Treatment of sleep disorders (insomnia)

Therapeutic relationship: The relationship between client and psychotherapist is an important factor in treatment. The therapist provides support in coping and tries to maintain a balance between change and stabilization.

Sleep restriction: The aim of this method is to ensure that the patient falls asleep more quickly, wakes less often and has a deeper sleep overall. The patient is encouraged to keep a sleep log. The patient is asked to keep a daily record of how many hours she spends in bed at night and how many hours she sleeps. After approximately one week of documentation, the average duration of sleep is calculated. If she has slept an average of 5 hours, a sleep window of 5 hours is set, i.e. if she has to get up at 7 am, she may not go to bed until 2 am. The patient is also required to keep a daily record of how long she sleeps and how long she lies in bed. After a further week, the therapist uses these values to calculate the so-called sleep efficiency (time spent lying in bed / sleep time x 100). If this value is at least 85%, the sleep window can be extended by 15 minutes per night. However, if this value is below 85%, the sleep window is reduced by 15 minutes per night, whereby the sleep window should not be less than 4.5 hours. After a further week, the value is recalculated. The more time the patient actually spends sleeping each night, the higher the sleep efficiency. This procedure is continued until a satisfactory result is achieved for the patient. The patient must not sleep during the day, as this would reduce the sleep pressure. Realistically, sleep restriction lasts about 8 weeks. During this therapy phase, sleep times must be strictly adhered to and should not be changed at all, even at weekends. In this respect, this therapy method is not suitable for patients with shift work. The initial reduction of the sleep window (e.g. from 2 a.m. to 7 a.m.) increases the sleep pressure, as a result of which the patient falls asleep more quickly and spends less time awake and brooding in bed. In the long term, this ensures that the patient no longer associates the bed with anger, worries, brooding, etc. The bed thus becomes a place of pain. As a result, the bed is increasingly transformed from a place of terror into a place of relaxation. In addition, the patient gets the feeling that she can influence or control her sleep again, which also has a positive effect on her well-being. Before, during and after the intervention, the quality of sleep is assessed using a questionnaire.

False assumptions about the nature of sleep (e.g: Regular sleep at night is vital, how you feel during the day depends solely on sleep at night, sleep before midnight is the most important, you need to sleep at least 8 hours to be refreshed) are corrected through knowledge transfer(psychoeducation) and replaced by realistic expectations.

Rules for healthy sleep(sleep hygiene) are taught: e.g. no alcohol should be consumed 2 hours before going to bed, naps during the day should be avoided, looking at the clock at night is not recommended.

With persistent disturbance, patients associate the bed with not being able to sleep, brooding, watching TV, reading, tossing and turning in bed, etc. These associations should be dissolved in therapy by teaching rules of so-called stimulus control . These include: the bed should only be used for sleeping and sexual activities, you should only go to bed when you are sufficiently tired, brooding in bed should be avoided - in this case it is usually better to get out of bed again - always get up at the same time in the morning, when you go to bed turn the light off immediately, etc.

Learning a relaxation method (progressive muscle relaxation, abdominal breathing, autogenic training, etc.) and using it regularly.

Dealing with background problems, e.g. grief work in the event of a separation, perfectionism, fear of failure, etc.

Cognitive therapy: Unfavorable (dysfunctional) thoughts / catastrophic thoughts concerning the sleep disorder (e.g. fear of failing at work, never being able to sleep again, losing the job, becoming unable to work, being left by the partner, etc.) are identified, subjected to a reality check (i.e. questioned) and replaced by constructive, realistic thoughts. The patient gradually learns to face her catastrophic thoughts more critically.

Mindfulness meditation helps to distance yourself from worries and fears of expectation.