University Of Michigan Cognitive Behavioral Therapies, Education Can Help Insomniacs

When interruptions to sleep become a chronic problem, doctors at the University of Michigan Behavioral Sleep Medicine Program, in the Department of Psychiatry and affiliated with the U-M Sleep Disorders Center, can offer patients a multidisciplinary approach to treating insomnia that teaches them how to sleep.

When lack of good sleep becomes a problem

Jane Heibel, 44, began having problems sleeping about three years ago.

"On and off, I'd have terrible nights of insomnia where I would fall asleep easily enough, but then I would wake up on and off and maybe get three hours of sleep the entire night," she says.

"I would come to work in the morning so tired that I was nauseated and I could barely function. I felt like my work was suffering. I was short with people. I would have to look things over twice or three times and I'd find mistakes. It just wasn't efficient."

When Heibel's lack of sleep began to interfere with her daily activities, she went to J. Todd Arnedt, Ph.D., director of the Behavioral Sleep Medicine Program, for treatment.

Insomnia, the most common sleep disorder, is characterized by difficulty falling asleep or staying asleep, waking early with the inability to fall back asleep, or just waking up feeling tired and un-refreshed from poor quality of sleep.

"About 33 percent of individuals suffer from some form of insomnia on an occasional basis at some point in their lives. We estimate that 10 percent to 15 percent are actually chronic sufferers, which we define as three or more nights per week for six months or more," Arnedt says.

Heibel's treatment

Part of learning how to get a good night's sleep is understanding how environmental factors affect your ability to sleep.

"Medications are the first line of defense against sleep problems. But when insomnia becomes a chronic problem, there are inevitably patterns of thinking and behaviors that contribute to the ongoing problem that medications cannot address," Arnedt says.

"One of the first things Dr. Arnedt talked to me about was my routine," Heibel says. "I would generally go up to bed pretty early but I would bring my checkbook, taxes, a book to read, whatever it was that I was working on, even my telephone, so I could make calls. I was turning my bedroom into a little office. I learned that was an absolute 'no-no,'" she says.

The Behavioral Sleep Medicine Program uses a three-pronged approach to treatment that includes behavioral strategies, cognitive techiniques, and sleep education. Treatment takes place in an office setting, over four to eight sessions. Each session lasts from 40 to 60 minutes. The treatment typically takes anywhere from four to six months to complete.

"Experts in psychological, behavioral and medical aspects of sleep problems provide a thorough evaluation to determine each individual's sleep issues and the factors that contribute to triggering their sleep problems," Arnedt says.

Key to the program's approach is targeting poor sleep habits and maladaptive behaviors that have developed over time and perpetuate insomnia; targeting patterns of thinking that can lead to frustration and worry about one's sleep; and teaching individuals new behavioral strategies.

"In some instances, we are re-teaching people how to sleep properly by helping to reshape their maladaptive behaviors and to implement more consistent good sleep practices," Arnedt says.

"We teach people specific behavioral strategies to help them sleep, and how to address the cognitive issues that arise in people who have repeated bad nights of sleep."

When people repeatedly have difficulty sleeping, they naturally fall into certain patterns of thinking; like worrying if they are going to fall asleep, becoming anxious about their sleep, and even becoming depressed about their sleep, which may perpetuate the problem and need to be targeted in treatment.

"Research shows that these cognitive behavioral therapies provide improvement in 70 percent to 80 percent of patients," Arnedt says.

"I don't bring my work to bed with me anymore. The treatment taught me to separate the place I sleep from everything else. I sleep much better now -- it's like night and day," Heibel says. "The best thing about the treatment was that it wasn't a big investment. I took the handouts and information I learned from my visits and started applying what I learned."

Tips for getting a good night's sleep

Arnedt suggests following the Principles of Sleep Hygiene:

* Go to bed and get up at the same time each day, even on the weekends

* Avoid daytime naps

* Avoid drinking alcohol in the evenings and do not use it to help you sleep

* Avoid caffeinated products (e.g. coffee, tea, soda, chocolate) after mid-afternoon

* Eliminate tobacco use, especially close to bedtime and during the night

* Exercise regularly during the day, but avoid evening exercise

* Use the bedroom only for sleep or marital relations; avoid school work, business affairs, TV, exercise, or other activities that could teach you to associate your bedroom with these experiences

* Keep the bedroom dark, quiet and comfortable

In addition, it is a good idea to set aside a 30 to 45 minute period each night to wind down before bedtime. During this time, engage in a quiet, non-stimulating activity, such as reading or watching television, dim the lights, and have a light carbohydrate snack.

If you find yourself lying in bed, unable to sleep, Arnedt also suggests getting up and engaging in a quiet activity until you feel sleepy enough to return to bed. This will help to re-establish the bed as a cue for sleep rather than a cue for wakefulness.

"This program is for people who have chronic sleep problems, are tired of being frustrated about their sleep and wish to gain a sense of mastery and control over their sleep. While the program takes time, the good news is that it really works," Arnedt says.

For more information on insomnia and the treatment of related disorders, visit

U-M Health Topics A-Z: Insomnia http://www.med.umich.edu/1libr/aha/aha_insomnia_crs.htm

U-M Health System Sleep Disorders Center http://www.med.umich.edu/neuro/sleeplab/index.htm

UMHS News release: Does the Sleeping Brain 'wake up' … http://www.med.umich.edu/opm/newspage/2004/sleep.htm

National Institutes of Health Brain basics: Understanding sleep http://www.ninds.nih.gov/disorders/brain_basics/understanding_sleep.htm

familydoctor.org: Insomnia: How to get a good night's sleep http://familydoctor.org/110.xml