- My name is Susan Rubman,
I'm a clinical psychologist in Sleep Medicine at Yale,
and I'm here to talk to you about managing sleepless nights.
Sleep is variable.
It's always gonna be variable from night to night,
and science recognizes that there
are differences in individuals, and across nights.
Insomnia is different from normal sleep,
in that
there are persistent and consistent difficulties in sleep,
and that can take the form of difficulty falling asleep,
difficulty staying asleep,
or being awake for too long during the night,
or waking up too early,
and not being able to return to sleep.
One of the hallmarks that we look for
in really recognizing whether this is
a problem for individuals,
is that there are also daytime consequences,
that's a hallmark of actual clinical insomnia.
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Our experience is, you get into bed and you go to sleep.
For people who don't have difficulty with sleep,
you get into bed and you go to sleep,
you get into bed you go to sleep,
you wake up in the middle of the night,
and you go back to sleep, and that's their learning history.
For people who have difficulty with sleep,
however it is that they got there, whether it's, you know,
they brought a new baby into the home,
or they had a stressful job,
or whatever the pathway is to getting there,
their experience is,
they get into bed and they toss and turn,
they wake up in the middle of the night
and they toss and turn,
they can't go back to sleep, they toss and turn.
And that's what their bodies learn,
and that's what their brains learn.
And through repeated pairings of being in bed
and tossing and turning,
and being in bed and tossing and turning,
the bed, and the bedroom, and the act of going to bed,
actually acquire the capacity to kind of create
arousal and awakening,
and that
learned habit, that bodily learned habit,
like any other habit, becomes persistent over time.
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CBTI is cognitive behavioral therapy for insomnia,
it addresses both thoughts and expectations about sleep,
and behaviors around sleep,
during the night when we can't sleep.
There are a couple of different components
of cognitive behavioral therapy.
The first is called stimulus control therapy.
Again, that's not a helpful name, right?
What it really means is that we're taking control of that
association between being in bed and not sleeping,
and that control, and we're gonna change it.
So
what we do is,
stimulus control has two basic rules to it.
The first rule is really that beds are for sleep only.
We wanna get rid of this association,
the being in bed and tossing and turning,
the being in bed and not being able to sleep,
being in bed and being frustrated,
and being in bed and, and being aroused.
So we really wanna separate out
and carve out the bed and the bedroom as a place for sleep.
The second part of that,
is that when you're not sleeping,
because beds are for sleep only,
you need to go someplace else and do something else
for a period of time,
until you recognize
that your natural sleep drive is starting to kick in,
and you start to feel sleepy, and drowsy,
and then go back to the bedroom to go to sleep.
That's the first component of CBTI.
The second component, also, is called sleep restriction,
which sounds just mean-spirited, right?
Why are you restricting my sleep when I'm already
having difficulty sleeping?
What it is, is actually restriction of time in bed.
We wanna compress the amount of sleep
that individuals are getting.
So if you're getting six hours of sleep
over nine hours in bed, that doesn't feel so good,
because you've got big patches of wakefulness.
We wanna compress your time in bed,
and compress your sleep, so that you get it in one big dose.
And we work with individuals
to manage both of those factors at the same time,
to improve their sleep.
It is a treatment strategy that is very effective.
When folks work on stimulus control therapy,
there's a latency to response,
it takes a little bit of time
to start to see the benefit,
but the benefits are enduring, and we know that,
that once people have changed
their sleep habits and patterns,
those gains are maintained, and in fact, extended over time.
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A couple of takeaway ideas
that are that are important for folks to know,
is that it's normal to have difficulty sleeping,
particularly under times of stress.
If it becomes persistent and consistent,
there's help available.
I would encourage people to reach out
to their primary care physician,
or to a sleep disorder center,
if they're experiencing ongoing difficulty with sleep.