First the industrial revolution and then, more recently, the digital revolution have led to shift work and sleep restriction as a widespread phenomenon across society. In modern life, we manipulate our light levels to disrupt and confuse our circadian rhythm. There is increasing sleep fragmentation and increased time to fall asleep in otherwise healthy older adults with and without sleep complaints ( 4). There is phase advance (i.e., falling asleep earlier) with every decade that passes with adults falling asleep by 30 minutes earlier a decade on average from the third decade onwards.
Teenagers and young adults need 8–9 hours of sleep on average with a delay in sleep phase such that many fall asleep after rather than before midnight ( 3). Both total sleep time and the circadian rhythm change over the course of our lives and tend to fragment and weaken over time ( 2). The homeostat drives an increasing pressure to sleep after every hour awake and the circadian rhythm drives alertness in the day and sleep at night with light intensity as the strongest external timekeeper ( 1). Normal sleep relies upon two distinct but overlapping neuronal circuits. Finally, the review will cover evidence for different modes of delivery (online, self, help, group or individual face to face) in a variety of clinical settings. Therefore, this review will cover the initial assessment of insomnia, including insomnia mimics, the selection of patients for treatment and the key components of CBT therapy. This is a simple CBT to deliver with better and safer outcomes than prescription hypnotics. Over 25 years of high quality research have shown evidence for sustained improvements in sleep in those with insomnia alone or insomnia comorbid with other conditions. The first line treatment is now well established as insomnia-specific cognitive behavioural therapy (CBTi) in the most recent US and European treatment guidelines. Patients and health professionals have often had limited teaching about effective strategies for insomnia which leaves many untreated and insomnia can be unfairly perceived as a challenging symptom to manage. If it is the patient’s main concern, it warrants treatment. While it is commonly comorbid with other physical and mental health problems, the new diagnostic classification has been helpfully simplified such that it is considered a disorder in itself. Insomnia disorder (“immoderate watchfulness”) remains the commonest sleep disorder in primary and secondary care with an estimated 5–10% of the adult population affected. Disrupted sleep for any reason has immediate and long term consequences on physical and mental health. Hippocrates recognized the importance of asking about sleep as long ago as 400 BC when he wrote “ sleep and watchfulness, both of them when immoderate, constitute disease”.
0 kommentar(er)
