Low quality of sleep and sleeping disorders can disrupt daily life and lead to serious health problems in the long term. Many people do not receive the proper diagnosis and treatment for the underlying cause of the sleeping disorder.
The Behavioural Sleep Medicine program is an area of sleep psychology that focuses on the assessment and treatment of sleep disorders by considering behavioural, physiological, and psychological factors that affect sleep. It is a non-drug, patient-centric program that recognizes that our thoughts and emotions play an important role in health and disease, and ultimately affect the quality of sleep.
What are the sleep disorders Behavioural Sleep Medicine can be used for?
Behavioural sleep medicine is useful for the evaluation and treatment of the following sleep problems in individuals:
- Insomnia
- Circadian rhythm disorder including shift work and non-24-hr sleep-wake disorder
- REM sleep behaviour disorder
- Continuous positive airway pressure (CPAP) therapies for sleep apnea
- Recurring nightmares
- Psychological dependency on sleeping pills
- Sleep problems due to anxiety, stress, and depression
Why should someone with sleep problems consider the behavioural sleep medicine program?
“Many of the treatment strategies that the sleep physician initiates are only successful or much more successful with behavioural strategies that the BSMP addresses and the doctors do not address. The BSMP focuses on the things that we do in our everyday life that definitely have a negative effect on our sleep. One of the most important aspects of the BSMP is to provide effective strategies for the patient to use to reduce the “stress effect” that definitely impairs our ability to sleep. So from the sleep doctor's perspective, all patients should have the opportunity to meet with a behavioural sleep medicine specialist because they provide important solutions to common sleep problems and ultimately this reduces the amount of sleep medication that the doctors prescribe, and that is a good thing.”
- Dr. Charles Samuels
What is the importance of the Behavioural Sleep Medicine program?
Several studies worldwide have shown that insomnia occurs in 10%-30% of the population, and sometimes it can be as high as 50%-60%. Lack of sleep not only makes you feel irritable and tired but also has serious long-term health consequences as well such as high blood pressure, heart disease, and mental health issues.
The Behavioural Sleep Medicine program is more than following good sleep hygiene tips for better sleep. It considers the entire individual and recognizes that the mind and body are connected and play important roles in the regulation of sleep. Some benefits of the behavioural sleep medicine program include:
Non-invasive and safe: Most behavioural sleep medicine therapies do not include medications and are considered safe with no side effects.
Improves quality of life: It reduces stress and improves emotional well-being.
Long-lasting results- The effects of behavioural sleep medicine are long-lasting and sustainable.
What are the components of the Behavioural Sleep Medicine program?
Most Behavioural Sleep Medicine Programs have multiple components combining behavioural approaches with cognitive techniques. They usually do not involve medications except in conjunction with other treatments to provide better outcomes for the patient.
Cognitive Behavioural Therapy (CBT) for Insomnia
Cognitive behavioural therapy for insomnia (CBTI) is an effective, first-line of treatment for chronic insomnia. It is also helpful for people with nightmares, and those resistant to CPAP therapy for sleep apnea. CBTI helps to identify thoughts, emotions, and behaviours contributing to insomnia and treat those.
Stimulus Control Insomnia – Stimulus control insomnia is when a patient starts to dread their bedroom as they see it as a place of restlessness and frustration. Stimulus control therapy for insomnia changes the habits or beliefs of a patient, transforming the bedroom into a place for sleep and relaxation. For example, patients are asked to remove electronics from the bedroom, refrain from watching TV or eating in the bedroom, follow a sleep schedule, and so on.
Sleep restriction – Sleep restriction is used to improve the quality and amount of your sleep. It limits your time spent in bed to achieve a consistent sleep schedule.
Sleep hygiene- Maintaining good sleep hygiene is a key element of CBTI. Good sleep hygiene tips include modifying your diet, including physical activity, creating a comfortable sleep environment, and so on. It works by encouraging practices that help you get better sleep, and reducing activities that hinder sleep.
Relaxation training – Relaxation training calms the mind so that it is easier to fall and stay asleep. Relaxation techniques are created in a way so that they can be easily incorporated into a person’s life without being too complicated. Some common relaxation techniques taught in CBTI are breathing exercises, meditation, and progressive muscle relaxation.
Cognitive control and psychotherapy – Both these approaches encourage patients with sleep disorders to manage stress and anxiety, cultivate habits that promote relaxation, and reinforce a positive mindset for better sleep.
Mindfulness - This practice helps reduce your anxiety and live more fully in the present moment. Mindfulness meditation can help you attain a relaxed state of mind that is conducive to falling asleep.
Imagery Rehearsal Therapy for Nightmares (IRT-N) - Image rehearsal therapy for nightmares (IRT-N) or dream rehearsal therapy is a cognitive-behavioural therapy for treating nightmares. The process helps individuals identify, confront, and achieve control over nightmares by addressing fears and negative feelings associated with bad dreams. People with PTSD, children, and adults with recurring nightmares can benefit from this technique.
Chronotherapy – This form of therapy aims to realign your biological clock or circadian rhythm to your bedtime, wake time, and daily routine until you achieve your desired sleep schedule. People who are extreme night owls or have shift work can benefit from it.
Circadian Entrainment- Circadian rhythm entrainment helps you synchronize your internal biological clock to external time cues so that you can adapt to a certain work, school, or routine schedule. It can also help people with delayed sleep phase syndrome, advanced sleep phase syndrome, irregular sleep-wake cycle, and non-24 sleep-wake disorder.
Bright Light Therapy – Light exposure is the strongest external stimulus that affects your body’s master clock, regulating homeostasis, moods, appetite, sleep, and alertness. Bright light therapy is used to treat circadian rhythm disorders, jet lags, and seasonal affective disorder.
Sleep Medication Tapering/ Reduction – Although sleeping pills are effective to provide quick relief for insomnia, long-term usage carries a high risk of dependency and over time, they lose their efficacy. CBTI, which is the first line of treatment for insomnia, identifies and treats the underlying cause of insomnia, and the results are long-lasting. This can reduce the dependency of patients on sleeping pills through a gradual process of decreasing sleeping pills intake.
The Sleep Institute offers a comprehensive Behavioural Sleep Medicine Program which consists of two to six, 30-minute sessions with a BSMS over one to six months. It is also covered by Alberta Health and Wellness, at no cost to the patient. If you experience any acute or chronic sleep disorder which is reducing the quality of your life and preventing you from getting the sleep you deserve, then please contact us to learn more about our program.