General Principles of
Treatment
Treatments for sleep disorders generally can be grouped
into three categories:
None of these general approaches is sufficient for all
patients with sleep disorders. Rather, the choice of a
specific treatment depends on the patient's diagnosis,
medical and psychiatric history, and preferences, as well as
the expertise of the treating clinician. In general,
medications and somatic treatments provide more rapid
symptomatic relief from sleep disturbances. On the other
hand, some emerging evidence suggests that treatment gains
with behavioral treatment of insomnia may be more durable
than those obtained with medications.
Some sleep disorders, such as narcolepsy, are best
treated pharmacologically, whereas others, such as chronic
and primary insomnia, are more amenable to behavioral
interventions. The management of sleep disturbances that are
secondary to mental, medical, or substance abuse disorders
should focus on the underlying conditions.
For most sleep disorders, behavioral/psychotherapeutic
and pharmacological approaches are not incompatible and can
be effectively combined to maximize therapeutic benefits.
Dr.
Michael Breus, Ph.D., in his book Good Night: The Sleep
Doctor’s 4-Week Program to Better Sleep and Better Health,
makes the distinction between “sleep disorder” and
“disordered sleep”.
He says to
think of sleep disorders as formal syndromes with definitive
criteria, which repeat time after time. They can be primary
sleep disorders, which are not attributed to other
conditions, or secondary sleep disorders that arise from an
underlying physical or mental disorder. Restless legs
syndrome (RLS), for example, is a type of sleep disorder.
There
are 85 recognized sleep disorders, the most recognizable of
which may be insomnia, sleep apnea, narcolepsy, and restless
legs syndrome.
"Disordered
sleep”, on the other hand, refers to everything else that
relates to sleep but does not qualify as a disorder. A
person’s symptoms might not meet the disorder criteria based
on severity or frequency, or there might be an external
factor that affect’s one’s sleep, such as the room being too
warm. For the majority of people, according to Dr. Breus,
disordered sleep, or poor “sleep hygiene”, is the major
culprit. These hygiene factors include things such as:
smoking, drinking alcohol or caffeine, strenuous exercise or
eating a large meal before bed, jet lag from travel, stress
from exams, marital conflict or job related issues. These
things may hinder your ability to fall asleep or stay
asleep.
Other
causes of disordered sleep include;
-
bed partners (do they
toss and turn or snore, waking you
up?)
-
parenting (do your
toddlers sleep in the same bed as you
or are you waking up for feddings?0
-
hormonal changes (women
going through menopause)
-
business travel.
-
Stress and anxiety
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