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"Sleep well and live better: overcoming insomnia using CBT"- a workshop with Colin Espie (first post)

Yesterday I went to a one-day workshop with Professor Colin Espie on sleep disorders and CBT organized by the Scottish Branch of the BABCP.  Bike to the station, then a train from Edinburgh to Dundee.  Lovely, early morning light up the Fife coast.  Then a taxi to the conference venue where they were serving egg rolls, bacon rolls, and plenty of coffee for the gradually arriving delegates.

Colin Espie knows his stuff.  He's a professor of clinical psychology & director of the Glasgow university sleep centre.  Overall the day was well worth going to for me.  As is so often the case, lecturers spend more time lecturing than I find ideal.  I suspect I do it myself when I'm giving a presentation.  I would have preferred a bit less time spent on the facts & figures (provide them as handouts and skim?) and a bit more time on the practical details of applying CBT ... with an opportunity to role-play teaching these interventions to clients.  Still I do agree that I'm probably "a pot calling the kettle black".

We began with a general introduction to "The nature and functions of sleep across the lifespan".  Plenty of interesting information.  I was struck, for example, by the slide "The functions and benefits of sleep" with its list of four/five factors: maintain good quality daytime function, restoration and recovery, cognitive consolidation, emotional stability, and (probably more important for other animals) energy conservation.  We moved on then to talk about insomnia.  The sequence to be followed was: What is insomnia?  Why is it a big deal?  What (sic) is cognitive behaviour therapy relevant?  Is it clinically effective?  How can it be delivered in real world practice?  Good stuff.

Insomnia involves a complaint of difficulty initiating and/or maintaining sleep and/or non-restorative sleep.  The problem should have lasted for more than a month (different definitions vary in the duration required for the diagnosis).  There is associated marked distress & impairment in social or occupational functioning.  Some definitions focus too on "Indications of sleep-preventing associations & conditioned arousal", "Somatised tension and sleep preoccupation" and that the disorder should be "Objectively verifiable (polysomnography)".  And the disorder is not better accounted for by associated medical, mental or substance use problems.  Actually primary insomnia as a diagnosis is a little blurry round the edges - see "Testing the reliability and validity of DSM-IV-TR and ICSD-2 insomnia diagnoses" - but it's still clear that difficulty sleeping is a major problem for many people.

Insomnia is common.  Different surveys produce different estimates, but typically from 1 in 10 to more than 1 in 3 people are classified as suffering from insomnia.  So Stein & colleagues in their recent paper "Impairment associated with sleep problems in the community" reported on a survey of over 4,000 adults in Germany and found that 35% reported current sleep problems (Pittsburgh Sleep Quality Index score of > 5).  Similar recent surveys in Greece, Spain and Sweden have shown prevalence rates of 25%, 21% and 32% respectively.  Physical & mental ill health and lack of physical activity make insomnia more likely.  Other more specific sleep diagnoses like obstructive sleep apnea,  restless legs syndrome & periodic movement disorders overlap with insomnia and may also need treatment.  We were given a useful handout with simple screening questions for other kinds of sleep disorder - see too the similar "Other disorders of sleep" sheet. 

Continuing Colin's second point "Why is insomnia a big deal?", I'll write next about "The links between sleep disturbance and depression".

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CBT for insomnia

Firstly, very glad to have discovered your blog and will be returning to it! Regarding the subject, having used Espie's Overcoming Insomnia myself some years ago and found it very effective (oh the relief of moving to 6 hours uninterrupted sleep!), I based a large part of a module I devised last year for customers of a condition management programme (NHS)on the material. What I (and the customers) found most helpful was the recognition of the need to combine several strategies, including traditional sleep hygiene,cognitive restructuring and relaxation methods to get best results. It also helped to uncover and then examine the unhelpful thinking (eg I'll never cope tomorrow at work if I sleep badly tonight).

CBT for insomnia

Thank you for your sharing your experience.  It's helpful.  With best wishes, James