As a sleep medicine nurse practitioner at Chesapeake Pulmonary and Sleep Physicians in Maryland, Doreen Gagne, CRNP, cares for patients with insomnia and other sleep disturbances. Doreen Gagne, CRNP, draws on an in-depth knowledge of cognitive behavioral therapy as a treatment for chronic insomnia.
Cognitive behavioral therapy for insomnia, or CBT-I, addresses chronic insomnia by helping patients to identify and change those thought patterns and behaviors that negatively impact their sleep. The patient works with a sleep therapist, who suggests a number of lifestyle modifications designed to eliminate those habits that cause the brain to resist sleep.
Many patients undergoing CBT-I learn to avoid lying in bed awake, which can lead to worries about sleep that then keep the patient awake. The therapist may also require the patient to avoid using the bed for anything other than sleep and sexual intercourse, so that the brain associates the bed with rest.
CBT-I also involves the introduction of positive behaviors, such as setting a consistent bedtime and manipulating the sleep environment. Such modifications can include darkening the bedroom, practicing meditation before bed, and starting a wind-down habit an hour before bedtime.
The specific modifications of CBT-I will depend on the patient’s individual needs and habits, as assessed by the clinician. Patients may keep a sleep diary for a number of weeks to assess the intervention’s effectiveness, which the clinician and the patient can then adjust as needed.
According to a study presented at the Annual Meeting of the Associated Professional Sleep Societies, these interventions lead to improvements in 50 to 60 percent of participants. Noticeable improvements are pervasive across all areas of sleep, including total nightly sleep time as well as the average number of awakenings.