Re: CBT for Insomnia
 

and what about her sleep hygiene?
would you please inform us about further evolution
i'm very interested

Re: CBT for Insomnia
 

Yes, very interesting. I agree with the preceeding comments, especially the importance of appropriate treatment for her thyroid problem.

One thought is that when she asserts that she is not anxious and that she is not worrying during the periods when she is having difficulty falling asleep, this does not necessarily prove that anxiety and/or worry is not part of the problem. Not all individuals are skilled at recognizing and reporting their thoughts and feelings and not all individuals are willing to acknowledge all of their thoughts and feelings.

It certainly is possible to have insomnia for reasons other than anxiety. Have you asked about caffeine consumption or medication that can produce insomnia as a side effect? You haven't mentioned if she is having trouble falling asleep, trouble staying asleep, or trouble with early-morning waking. My experience is that difficulty falling asleep is often due to anxiety but also can be due to too much caffeine, to an irregular sleep schedule, to not allowing time to "wind-down" before sleep, or even can be due to anger at one's spouse. Waking during the night often is due to anxiety but also can be due to physical discomfort, nightmares, or concerns that areon the person's mind. Early-morning waking can be due to depression rather than anxiety or can be due to thoughts about all that needs to be done in the coming day.

It could be quite useful to have her write down her thoughts and feelings (1) as bedtime approaches, (2) when she first goes to bed, and (3) when she realizes that time has passed and she is not falling asleep.

Given her long-standing insomnia, it wouldn't be surprising if she has anticipatory cognitions ("Will I be able to get to sleep?") as bedtime approaches. Given the stressors that she is facing, it wouldn't be surprising if some of those issues come to mind as she is lying in bed (especially if she tries not to think about them during the day or tries not to be uspet by them). Once she notices that she is again having difficulty falling asleep, it wouldn't be surprising if she has some cognitions about how frustrating it is to be unable to fall asleep or some cognitions about how terrible it will be if she doesn't sleep well.

Re: CBT for Insomnia
 

Dear Colleague

I was wondering if you had some news about the case of your patient suffering from insomnia? Did you have any news about her possible thyroid problem?
You also wrote: she also did tell me that her attempts at visualization / relaxation etc. do not seem to help. In my experience, one of the greatest problems in practicing CBT for insomnia is that patiënts have great expectations and were hoping for some miracle to happen. Therefore I found it very useful to ask them (and registrate) how many times they have done their homework. This kind of stuff needs some weeks before it brings some solution. And I learned that it is useful to tell the patient that they don't had to learn how to get to sleep, but that the aim is to get relaxed.

Re: CBT for Insomnia
 

Yes,
Where the root of the problem was pain. More specifically bodily pain that i treated using guided visualisation. Then teaching these skills to my client putting her back in control which also had the added affect of reframing her old beliefs around the pain.My client now looks forward to her bedtime to practice her new skill!
All the best Jimmy.

Recent review of treatments for Insomnia
 

Two recent articles, a review of behavioral interventions for insomnia and a discussion of who is a good candidate for CBT for insomnia sound useful (I haven't read them). They are:

Irwin, M. R. (2006). Comparative meta-analysis of behavioral interventions for insomnia and their efficacy in middle-aged adults and in older adults 55+ years of age. Health Psychology, 25, 3-14. (Note: I object to referring to indiviuals who are 55+ as "older adults." Never mind why.)

Smith, M. T. & Perlis, M. L. (2006). Who is a candidate for cognitive-behavioral therapy for insomnia? Health Psychology, 25, 15-19.

Re: CBT for Insomnia
 

hypo- or hyperthyroid? i treated somebody whose GP claimed that all symptoms were due to her hyperthyroidism (S&S very close to those of anxiety). However the marked reduction in symptoms following therapy suggested to me that there was a large psychological componant to the problem - not that he was impressed!

Re: CBT for Insomnia
 

Certainly, a physical to rule out medical causes is always a good idea. Thyroid problems can mimic anxiety or depression or can play a role in anxiety or depression. Side-effects of medication can also play a role.

If treatment for her elevated thyroid level took care of the insomnia, then maybe it was a purely medical problem. That certainly isn't the case with most insomnia.

Training in CBT for Insomnia
 

Weekend Training Seminars on CBT for Insomnia
=============================================
When: May 4th-6th
October 19th-21st

Where: The Woodcliff Lodge
http://www.woodclifflodge.com/
Rochester New York

Sponsor: University of Rochester

COURSE DESCRIPTION
This activity is intended for Clinical Psychologists, PhD/NP
level Nurses and Physicians who are interested in the assessment
and treatment of Insomnia. Clinical Trainees are also welcome.

The seminar will provide information on both pharmacologic and
non-pharmacologic treatment. The majority of the course, however,
will be focused on how to conduct Cognitive Behavioral Therapy for
Insomnia (CBT-I)as an evidenced based intervention for Primary
and Secondary Insomnia.

This non-profit activity offers CE and CME credits.

Registration contact: Paul Lambiase
PJLambiase@UR.Rochester.edu

Course Director: Michael Perlis
Michael_Perlis@URMC.Rochester.edu

Web: http://www.urmc.rochester.edu/cpe/CBT-I

Increased concern re Meds for Insomnia
 

Many laypersons (and many MDs) assume that medication is the preferred treatment for insomnia. Not only does CBT seem to be more effective, there also are increased concerns about some commonly used meds. See http://www.medscape.com/viewarticle/553654?src=mp