According to the Centers for Disease Control, sleep insufficiency has become a major problem, linked to motor vehicle and industrial accidents as well as to some chronic physical conditions.
The issue of sleep deprivation is complicated and multi-faceted. While seemingly a medical problem, sleep may have psychological underpinnings that mental health professionals can address.
Heather C. Finley, Ph.D., sleep medicine specialist at the University of Vermont Medical Center in Burlington, cited the 3P model, a framework comprising predisposing, precipitating and perpetuating factors developed by Paul Glovinsky and Art Spielman, as a way to better understand sleep disorders, particularly insomnia.
The first element pertains to genetics as well as to individuals who have a “hyperactive physical nature” or are “night owls or morning larks,” she noted.
Precipitating factors may include a loss of some kind, birth of a baby, a job promotion, divorce or some other disruption in the normal course of life, according to Finley. “Sleep is vulnerable to stress,” she said. “When stress remits, sleep habits may return to normal.”
In some cases, individuals compensate for sleep deprivation by taking a nap, sleeping in on the weekends to make up for lost shut-eye or relying on sedating medications. Finley said these perpetuating factors might make the person feel “victimized.”
For the most part, psychologists do not see clients regarding sleep issues for months or even years following the onset of symptoms, Finley pointed out. Usually the individual first sees his primary care provider who prescribes medication. But the good news is that a weaning protocol can help even a 30-year medication user kick the habit.
“Psychological dependence is the real key. It’s the thing that challenges the person. Changing the mindset frees the person up,” she added.
Claudia M. Toth, Psy.D., CBSM (Certification in Behavioral Sleep Medicine), noted that insomnia and sleep apnea are often linked to depressive disorders. “More than 95 percent of people with depression have sleep complaints,” she said, adding that anxiety often also goes hand-in-hand with sleep issues.
While sleep hygiene practices – avoiding alcohol, nicotine, heavy meals, strenuous exercise and keeping the room cool and dark – are useful, “in general, they are not sufficient to treat chronic sleep disorders,” said Toth.
Rather, cognitive behavioral therapy, which attempts to change thoughts about sleep, is one of the most effective treatment options for insomnia. “You have to challenge anxiety-provoking thoughts,” she said. “However, CBT is not a cure for all patients. The goal is to manage the condition more efficiently so it’s less interfering with life.”
Additionally, sleep restriction, i.e., limiting the amount of time spent in bed, helps to strengthen the association between the bedroom and sleep, according to Toth.
By going to bed closer to the time you actually fall asleep can help reinforce the body’s “sleep drive,” she added. Relaxation through diaphragmatic breathing and progressive muscle relaxation may also help to reduce chronic sleep issues.
As for sleep apnea, Toth pointed out that it might be misdiagnosed as depression. “The patient is tired and not as interested in things. Many people go for years labeled as depressed until someone figures out it could be sleep apnea,” she said.
“Psychologists, even if they don’t specialize in sleep disorders, are in a position to help identify sleep disorders. If they recognize this, the patient could move up to another level of care,” said Toth. “Partnering with a primary care doctor will help improve the patient’s quality of life.”
By Phyllis Hanlon