Assessing sleep disturbances – Guidance for holistic therapists

Dr Robert Becker FCMA

Introduction

Sleep disturbances are a common problem among individuals of all ages and can have significant negative effects on physical, emotional, and cognitive health. As therapists, it is important to have a good understanding of sleep disturbances, and their impact on clients’ lives. This essay aims to provide guidance for therapists on assessing sleep disturbances and developing appropriate treatment plans.

Assessing Sleep Disturbances

The first step in assessing sleep disturbances is to gather information about the client’s sleep habits and patterns. This can be done through a detailed sleep history questionnaire or an interview. Therapists should ask questions about the client’s typical bedtime, wake-up time, and total sleep time. They should also inquire about any difficulties falling or staying asleep, waking up too early, or feeling excessively sleepy during the day. 

The therapist should also ask about any medical or psychological conditions that may be contributing to the sleep disturbance. For example, depression, anxiety, chronic pain, or sleep apnoea can all interfere with sleep quality. The therapist may also want to know about any medications the client is taking, as some can have a negative impact on sleep.

Sleep diaries or actigraphy can be useful tools for monitoring sleep patterns over time. Sleep diaries allow clients to record their sleep patterns each night, including the time they go to bed, the time they wake up, and any disturbances during the night. Actigraphy involves wearing a device that tracks movement during sleep and provides data on sleep duration and quality.

In addition to gathering information about sleep patterns, the therapist should also assess the client’s attitudes and beliefs about sleep. Some clients may have unrealistic expectations about how much sleep they need or may engage in unhelpful behaviours such as spending excessive time in bed or relying on medication to fall asleep.

Treatment for Sleep Disturbances

Treatment for sleep disturbances will depend on the underlying cause. For example, if the client is experiencing depression or anxiety, treatment for these conditions may improve sleep quality. In cases where the sleep disturbance is related to a medical condition, the client may need to consult with a physician or sleep specialist. 

In cases where there are no underlying medical or psychological conditions, therapists may recommend behavioural interventions to improve sleep quality. Cognitive-behavioural therapy for insomnia (CBT-I) is an evidence-based treatment that has been shown to be effective for improving sleep in many individuals. CBT-I focuses on identifying and changing unhelpful thoughts and behaviours that contribute to insomnia.

Some specific strategies that may be included in CBT-I include sleep restriction therapy, stimulus control therapy, and relaxation techniques. Sleep restriction therapy involves limiting the amount of time spent in bed to match the client’s average sleep duration, which can help improve sleep efficiency. Stimulus control therapy involves associating the bed with sleep, and reducing behaviours that interfere with sleep, such as watching television or using electronic devices in bed. Relaxation techniques, such as progressive muscle relaxation or deep breathing, can help promote relaxation and reduce anxiety around sleep.

Other behavioural strategies that may improve sleep quality include improving sleep hygiene, such as avoiding caffeine or alcohol before bedtime, establishing a consistent bedtime routine, and creating a sleep-conducive environment by minimizing noise and light. 

Conclusion

Assessing and treating sleep disturbances is an important aspect of therapy, as poor sleep can have significant negative effects on physical, emotional, and cognitive health. Therapists can use a variety of tools and techniques to assess sleep patterns and develop appropriate treatment plans. Behavioural interventions, such as CBT-I, can be effective in improving sleep quality in many individuals. As therapists, it is important to be aware of the impact of sleep on overall well-being and to work collaboratively with clients to improve sleep habits and patterns. 

Dr Robert Becker, is a Fellow of The CMA, and he is a Mental Health Specialist, Certified Sleep Disturbances Specialist (Insomnia Practitioner), Psychotherapist, and Psychiatric Assessor.