Read Online Sleep Soundly Every Night, Feel Fantastic Every Day by Robert S. Rosenberg - Free Book Online Page A
Book: Sleep Soundly Every Night, Feel Fantastic Every Day by Robert S. Rosenberg
Read Free Book Online
Authors: Robert S. Rosenberg
Ads: Link
bedroom. He had become so anxious about his inability to fall asleep that now he was having trouble falling asleep. His primary care physician was wise to send Tom to me first because sleeping well could turn his life around, and Tom was desperate to do so.
To determine Tomâs problem, I needed to sort through several symptoms. Early morning awakenings had become a chronic problem with negative consequences such as fatigue and irritability. Tom had poor sleep hygiene such as caffeine intake, alcohol use, and staying in bed and doing work-related activities when unable to return to sleep. He also had an insomnia severity score of 27, which was consistent with very severe insomnia, and a General Anxiety Score (GAD-7) of 16, also high, and consistent with his reports of his racing mind. There was no indication of depression from his assessment.
After weâd identified the symptoms, my job was to sort through them and reverse the situation. The process was time-consuming, but the detective work is well worth the end result. Possibilities included a breathing disorder, sleep apnea, or a rapid eye movement (REM) sleep disorder.
To narrow things down, Tom first needed to work on his poor sleep hygiene and learn how he had developed the counterproductive habits. I explained
  How the blue light from his laptop in the middle of the night would put an end to any chance of returning to sleep.
  That the nicotine of his cigarette was a major stimulant promoting wakefulness.
  That he could not make himself return to sleep, and the harder he tried, the more anxious and awake he became.
  That lying in bed not sleeping was far worse than getting out of bed and doing something peaceful and soothing.
  Consistent rising with an alarm every morning would help reset Tomâs circadian clock.
  No naps in the afternoon after work would make sleep more likely moving forward.
I explained the behavioral technique called stimulus control, discussed later in this chapter. This treatment focuses on reducing exposure to things that cause wakefulness at night, and the goal is to establish immediate sleep and an optimal sleepâwake cycle. If Tom did not fall asleep within 20 minutes after waking, he got out of bed and chose to stay in the living room area with no computer and read. He avoided stimulating activities, and if he got sleepy again, he returned to bed. If he still could not sleep then he was to return to the living room and do something that was relaxing.
We also used cognitive restructuring, delving into Tomâs dysfunctional beliefs about insomnia. Focusing on thoughts like this lack of sleep will give me a heart attack only made matters worse. However, Tom could affirm his sleep as restorative and healthy.
Tom went home with several weeks of sleep logs to be filled out in the morning after he was awake and out of bed for the day. He would bring these back for his weekly appointments.
My hope was that these strategies would correct his insomnia. If not, my next step would be a sleep study to determine if sleep apnea was the root cause of the problem. Only recently have we sleep specialists come to appreciate how often an inability to remain asleep or early morning awakenings can be triggered by a primary sleep disorder such as sleep apnea and sometimes by periodic leg movements causing arousals from sleep.
If we still had not resolved the problem, I would consider placing Tom on one of the more sedating anti-anxiety antidepressant medications. I have had great success with these medications when generalized anxiety disorder has been at the root of the problem. The medications are even more effective when combined with CBT.
After a few months there was a significant improvement in that Tom was still awakening in the early morning hours after sleep onset, but he was able to return to sleep in a much shorter time. At this point, bothered by his continued awakening from
To determine Tomâs problem, I needed to sort through several symptoms. Early morning awakenings had become a chronic problem with negative consequences such as fatigue and irritability. Tom had poor sleep hygiene such as caffeine intake, alcohol use, and staying in bed and doing work-related activities when unable to return to sleep. He also had an insomnia severity score of 27, which was consistent with very severe insomnia, and a General Anxiety Score (GAD-7) of 16, also high, and consistent with his reports of his racing mind. There was no indication of depression from his assessment.
After weâd identified the symptoms, my job was to sort through them and reverse the situation. The process was time-consuming, but the detective work is well worth the end result. Possibilities included a breathing disorder, sleep apnea, or a rapid eye movement (REM) sleep disorder.
To narrow things down, Tom first needed to work on his poor sleep hygiene and learn how he had developed the counterproductive habits. I explained
  How the blue light from his laptop in the middle of the night would put an end to any chance of returning to sleep.
  That the nicotine of his cigarette was a major stimulant promoting wakefulness.
  That he could not make himself return to sleep, and the harder he tried, the more anxious and awake he became.
  That lying in bed not sleeping was far worse than getting out of bed and doing something peaceful and soothing.
  Consistent rising with an alarm every morning would help reset Tomâs circadian clock.
  No naps in the afternoon after work would make sleep more likely moving forward.
I explained the behavioral technique called stimulus control, discussed later in this chapter. This treatment focuses on reducing exposure to things that cause wakefulness at night, and the goal is to establish immediate sleep and an optimal sleepâwake cycle. If Tom did not fall asleep within 20 minutes after waking, he got out of bed and chose to stay in the living room area with no computer and read. He avoided stimulating activities, and if he got sleepy again, he returned to bed. If he still could not sleep then he was to return to the living room and do something that was relaxing.
We also used cognitive restructuring, delving into Tomâs dysfunctional beliefs about insomnia. Focusing on thoughts like this lack of sleep will give me a heart attack only made matters worse. However, Tom could affirm his sleep as restorative and healthy.
Tom went home with several weeks of sleep logs to be filled out in the morning after he was awake and out of bed for the day. He would bring these back for his weekly appointments.
My hope was that these strategies would correct his insomnia. If not, my next step would be a sleep study to determine if sleep apnea was the root cause of the problem. Only recently have we sleep specialists come to appreciate how often an inability to remain asleep or early morning awakenings can be triggered by a primary sleep disorder such as sleep apnea and sometimes by periodic leg movements causing arousals from sleep.
If we still had not resolved the problem, I would consider placing Tom on one of the more sedating anti-anxiety antidepressant medications. I have had great success with these medications when generalized anxiety disorder has been at the root of the problem. The medications are even more effective when combined with CBT.
After a few months there was a significant improvement in that Tom was still awakening in the early morning hours after sleep onset, but he was able to return to sleep in a much shorter time. At this point, bothered by his continued awakening from
Similar Books
