this book to. Give it a try yourself!” —L inda W. Craighead, PhD, professor of psychology and director of clinical training at Emory University, and author of The Appetite Awareness Workbook End the Insomnia Struggle A Step-by-Step Guide to Help You Get to Sleep and Stay Asleep Colleen Ehrnstrom, PhD, ABPP Alisha L. Brosse, PhD New Harbinger Publications, Inc. Publisher’s Note This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is sold with the understanding that the publisher is not engaged in rendering psychological, financial, legal, or other professional ser- vices. If expert assistance or counseling is needed, the services of a competent professional should be sought. Distributed in Canada by Raincoast Books Copyright © 2016 by Colleen Ehrnstrom and Alisha L. Brosse New Harbinger Publications, Inc. 5674 Shattuck Avenue Oakland, CA 94609 www.newharbinger.com Cover design by Amy Shoup Interior design by Michele Waters-Kermes Acquired by Catharine Meyers Edited by Ken Knabb All Rights Reserved Library of Congress Cataloging-in-Publication Data on file Contents Introduction 1 Part 1: Laying a Foundation 1 Taking a Lok at Your Slep 7 2 How Slep Works 25 3 The Insomnia Spiral 31 4 Wilingnes: The Oposite of Strugle 41 5 Create Your Own Individualized Treatment Plan 49 Part 2: Behavioral Strategies 6 Retrain Your Brain (Stimulus Control Therapy) 7 7 Quality Over Quantity (Slep Restriction Therapy) 93 8 Combining Stimulus Control and Sleep Restriction 111 9 Slep Hygiene 19 Part 3: Cognitive Strategies 10 Changing What You Think (Cognitive Restructuring) 139 11 Changing When and Where You Think (Designated Worry Time) 153 12 Accepting Your Thoughts (Mindfulness and Cognitive Defusion) 165 End the Insomnia Struggle Part 4: Reviewing Your Progress and Maintaining Your Gains 31 w o H E e v t i c e f f sI ru o Y ? g a m r o r P 183 41 ainM aitnin g aiGn s so r c A nCo ts x e t 195 51 t Las dr o W s 203 kncA de l w o neg m t s 205 nepA di x A : dac i r C ani yth R m h drDoi s s r e 207 nepA di x B : nI mnos a i and neM e su a p o 215 nere f e R s e c 219 iv Introduction f you have trouble falling asleep or staying asleep, or you do not feel refreshed in the morning even after a full night’s sleep, you are not alone. Insomnia is a large- I scale problem, with one in three people experiencing insomnia in their lifetime, and about one in ten US adults reporting insomnia that is severe and chronic (National Institutes of Health, 2005). You also are not alone in what insomnia is costing you. Are you exhausted during the day? Do you move more slowly and get less done? Do you have trouble with memory or concentration? Do you worry that others can see that something is wrong? Do you give up activities either because you are too tired or because you worry that the activity will make it hard to sleep? Perhaps you are more irritable than your normal, well-r ested self. Maybe you have a lot of anticipatory stress and anxiety about how you will sleep tonight. Insomnia is not only about how you sleep at night. It is also about how you suffer during the day. Nearly everyone struggles with sleep from time to time, but if poor sleep has become the new norm for you, you may have adopted some behaviors to try to cope (for example, staying in bed longer and longer). You also may be so worried about sleep that you are pre- occupied with thoughts about how you will sleep (I have to sleep tonight, I just have to!) or about the possible consequences of sleeping poorly (Tomorrow is going to be awful!). These behaviors and thoughts are perfectly natural responses to poor sleep— and they tend to make insomnia worse, interfering with your body’s ability to naturally self-c orrect when sleep gets off track. Cognitive behavioral therapy for insomnia (CBT-I ) addresses the thoughts (also called cognitions) and behaviors that influence sleep, helping people get out of their own way so their minds and bodies can remember how to sleep again. Decades of research show that CBT-I works as well as sleep medications by the end of a six-s ession treatment program, and better than medications when people are interviewed a year after the program (Mitchell et al., 2012). Unfortunately, many communities do not have enough professionals trained to provide high-q uality CBT-I , and some people cannot afford the cost of seeing a professional for six sessions. Fortunately, there are many books available to walk you through a standard CBT-I program. These books have been valuable resources for the millions of people who live with insomnia. End the Insomnia Struggle eTh t e e w S t o p S So why another book on insomnia? About ten years ago we were approached by a psychia- trist who specializes in sleep medicine. He was desperate for people like us, clinical psy- chologists trained in cognitive behavioral therapy, to start providing CBT for insomnia. We dove in, excited to be able to offer a treatment that works so well for so many. For the most part, it was very gratifying work, because so many clients responded well and quickly to a brief CBT-I intervention. However, we also met many people who claimed that they already had tried CBT-I — using a self-h elp book or very basic instructions from a doctor—w ithout success. We started to see certain patterns, with two main groups of people for whom CBT-I did not seem to be working. The first group of people were those who did not really complete the program. Some became frustrated and gave up on CBT-I when they did not see quick results; others were too scared to fully implement the program, though they generally believed that they had done the treatment as prescribed. The second group of people were those who wanted the program to work so badly that they took it on like military boot camp—t hey tried very hard and followed all the rules very strictly. Despite all their best intentions and effort, their sleep did not improve, and their lives revolved around sleep, adding to their frustration. We learned that there is a sweet spot. To successfully use CBT-I you need to: • be strict enough with yourself that you are actually doing the treatment fully and it has the time it needs to work; but • not so strict that your anxiety increases or that you do not allow yourself to adapt the treatment to your own unique situation and circumstances. We teach people to achieve the sweet spot. We blend traditional CBT-I with parts of a treatment called acceptance and commitment therapy (ACT). The addition of ACT strat- egies has helped many of our clients become more willing to do CBT-I fully, and to stay committed through some initial discomfort, allowing them to benefit from the full power of CBT-I . We will be emphasizing willingness and commitment throughout this workbook. ACT also provides some additional tools for working with the thoughts that impact your sleep, such as mindfulness and cognitive defusion (chapter 12). Finally, ACT’s focus on acceptance (chapter 3) has helped our clients decrease their struggle with sleep and with the daytime consequences of insomnia, changing their relationship with sleep. You see, your relationship with sleep really does matter. If you try to control sleep, it may end up controlling you! Unfortunately, some people perceive CBT-I and other sleep 2 Introduction strategies as more ammunition to control their sleep. We would like to suggest something different: think of all of our recommendations as strategies to promote (rather than control) sleep. The difference may seem subtle, but the result of this shift in perspective can be quite profound. Who Can Benefit from This Book This hybrid CBT-A CT program is specifically designed to help you with insomnia, which can be defined as difficulty falling or staying asleep, or nonrestorative sleep, with negative daytime consequences such as fatigue or difficulty concentrating. It is not likely to help you if you are sleep deprived simply because you do not have enough time to sleep. If you can get plenty of good-q uality sleep but only at a time that is out of sync with everyone else (for example, if your body can sleep 7 p.m. to 3 a.m., or 3 a.m. to 11 a.m.), you may have a circadian rhythm disturbance. Many people with circadian rhythm distur- bances also have insomnia and can benefit from this entire workbook. However, only appendix A directly targets shifting your clock. We do not specifically address circadian rhythm issues related to jet lag and shift work. Many people with disorders like sleep apnea, periodic limb movements, and restless legs syndrome also have insomnia, and can benefit from this book. However, these conditions need to be treated by a physician, and we encourage you to seek treatment before beginning this program (more on this in chapter 1). If you have a medical condition like bipolar disorder or a seizure disorder, we strongly encourage you to use this book with the close guidance and supervision of a professional who is trained in CBT-I and has working knowledge of your medical condition. Some com- ponents of CBT-I will initially lead to less rest or sleep. This can make seizures and mood instability more likely in people who are vulnerable. With proper supervision, you can benefit from this program even with these vulnerabilities. How to Use This Book This book is not about what works for everyone. It is a book designed to help you figure out what will likely work for you, with your unique physiology, environment, and lifestyle. Unlike some CBT-I therapists, we do not believe that all people need every component of CBT-I , and we tailor the order of the different components or strategies based on our assess- ment of each patient. 3

See more

The list of books you might like

Most books are stored in the elastic cloud where traffic is expensive. For this reason, we have a limit on daily download.