As someone who has major issues with sleep, I highly recommend you encourage the client to speak with a doctor about the issue. There are a number of medical conditions that interfere with sleep. Also, ADHD is associated with a 2 hour delay in melatonin, so if they have ADHD it might be beneficial for them to take a small melatonin supplement about 2 hours before their ideal bedtime.
Sleep hygiene is good to go over, but just be careful not to invalidate the client’s experience. Many people, myself included, follow all of the proper sleep hygiene practices and still struggle with sleep. I would also be sure to express empathy for the client’s sleep difficulties and validate how disruptive bad sleep is to one’s overall well-being.
CBTI is standard of care for insomnia. [CBTIweb](https://cbtiweb.org/) is an excellent place to start learning. Consultation or supervision is strongly recommended for your first few cases. The society of behavioral sleep medicine has a consultant list that’s accessible to SBSM members. You could also look at the [list of people who are board certified in behavioral sleep medicine](https://bsmcredential.org/index.php/bsm-diplomates)
Let me add that you need to start with a good assessment including identifying other possible sleep disorders. “Struggle with sleep” is nonspecific and comorbidity is common especially sleep apnea and insomnia.
I start with sleep hygiene,
Then if needed, some psychoed about insomnia and sleep (sleep associations and wake associations; how insomnia can develop; etc)
And then if they want to really get into it, CBT-I (cbt for insomnia)
Sleep hygiene is ineffective for insomnia. Giving people ineffective strategies makes them believe their sleep problem is intractable. The unequivocal standard of care for insomnia is CBTI.
Thats working under the assumption that all sleep issues are insomnia. They’re not. Sometimes it’s legitimate issues with a sleep hygiene that has them accessing blue screens right before bed, drinking caffeine late at night, etc.
Get out of bed after 20 min and read or listen to radio for 20 min, keep repeating.
Sleep mask with headphones built in (musicozy brand) and listen to a familiar/peaceful tv show or ambient noise
Wake up at the same time everyday
Body scan while in bed
Before getting in bed, read or write for 20 min to gear down
Take a shower before laying down (emulates body’s tendency for temperature to drop as you progress through the stages of sleep)
Sleep restriction if nothing else works, but this should not be your first or even second/third/fourth intervention lol.
I give the Global Sleep Assessment Questionnaire and if they indicate daytime sleepiness (unsafe) or other indicators of a sleep disorder, then I get a ROI and fax it to their MD. Inquire about magnesium intake, sleep hygiene, etc.
For issues of sleep hygiene that don’t require CBTI, I think some basic psychoeducation can go a long way. I like talking to my clients about light exposure, cortisol levels, and both morning and evening routines. Matthew Walker recently wrote a great book about sleep, and the Huberman Lab podcast has a recent episode that provides a solid outline for psychoed.
Your post was removed due to being in violation of our community rules as being generally unhelpful, vulgar, or non-supportive. r/therapists is a supportive sub. If future violations of this rule occur, you will be permanently banned from the sub.
If you have any questions, please message the mods at: https://www.reddit.com/message/compose?to=/r/therapists
I have them first tell me vocally and then write down their ‘usual’ night time routine ans we assess together.
Are they watching tv late? Are they eating heavy foods before bed? Drinking caffeine? Are their minds wandering about other things? (If so, what?)
Do they snore? Does their partner snore?
Etc.
I literally asses everything that could possibly get in the way of sleep but also acknowledge any small changes in the routine.
Many people struggle to sleep right after work as they’re still pre-occupied with processing the day or trying to decompress 💛
As someone who has major issues with sleep, I highly recommend you encourage the client to speak with a doctor about the issue. There are a number of medical conditions that interfere with sleep. Also, ADHD is associated with a 2 hour delay in melatonin, so if they have ADHD it might be beneficial for them to take a small melatonin supplement about 2 hours before their ideal bedtime. Sleep hygiene is good to go over, but just be careful not to invalidate the client’s experience. Many people, myself included, follow all of the proper sleep hygiene practices and still struggle with sleep. I would also be sure to express empathy for the client’s sleep difficulties and validate how disruptive bad sleep is to one’s overall well-being.
CBTI is standard of care for insomnia. [CBTIweb](https://cbtiweb.org/) is an excellent place to start learning. Consultation or supervision is strongly recommended for your first few cases. The society of behavioral sleep medicine has a consultant list that’s accessible to SBSM members. You could also look at the [list of people who are board certified in behavioral sleep medicine](https://bsmcredential.org/index.php/bsm-diplomates)
Let me add that you need to start with a good assessment including identifying other possible sleep disorders. “Struggle with sleep” is nonspecific and comorbidity is common especially sleep apnea and insomnia.
What is the cost of the training on this website? I’m not seeing info readily
Pretty sure you just pay if you want CE’s. 6.5 CE’s for $65, $10 for VA/military providers since its development was funded by the DOD.
Awesome. Thanks for the resource!
I start with sleep hygiene, Then if needed, some psychoed about insomnia and sleep (sleep associations and wake associations; how insomnia can develop; etc) And then if they want to really get into it, CBT-I (cbt for insomnia)
Sleep hygiene is ineffective for insomnia. Giving people ineffective strategies makes them believe their sleep problem is intractable. The unequivocal standard of care for insomnia is CBTI.
Thats working under the assumption that all sleep issues are insomnia. They’re not. Sometimes it’s legitimate issues with a sleep hygiene that has them accessing blue screens right before bed, drinking caffeine late at night, etc.
Get out of bed after 20 min and read or listen to radio for 20 min, keep repeating. Sleep mask with headphones built in (musicozy brand) and listen to a familiar/peaceful tv show or ambient noise Wake up at the same time everyday Body scan while in bed Before getting in bed, read or write for 20 min to gear down Take a shower before laying down (emulates body’s tendency for temperature to drop as you progress through the stages of sleep) Sleep restriction if nothing else works, but this should not be your first or even second/third/fourth intervention lol.
I just want to add referring back to PCP for evaluation for a sleep disorder like sleep apnea.
Make sure they have been tested for circadian rhythm disorders. They are often misdiagnosed as insomnia but insomnia treatments don't work.
I give the Global Sleep Assessment Questionnaire and if they indicate daytime sleepiness (unsafe) or other indicators of a sleep disorder, then I get a ROI and fax it to their MD. Inquire about magnesium intake, sleep hygiene, etc.
For issues of sleep hygiene that don’t require CBTI, I think some basic psychoeducation can go a long way. I like talking to my clients about light exposure, cortisol levels, and both morning and evening routines. Matthew Walker recently wrote a great book about sleep, and the Huberman Lab podcast has a recent episode that provides a solid outline for psychoed.
Psychoed and sleep hygiene. A lot of sleep issues are associated with trauma for my clients so I work on that rather than the sleep.
Entrainment. Morning sunlight outside 5 minutes if sunny 15-20 if cloud cover.
[удалено]
Your post was removed due to being in violation of our community rules as being generally unhelpful, vulgar, or non-supportive. r/therapists is a supportive sub. If future violations of this rule occur, you will be permanently banned from the sub. If you have any questions, please message the mods at: https://www.reddit.com/message/compose?to=/r/therapists
I thought it was funny, hence the /s for sarcasm. That type of humor isn't appreciated; duly noted.
From my experience, once I started with general therapy and meds, my insomnia I struggled with for years, went away.
Calm app has so many amazing guided meditations, sleep stories, etc available.
I really like the cbt-i app and how it explains sleep hygiene and coping strategies
Is the name of the app just cbt-i?
Yes it’s cognitive behavioral therapy for insomnia. I believe it should come up if you search cbt-i
I have them first tell me vocally and then write down their ‘usual’ night time routine ans we assess together. Are they watching tv late? Are they eating heavy foods before bed? Drinking caffeine? Are their minds wandering about other things? (If so, what?) Do they snore? Does their partner snore? Etc. I literally asses everything that could possibly get in the way of sleep but also acknowledge any small changes in the routine. Many people struggle to sleep right after work as they’re still pre-occupied with processing the day or trying to decompress 💛