Session Details
Sessions Content
Session 1 Understanding sleep and assessing your sleep difficulties Session 2 Scheduling a new sleep pattern Session 3 Sleep hygiene Session 4 Dealing with a racing mind Optional Review
Optional daytime 1:1 session to review progress
Session 5 Dealing with nightmares and recurrent dreams Session 6 Putting it all together
Info About The Course
• Housekeeping.
• DNA / Cancellations procedure.
• What is CBT? Treatment with best evidence of success
for persistent Insomnia is CBT.
• Homework tasks.
Week 1 Understanding and Assessing Your Sleep Difficulties
This session will:
• Measure the level of your Insomnia (baseline measurement)
• Tell you some facts about sleep, Insomnia and how much sleep we need
• Introduce you to using a sleep diary on a daily basis and show you how to calculate your sleep efficiency rating
• Help you to set yourself some individual goals to work towards
Features of Insomnia
• Difficulty getting to sleep. • Difficulty maintaining sleep – frequent awakenings / early
morning awakenings with inability to return to sleep. • Sleep that is not refreshing. • Sleep onset is more than 30 minutes after retiring to bed. • Duration is for longer than 1 month (usually longer). • Early Experience of significant distress or impairment in
occupational, educational, academic, behavioural, or other important area of functioning.
• The sleep difficulty occurs at least 3 nights a week.
Statistics and Facts!
• Sleep disorders are among the most common psychological disorders and are core symptoms of a range of mental health problems such as depression or anxiety disorders.
• The Great British Sleep Survey found that people with
insomnia are twice as likely to lack energy in their everyday life, three times more likely to have low mood or lack concentration and four times as likely to experience relationship problems as people who sleep well (From the Great British Sleep Survey – ongoing at Sleepio.com).
Statistics and Facts!
• Research has found that non-depressed people with insomnia have double the chance of developing depression in the future, compared with those that reported no sleep difficulties (Journal of Affective Disorders, 2011).
• One in 10 of the adult population have persistent problems in getting to sleep or staying asleep.
• One in 5 adults over the age of 65 have this difficulty. • You can survive for three times as long without food as
you could without sleep.
Stages of Sleep Stage Details
Stage W - Wakefulness Periods of being awake REM sleep (light sleep) Characteristic eye movements; where
we do most of our dreaming, occurs after each stage and more frequent towards morning
Stage 1 (light sleep) Relaxed muscles and slow eye movements, lasts a couple of minutes before moving onto Stage 2
Stage 2 (light sleep) Occupies the largest proportion of time (50-60%) though the first phase is usually short
Stage 3 and 4 (Deep Sleep) Deepest part of our sleep, occurring during the first third of the night
Changes in Sleep Patterns Over A Lifetime
0
20
40
60
80
100
Age 0 Age 20 Age 40 Age 60 Age 80 Age 100
% o
f Sle
ep
Light SleepDeep SleepAwake Time
What Controls Our Sleep Pattern?
• Sleep homeostat – this controls our drive for sleep. • Circadian rhythm – this is the sleep/wake cycle, also
known as the ‘body clock’, controls when we sleep. • The interaction of these two influences good sleep. • Automatic sleep also involved – good sleepers usually
don’t know why their sleep is good, because they usually don’t put effort into sleeping. Insomnia is maintained by effort to sleep.
How Much Sleep Is Needed?
Age Range Average Amount of Sleep Required
Newborn Up to 18 hours across 24 hour period
Young Child 12 hours at night + up to 2 hours during daytime naps
Child 10-12 hours at night
Teenager 9 hours with variation of when sleep is taken (go to bed late, rise later)
Young Adult 7.5 – 8.5 hours sleep
Adult 7-8 hours
Older Adult 6-6.5 hours with a tendency for daytime naps
• Cognitions (how you think) • Emotions (how you feel)
• Behaviours (what you do)
This Cognitive Behavioural Therapy course will help you to change thoughts and behaviours to improve your sleep and
the way you feel.
What Are You Like When You Lose Sleep?
Consequences of Insomnia
Consequences
Disorientation
Lower life expectancy
Relationship impact
Poor concentration
Memory problems
Irritability and Mood
Ill Health
Bad Nights Sleep
Fatigue and
Tiredness
What are the consequences
for you?
Insomnia and PTSD…
Treatment focusing on sleep does alleviate
both sleep disturbances and PTSD symptom
severity.
It is not enough to treat the PTSD symptoms
without treating insomnia.
Good Sleep!
“Good sleep is automatic – we don’t think about it – persistent sleep problems occur when we make sleep a
process full of effort, attention and determination” Colin Espie
Insomnia Stages - How It Takes Hold
Sub-Acute • Attention Acute • Attention
Insomnia • Intention
Sub • Attention
Chronic • Intention
Insomnia • Evaluation
1) 2)
3) Chronic
• Attention
Insomnia • Intention
• Evaluation
• Effort
4)
Sleeping Tablets
• Only recommended for short-term insomnia, not persistent insomnia.
• Not recommended for older adults whose bodies are slower to break down the chemical compounds in the drugs.
• Sleep problems return when ceased. • Benefits wear off, needing a higher dose or different
drug.
Sleep Diary
• Important to measure both sleep pattern and quality. • Diary will help you to identify where your difficulties lie. • As it measures across the week, you’ll be able to see
variability and patterns. • It will also help you to monitor changes that occur as you
complete this course. • Keep your diary from tonight right until the end of the
course. • Pick a new one up at every session for the coming week.
DO • Complete the diary within 1 hour of rising from bed. • Write down the times to the nearest 5 to 10 minutes if
you can. • Double-check your answers. • Calculate your sleep efficiency and make a note of it in
your workbook.
DON’T • Worry about it (it is just a record of your sleep). • Make up answers (it’s ok to leave a blank if you forgot).
Adult Community
Completing Your Diary
Calculating Sleep Efficiency
Total time asleep ---------------------------- x 100
Total time in bed
Aiming for above 85% Please bring your diary back next week with
details of your sleep efficiency and average number of sleep hours for the week!
Setting Sleep Goals
Your success in overcoming your problems will be partly determined by your goals. Is my sleep goal achievable? Is my sleep goal measurable? Possible Goals:
– More Sleep – A More Satisfying Sleep – A More Restorative Sleep – A More Reliable Sleep – A More Normal Sleep
Write down your personal sleep goals.
Setting Sleep Goals
Must get out of any self-defeating perspective that leave you feeling powerless. Move firmly towards solving this problem, and away from a position of defeat! Your frustration and anger with insomnia will likely keep it going!
Session 1
Homework • Sleep Efficiency Calculation • Sleep Diary • Goals of Therapy What’s Coming Next Session? • How to use your sleep efficiency and average sleep
hours calculations to improve your sleep. • Learn how to ‘schedule’ sleep and change thoughts
that are affecting sleep.