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Behavioral Sleep Medicine

Our Behavioral Sleep Medicine program responds directly to the significant need for treatment and patient preferences. Specific behavioral and cognitive techniques are successfully applied to sleep problems like insomnia, habituation to treatment for OSA (CPAP), nightmare management and problematic sleep-related behaviors, otherwise known as parasomnias. Parasomnias may include sleep-walking, sleep-talking, and/or sleep-eating. The most developed and widely used BSM approach at The Sleep Center of Nevada and within the field of behavioral sleep medicine is a collection of techniques used to treat insomnia known as Cognitive Behavior Therapy (CBT-I).

Comprehensive insomnia assessment and treatment is offered at The Sleep Center of Nevada. There are several types of insomnia.  There are also other disorders that may influence the amount and quality of sleep, such as circadian phase sleep-wake disorders and inadequate sleep hygiene. Assessment can involve an in-depth interview, careful behavior analysis, sleep diary completion and actigraphy monitoring. 

Polysomnography (a sleep study in the laboratory) is rarely done for symptoms of insomnia only Sleep-related breathing disorders can sometimes contribute to sleep maintenance insomnia.

Insomnia is often produced or maintained by conditioned factors and poor sleep hygiene. Change in behaviors related to sleep and attitudes and thinking about sleep can help to resolve insomnia. Behavioral therapy can be used instead of, or in combination with, short-term use of low-dose hypnotic medication. Behavioral therapy techniques have been found to be as effective as benzodiazepine hypnotic medications in the treatment of insomnia. Long-term and regular use of hypnotics is not recommended, especially for older patients. Behavioral therapy has been found to produce improvements that are longer lasting than those of hypnotic medications. Use sunlight to set your biological clock.  Get sunshine in the morning with appropriate sun protection.  Try to minimize light exposure later in the day.

Sleep Hygiene

Regular exercise is recommended to help you sleep well. There ARE things you can do! Read on and learn some new tricks to sleep well. These tips are also known as “Sleep Hygiene.”

If you can’t fall asleep within 20 minutes, get up and do something boring until you feel sleepy. Sit quietly in the dark or read the warranty on your refrigerator. Don’t expose yourself to bright light while you are up. The light gives cues to your brain that it is time to wake up.

Get up and go to bed the same time every day; even on weekends! When your sleep cycle has a regular rhythm, you will feel better.

Refrain from exercise at least 4 hours before bedtime. Regular exercise is recommended to help you sleep well, but the timing of the workout is important. Exercising in the morning or early afternoon will not interfere with sleep.

Develop sleep rituals. It is important to give your body cues that it is time to slow down and sleep. Listen to relaxing music, read something soothing for 15 minutes, have a cup of caffeine free tea, do relaxation exercises.

Only use your bed for sleeping. Refrain from using your bed to watch TV, pay bills, work, or read. So when you go to bed your body knows it is time to sleep. Sex is the only exception.

Stay away from caffeine, nicotine and alcohol at least 4-6 hours before bed. Caffeine and nicotine are stimulants that interfere with your ability to fall asleep. Coffee, tea, cola, cocoa, chocolate and some prescription and non-prescription drugs contain caffeine. Cigarettes and some drugs contain nicotine. Alcohol may seem to help you sleep in the beginning as it slows brain activity, but you will end up having fragmented sleep.

Have a light snack before bed. If your stomach is too empty, that can interfere with sleep. However, if you eat a heavy meal before bedtime, that can interfere as well. Dairy products and turkey contain tryptophan, which acts as a natural sleep inducer. Tryptophan is probably why a warm glass of milk is sometimes recommended.

Take a hot bath 90 minutes before bedtime. A hot bath will raise your body temperature, but it is the drop in body temperature that may leave you feeling sleepy.

Make sure your bedroom is dark and quiet, and that your bed is comfortable. A hot room can be uncomfortable. A cooler room along with enough blankets to stay warm is recommended. If the light in the early morning bothers you, get a blackout shade or wear a slumber mask. If noise bothers you, wear earplugs or get a “white noise” machine.

Cues to help you fall asleep can include listening to relaxing music, reading soothing material with a light source placed behind you (not on a tablet or screen), having a cup of caffeine-free tea, or doing relaxation exercises.

Behavioral Therapy Treatment Techniques for Insomnia and other Sleep Problems

Progressive relaxation and other relaxation techniques

Stimulus control

Sleep hygiene instruction and education about sleep

Adjustment of sleep/wake schedule

Sleep restriction

Systematic desensitization

Assessment and analysis of eating behavior and how it may interfere with sleep

Development of plan for systematic change in eating behavior that may interfere with

Cognitive restructuring

Covert assertions and imagery

Applications of social cognitive theory, particularly with respect to approach to CPAP use and adaptation, for those who have sleep apnea

Imagery rehearsal therapy for nightmare reduction

Exploration of thoughts that may contribute to behavior that interferes with sleep