As a clinical psychologist who specializes in sleep disorders, I've seen everyone from those who chase sleep each night to no avail to those who become unrecognizable characters once they enter never-never land. Here's a guided tour through some of my most memorable case files. (Details have been changed to protect patients' confidentiality.)
ID: Trouble falling asleep and staying asleep.
Prevalence: The condition affects about a third of Americans and is a persistent problem for 10 percent of the population.
Treatment: Sleep medication and/or cognitive-behavioral therapy.
Case Study: Dr. J is a 55-year-old neurosurgeon who had recently gone through a divorce and was involved in tense negotiations with his hospital over his schedule. For the last six months, he had been unable to fall asleep, or would have long periods of "semi-wakefulness."
As he stared at the ceiling, he was filled with regrets about his marriage, worries about his finances, and fears that, in his perpetually drowsy state, he could make a mistake that would harm a patient.
Dr. J tried a prescription sleep medication, but saw only minimal improvement. He was forced to give up emergency call duties—which meant a dock in pay and a blow to his self-esteem.
When his physician referred him to me, I began cognitive-behavioral therapy. In the sleep field, CBT, which involves educating patients about sleep, establishing good "sleep hygiene" or daily habits, and teaching patients to challenge thoughts and beliefs that are causing them anxiety, is the gold standard. It's more effective over the long term than medications. (In my practice, if CBT doesn't seem to be getting at the deeper psychological issues that led to the patient's sleep problems, I may also do psychodynamic-oriented therapy.)
During a five-session program, Dr. J learned about aspects of sleep that were not covered during his medical training. Though sleep affects our bodies and minds in countless ways, budding doctors—often sleep-deprived themselves—are not told much about the factors that set and disrupt the sleep-wake cycle.
Working on a bright computer screen at night, for example, sends signals to your body that it's time to be alert. I taught Dr. J to power down at least an hour before bedtime.
Dr. J was especially helped when I challenged his inaccurate ideas about how much sleep he was getting. Many insomniacs underestimate the amount; just knowing that he was likely getting more shut-eye than he thought quelled some of his anxiety.
I also taught him to accept stressful situations as a natural part of life. A high achiever, Dr. J had thought of himself as a superhuman of sorts. That made it hard for him to believe that he had limitations suddenly made apparent by his personal and professional troubles. Reframing his problems as normal and manageable disrupted the persistent "worry, can't sleep, then worry about not sleeping" pattern.
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