Behavioral Sleep Medicine*

Our BSM 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 eating behaviors. The most developed and widely used BSM approach at Sleep HealthCenters and within the field of behavioral sleep medicine is a collection of techniques used to treat insomnia, known as cognitive behavior therapy (CBT-I), for insomnia.

Comprehensive insomnia assessment and treatment is offered at Sleep HealthCenters. There are several types of insomnia including conditioned insomnia, idiopathic insomnia, inadequate sleep hygiene and sleep/wake schedule disorders. 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.

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 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. Insomniacs can learn skills that can be used repeatedly to manage their own insomnia at home and allow them to develop a greater sense of control over their sleep problem.

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 sleep

Cognitive Techniques

  • 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

Bright Light Therapy

  • Recommendations regarding use of natural outdoor light to adjust sleep-wake schedule
  • Exposure to light box therapy

Psychotherapy

  • Identification of and counseling for psychosocial factors that are implicated in sleep disturbance
  • Counseling for weight management

*available in select locations