Therapy Is Breaking the Cycle of Insomnia

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Cognitive therapy at Kaiser Permanente in the Santa Clara area is helping hundreds of insomniacs learn how to get a good night’s sleep.

A staggering 10 percent of adults in the U.S. now suffer from chronic insomnia. That’s when we have trouble falling or staying asleep at least 3 days a week for at least 3 months.

While probably most people have the occasional rough night resulting in feeling foggy the following day, chronic insomnia can lead to lack of focus, irritability, and even depression.

“If you are too tired for too long, it results in lack of productivity, which can result in feelings of helplessness,” explained Janice Raj, PsyD, a psychologist at Kaiser Permanente’s Milpitas Medical Office. “It’s a vicious cycle.”

For Kaiser Permanente patients in the Santa Clara area, though, there is help. It comes in the form of a series of Cognitive Behavioral Therapy for Insomnia (CBTi) sessions designed by Dr. Raj and led by her and colleagues at the Santa Clara, Milpitas, Mountain View, and Campbell locations.

Insomnia Is Common

“Insomnia is considered the most common sleep-related disorder in the U.S.,” Dr. Raj explained. “The condition is greater in women and older adults.”

The commonality as well as her interests led her to help insomniacs.

“I’m fascinated by the bridge between the mind and the body, or psychology and physiology, and how the two interact with one another,” she said.

Two years ago, Dr. Raj began creating CBTi group therapy sessions for patients suffering from chronic insomnia. She first trained by going to a seminar by Colleen E. Carnie, PhD, a leading insomnia researcher. “My protocol is based on her work,” Dr. Raj explained.

Today the 8-week sessions, which include 10 to 30 patients per group, are facilitated at Kaiser Permanente by Dr. Raj in Milpitas, Patricia Eaton, MFT, in Campbell; Keely Hirsch, PsyD, in Santa Clara; and Sarah Pack, MFT, in Mountain View.

“I see patients from as far away as Santa Cruz,” Dr. Raj said, explaining that patients are referred by Kaiser Permanente physicians, including primary care physicians, specialists, neurologists, and therapists.

Advice from an Expert

CBTi helps insomniacs identify and address thoughts and behaviors that cause sleep problems and replace them with habits that promote sound sleep. Techniques help target struggles with circadian rhythm, sleep drive, and hyperarousal.

Five of the 8 sessions cover the participants’ issues, teach them about how sleep and insomnia each work, their goals for their own sleep, and behavior techniques.

When it comes to the latter, Dr. Raj said that a “normal” sleeper thinks of bed as sleep, cozy, warm, and other positives. Someone with insomnia thinks of tossing and turning, frustration, and anxiety. “We are helping them to retrain their brain, so they return to think of bed as a place of sleep and relaxation.”

The remaining 3 sessions are on the phone, in order to answer last questions or provide personalized resources to help the individual. Some of the most popular tools her patients use are mindfulness apps such as Headspace, which put the body in a restful space and can be a bridge to connect people to sleep.

Dr. Raj emphasized that people should only go to bed when they are sleepy. “If you’re unable to sleep in 20 minutes, get out of bed. Do not put effort into sleep or your stress mechanisms kick in. Sleep is a biological process. Take pressure off and you end up sleeping.”

“While sleep medications may be beneficial for certain cases, behavioral techniques can be used now, 5 years later, or 10 years later,” Dr. Raj said of the sessions. “Research shows behavioral change has longer-lasting benefits. CBTI is now considered the first line of treatment by research.”

Discussion2 Comments

  1. Kaiser’s BHE Dept offers a course in “Improving Your Sleep.” I took the free 4-week course in Oakland almost 4 years ago and it is available in many Kaiser locations. It changed my sleep habits and I can fall asleep most nights without difficulty. I encourage others to try this.

  2. I’ve struggled daily with waking up in the middle of the night from 1998 till today. I’ve tried many different remedies with little success. For many years, my best option was to get to bed as soon as I could. Doing so allowed me a greater window of time to sleep, usually waking up and getting out of bed for a couple of hours and then finally going back to sleep.

    In the 20+ years I’ve struggled, no one ever mentioned drinking more water. Over the course of the last year, I’ve discovered drinking at least 3 liters of water throughout the day is enough and allows me to sleep through the night, even if I have to get up to relieve myself, I can still get back to sleep as soon as I get back to bed.

    I would like to see a sleep study considering the effects of hydration.

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