Managing Sleepless Nights - Yale Medicine Explains

Transcript

• 00:00- My name is Susan Rubman,
• 00:01I'm a clinical psychologist in Sleep Medicine at Yale,
• 00:04and I'm here to talk to you about managing sleepless nights.
• 00:11Sleep is variable.
• 00:12It's always gonna be variable from night to night,
• 00:14and science recognizes that there
• 00:16are differences in individuals, and across nights.
• 00:21Insomnia is different from normal sleep,
• 00:23in that
• 00:25there are persistent and consistent difficulties in sleep,
• 00:29and that can take the form of difficulty falling asleep,
• 00:33difficulty staying asleep,
• 00:34or being awake for too long during the night,
• 00:36or waking up too early,
• 00:37and not being able to return to sleep.
• 00:40One of the hallmarks that we look for
• 00:42in really recognizing whether this is
• 00:47a problem for individuals,
• 00:49is that there are also daytime consequences,
• 00:51that's a hallmark of actual clinical insomnia.
• 00:54(gentle music)
• 00:57Our experience is, you get into bed and you go to sleep.
• 01:00For people who don't have difficulty with sleep,
• 01:02you get into bed and you go to sleep,
• 01:03you get into bed you go to sleep,
• 01:04you wake up in the middle of the night,
• 01:05and you go back to sleep, and that's their learning history.
• 01:09For people who have difficulty with sleep,
• 01:11however it is that they got there, whether it's, you know,
• 01:14they brought a new baby into the home,
• 01:16or they had a stressful job,
• 01:18or whatever the pathway is to getting there,
• 01:21their experience is,
• 01:22they get into bed and they toss and turn,
• 01:24they wake up in the middle of the night
• 01:25and they toss and turn,
• 01:26they can't go back to sleep, they toss and turn.
• 01:28And that's what their bodies learn,
• 01:30and that's what their brains learn.
• 01:31And through repeated pairings of being in bed
• 01:35and tossing and turning,
• 01:36and being in bed and tossing and turning,
• 01:38the bed, and the bedroom, and the act of going to bed,
• 01:41actually acquire the capacity to kind of create
• 01:45arousal and awakening,
• 01:47and that
• 01:49learned habit, that bodily learned habit,
• 01:53like any other habit, becomes persistent over time.
• 01:56(gentle music)
• 01:59CBTI is cognitive behavioral therapy for insomnia,
• 02:02it addresses both thoughts and expectations about sleep,
• 02:06and behaviors around sleep,
• 02:08during the night when we can't sleep.
• 02:11There are a couple of different components
• 02:13of cognitive behavioral therapy.
• 02:16The first is called stimulus control therapy.
• 02:19Again, that's not a helpful name, right?
• 02:22What it really means is that we're taking control of that
• 02:27association between being in bed and not sleeping,
• 02:31and that control, and we're gonna change it.
• 02:35So
• 02:37what we do is,
• 02:38stimulus control has two basic rules to it.
• 02:42The first rule is really that beds are for sleep only.
• 02:45We wanna get rid of this association,
• 02:48the being in bed and tossing and turning,
• 02:49the being in bed and not being able to sleep,
• 02:51being in bed and being frustrated,
• 02:53and being in bed and, and being aroused.
• 02:55So we really wanna separate out
• 02:58and carve out the bed and the bedroom as a place for sleep.
• 03:02The second part of that,
• 03:04is that when you're not sleeping,
• 03:08because beds are for sleep only,
• 03:10you need to go someplace else and do something else
• 03:13for a period of time,
• 03:14until you recognize
• 03:17that your natural sleep drive is starting to kick in,
• 03:19and you start to feel sleepy, and drowsy,
• 03:21and then go back to the bedroom to go to sleep.
• 03:23That's the first component of CBTI.
• 03:25The second component, also, is called sleep restriction,
• 03:30which sounds just mean-spirited, right?
• 03:32Why are you restricting my sleep when I'm already
• 03:34having difficulty sleeping?
• 03:35What it is, is actually restriction of time in bed.
• 03:38We wanna compress the amount of sleep
• 03:41that individuals are getting.
• 03:42So if you're getting six hours of sleep
• 03:45over nine hours in bed, that doesn't feel so good,
• 03:48because you've got big patches of wakefulness.
• 03:51We wanna compress your time in bed,
• 03:53and compress your sleep, so that you get it in one big dose.
• 03:57And we work with individuals
• 03:59to manage both of those factors at the same time,
• 04:05to improve their sleep.
• 04:06It is a treatment strategy that is very effective.
• 04:10When folks work on stimulus control therapy,
• 04:14there's a latency to response,
• 04:15it takes a little bit of time
• 04:20to start to see the benefit,
• 04:21but the benefits are enduring, and we know that,
• 04:23that once people have changed
• 04:25their sleep habits and patterns,
• 04:27those gains are maintained, and in fact, extended over time.
• 04:32(gentle music)
• 04:35A couple of takeaway ideas
• 04:38that are that are important for folks to know,
• 04:39is that it's normal to have difficulty sleeping,
• 04:41particularly under times of stress.
• 04:44If it becomes persistent and consistent,
• 04:47there's help available.
• 04:49I would encourage people to reach out
• 04:52to their primary care physician,
• 04:54or to a sleep disorder center,
• 04:56if they're experiencing ongoing difficulty with sleep.