Cognitive Behavioral Treatment of Insomnia
Treatment must be given to restore the mechanisms that have been broken, which implies two steps,
1.Restore the conditions that trigger automatically sleep and then
2.Ensure that the operator is established.
To make the first step you should:
1.Getting appropriate physiological conditions.
2.Maintaining an environment conducive to sleep.
3.Get a disabling physical and cognitive.
Finally, to retrieve the operator has to go to classical conditioning so that these mechanisms are made automatically and effortlessly. These control stimuli so that, for example, get into bed itself triggered by sleep.
Below are tips that can help achieve these two objectives.
Getting the right conditions
Sleep hygiene achieve appropriate physiological conditions.
To achieve physiological conditions necessary for sleep is necessary to align our behavior is to change personal habits that keep us from that goal. This provides:
1. Carry on a continuous moderate exercise, but intense exercise just before going to bed.
2. Control physiological variables before going to bed, do not go to bed with hunger, thirst, urination, etc.
3. Eating a proper diet and not eat too much before bedtime.
4. Avoid intake of coffee, tea, colas, nicotine or any CNS stimulant all day, but especially at times close to sleep.
5. The initial alcohol increases the drowsiness and can lead to sleep four or five hours, but increases the likelihood of waking up in the second half of the night. The metabolism of alcohol consumed much water as is necessary to avoid excess alcohol to not wake up thirsty in the middle of the dream.
Getting a suitable environment: Control of physical stimuli
1. Check the room environment, ensuring that room temperature is cool and pleasant, there is no strong light and moisture is adequate.
2. Check that the bed is adequate, the mattress and box spring have sufficient strength and comfort and that clothing is not limited, excessive or annoying.
3. The sounds are an important factor distorting sleep on that we must ensure that during sleep there is a calm and quietly.
Disabling Physical relaxation
The Jacobson’s relaxation method has been used traditionally to promote sleep and who teaches us to reduce muscle tension and therefore encourages the physiological deactivation. However, can not be applied as a sleeping pill, or do the exercises when not sleeping, because the condition is essential to relax it without a purpose, because in reality we are becoming an effort to sleep and efforts do not lead or relaxation or sleep. Therefore it is recommended to do relaxation exercises later in the day and with the sole objective of learning to distinguish when you’re tense and how to relax. The Jacobson’s relaxation exercises included in the “Acceptance Therapy Course,” which are engraved on CD1 are the ideal way to enhance the physical deactivation.
Breathing is also a good method of relaxation. The sleep is associated with a deep breath, regular and abdomen can lead to physiological deactivation (Wilhelm et al, 2001). The exercise of the “s” whistling of “Acceptance Therapy Course” helps them learn to regulate breathing, is also recorded in the CD1
Disabling cognitive
The thoughts and concerns are to some authors (Espie, 2002) the fundamental component of insomnia. We have studied the type of thoughts that prevent sleep and are those to which the person spent in bed and not sleep and have identified the following classes: solving everyday problems, worry about not sleeping, noise House and other conditions of the room, and general concerns (Harvey, 2000). Other studies (Watts et al. 1994) pose more of intrusive thoughts that interfere with sleep such as trivial topics, thoughts about sleep, family issues and long-term business plans and positive, somatic concerns, work and recent cases.
The problem of thought control is that it is ironic or paradoxical (Wegner, 1994) because there is a process of seeking alternative thoughts and another in the background check if they are getting or is there something wrong and makes the mind grow frequency. When we are not thinking about something we thought of something else and we got it, but then we realize that we have achieved and we have not thought about it, so that again the thought is present. It has shown that they want to stop thinking about something leads to an increase in the frequency of that thought (see for example, Wenzlaff, 2000).
Consequently, to achieve cognitive deactivation, have used the following techniques:
1. The paradoxical intention instructing you to follow all the thoughts that are taking without making any fight to avoid them, even write to attain them and make them concrete, of course you have to do out of bed. Acceptance exercises help very signiticativa to accept the anxiety about not sleeping. (See “Therapeutic Course of Acceptance”)
2. It is also proposed the observation of thought, ie, realize what you’re thinking and let go. Symbolically one can imagine that you put a thought in a jar or a door is opened in the head to go away. This exercise can be found on CD1 of “Acceptance Therapy Course.”
3. Meditation. The techniques mentioned in the previous point, in fact, are forms of meditation that result, not objective, leave the mind blank. In this sense the use of a mantra or a cognitive task, we require much attention and has no emotional relevance, like saying the alphabet backwards, can help control the thoughts.
4. Imagination addressed. Harvey A. G. (2001) proposes to use imagination directed at a particular thought or image that is not exciting as a means to combat triggers thoughts at the time of sleep.
5. The interruption of stay in bed when not sleeping is also used for this purpose, although its primary mission is to associate the bed to sleep.
Specific elements within a cognitive behavioral treatment is to be noted:
1. Getting used to make plans for the day in the morning, preventing the bed is an item to plan what things mandatory leave pending and without (Harvey, L., 2001).
2. Fichter et al. (2001) propose to change the thoughts that are exciting or distressing, watch TV or read because in this way can detract attention.
3. These authors also suggest that since there is influence of the daily concerns that occur in the waking moments, we must solve everyday problems to promote restful sleep.
4. Exercises of meditation, relaxation and acceptance, made out of bed is a perfect training to get off physiological and cognitive. In the “Therapeutic Course Acceptance” ** includes basic exercises that enable to carry out the plan included in these pages.