The world is made up of two kinds of people: those who sleep well, and those who wish they could. Unfortunate souls in the latter category know the bone-deep weariness that comes from desperately seeking ZZZZs.
At the Insomnia Clinic, located at 1282 Union, clinical psychologist Russell Bolyard works in the field of "behavioral sleep medicine." He often takes referrals from the Methodist Hospital Sleep Disorders Center, which sees patients with such physical problems as sleep apnea or restless leg syndrome. "Once doctors there have ruled out medical conditions," says Bolyard, "they send the insomnia patients to me."
Each month he treats as many as 25 people who suffer from "primary insomnia" -- difficulty falling asleep or staying asleep at least three times a week for more than a month -- a condition most common in women and older people. "Over 40 percent of those past age 60 report sleep problems," says Bolyard. "Young adults have more difficulty falling asleep, while midlife or elderly adults have trouble maintaining sleep or waking up early."
After reviewing the medical history taken by the Sleep Disorders Center, Bolyard embarks with the patient on 12 to 20 sessions. First they explore sleep hygiene -- or habits -- and the psychologist's main goal is to establish the association between bed and sleep. That's not easy when people lie in bed to watch TV, listen to the radio, read the paper, work on laptops, "and generally ruminate about their day," says Bolyard. "We try to eliminate things that aren't conducive to sleep."
Experts also emphasize the need for a sleep ritual that doesn't include exercise, caffeine, or alcohol. The latter may help you get to sleep, but you"re likely to wake up once alcohol's sedative effect has worn off. Instead, Bolyard suggests a warm bath or some activity that will help you wind down, such as progressive muscle relaxation. This involves sitting in a chair and deliberately tensing and relaxing different muscles. "Attention will be focused on your physical state instead of your mental state, which is important if something is worrying you," says Bolyard.
Another technique, especially for stress-induced insomnia, is autogenic training. During a series of sessions, patients learn to relax their limbs, heart, and breathing to calm the nervous system.
Bolyard also asks patients to maintain sleep diaries. If they record being in bed for eight hours but sleep only four hours, Bolyard may try "sleep-restriction" therapy and limit their time in bed to four hours. Once they remove the extra time used trying to sleep, their time in bed is more likely to be spent in actual slumber, he explains.
About 80 percent of patients seeking help from behavioral sleep medicine in general report improvement, says Bolyard. "Some might get relief in the first one or two sessions," he says, "others may need longer."
If it's any comfort, EEG results from the Sleep Disorders Center often show that patients exaggerate their sleep loss. Says Bolyard: "They tend to underestimate the amount of sleep they're getting and overestimate the number of awakenings."
Feel better? Then close your eyes . . . and say good night.
For more information call 729-5159.
Put a Lid on It
Physicians advise against reaching for that bottle of sleeping pills; their concerns include drug dependence and side effects. But on a short-term basis -- two to four weeks -- they"ll prescribe the following "hypnotics" :
• Benzodiazepines (Dalmane, Klonopin, Xanax, Serax)
• Non-benzodiazepines (Ambien, Lunesta, Sonata)
• Antidepressants (Desyrel and Trazadone)
According to The American Insomnia Association, more doctors are prescribing non-benzodiazepines because of their effectiveness, safety, and perceived lower risk of dependence. In lieu of drugs, some patients receive help from melatonin supplements and herbal remedies. (See www.helpguide.org/life/sleep aids.) Before taking any sleep aid, talk to your doctor.
