Alla Arshakyan, M Ed, MA
Sleep problems are often associated with depression, anxiety, panic, physical illnesses, and in most cases, with ongoing stress. I believe that in order to develop an effective treatment plan, we have to take into consideration all concurrent conditions and to identify possible reasons. Only after that we can develop an appropriate treatment plan, individually tailored for the patient
I incorporate various methodologies into the treatment of chronic or onset insomnias.
• Relaxation Training, directed on reducing somatic tension; changing cognitions regarding sleep and insomnia; filling out daily activities and sleep logs, and based on that – re-evaluating sleep schedules and establishing wind down and anchor (wake up) times. The relaxation module, with deep diaphragmatic breathing and muscle relaxation, followed by meditation and visual imagery (creating pleasant and soothing mental images), proved to be extremely effective (at least in my patients)
• Life-style Changes: avoiding large meals, restricting caffeine and alcohol (to prevent rebound insomnia upon metabolism) consumption; restricting physical activities, mentally challenging activities, watching emotionally-charged programs on TV
• Stimulus-control therapy can be used to re-associate bed and bedroom with sleep, and to establish a firm sleep-wake up schedule. It is important to create a relaxed and cozy atmosphere, complete darkness in the room; to remove anything or anybody preventing from falling asleep (TV, pets, even snoring spouses). I advice to get up and leave the bedroom if the patient does not fall asleep in 10 minutes (may be more for older patients or people with physical health issues), and then to come to bed when feeling really sleepy.
• Sleep restriction, i.e., creating a mild sleep deprivation, can also be implemented. For example, patients have to learn to refrain from evening napping in front of the TV. Some researches recommend avoiding naps during the day; however, I found that having 1-2 short naps may actually improve sleep patterns, depending on the physical and mental condition of the patient.
• Sufficient exposure to daylight is important for regulating circadian rhythms. I advice my patients to increase their sun exposure; in the winter time light therapy can be used (in my practice, bright light therapy lamps proved to work well).
In most cases overcoming insomnia is possible without medications, but rather through thoughtful re-establishing of body-mind connections, and consistent mobilization of our inner resources.