O slideshow foi denunciado.
Utilizamos seu perfil e dados de atividades no LinkedIn para personalizar e exibir anúncios mais relevantes. Altere suas preferências de anúncios quando desejar.
Treating
Insomnia in 10
Minutes
Dr Hugh Selsick
Insomnia Clinic
Royal London Hospital for
Integrated Medicine/UCLH
How We Treat Insomnia
 30

minute assessment.
 Possibly blood tests and overnight sleep
studies.
 Five 60 – 90 minute g...
Don’t:
 Waste

time on sleep hygiene. Sleep
hygiene has been shown not to work and
is often used as the control when test...
Minute 1
 Take

their insomnia seriously.
 Insomnia has a similar impact on quality of
life to depression and congestive...
Minute 2






Reassure them that,
despite being a serious
illness, insomnia will not kill
them.
People with insomnia d...
Minute 3







Discard the myth of the 8 hour sleep.
The average sleep time in adults in the
Western world is about ...
Minute 4





Don’t tell them to go to bed at the same time
every night. This often makes insomnia worse.
Tell them to ...
Minute 5
 Discourage

napping.
 If fatigue is the fuel that drives sleep, then
every nap is like stealing some of that
s...
Minute 6
 Tell

them never to go to bed until they are
sleepy.
 If they go to bed when they are not
sleepy they will jus...
Minute 7






Tell them to spend less time in bed, not more.
They should set an earliest bedtime and
should not go to...
Minute 8
Things Allowed in the
Bedroom
Sleep
Sex
Getting dressed and
undressed.

Things Not Allowed in the Bedroom
TV/...
Minute 9





If they go to bed, or wake up in the middle of
the night, and they are not asleep within
about 20 minutes...
Minute 10





Explain that these techniques work, but they
work slowly.
They will not sleep better straight away and,...
A Final Word
 Do

not dismiss the possibility of using
medication out of hand.
 Hypnotics carry certain risks.
 So does...
Próximos SlideShares
Carregando em…5
×

Treating Insomnia in 10 Minutes with Dr Hugh Selsick

6.024 visualizações

Publicada em

Pitched at London GPs, Dr Hugh Selsick from the Insomnia Clinic at the Royal London Hospital for Integrated Medicine/UCLH gives top tips for doctors on how to assess an insomniac patient in a 10-minute consultation.

Publicada em: Saúde e medicina, Negócios

Treating Insomnia in 10 Minutes with Dr Hugh Selsick

  1. 1. Treating Insomnia in 10 Minutes Dr Hugh Selsick Insomnia Clinic Royal London Hospital for Integrated Medicine/UCLH
  2. 2. How We Treat Insomnia  30 minute assessment.  Possibly blood tests and overnight sleep studies.  Five 60 – 90 minute group sessions of Cognitive Behaviour Therapy for Insomnia.  One or two 30 minute follow up sessions.  If on medication will then have ongoing monitoring sessions.
  3. 3. Don’t:  Waste time on sleep hygiene. Sleep hygiene has been shown not to work and is often used as the control when testing insomnia treatments.  Assume that the insomnia is simply a sign of depression. Insomnia frequently causes depression, is a common residual symptom when depression lift and predisposes the patient to relapse.
  4. 4. Minute 1  Take their insomnia seriously.  Insomnia has a similar impact on quality of life to depression and congestive heart failure (Katz, 2002).  Insomnia leads to increased health resource utilization (Hatoum, 1998).
  5. 5. Minute 2    Reassure them that, despite being a serious illness, insomnia will not kill them. People with insomnia don’t die any younger that people without insomnia. Remind them that the scare stories they read in the papers are often overextrapolations from limited data and even then they are almost always talking about sleep deprivation.
  6. 6. Minute 3      Discard the myth of the 8 hour sleep. The average sleep time in adults in the Western world is about 7.5 hours. But there is variation either side of that mean. Naturally short sleepers are at risk of developing insomnia when they try to strive for the 8 hour ideal and fail. Explain that the right amount of sleep for them at the moment is the amount that makes them feel alert most of the day most days.
  7. 7. Minute 4    Don’t tell them to go to bed at the same time every night. This often makes insomnia worse. Tell them to get up at the same time every morning, seven days a week, whether they have slept well or slept badly, whatever time they went to bed. This way they start accumulating tiredness at the same time each day and will gradually come to feel sleepy around the same time each day.
  8. 8. Minute 5  Discourage napping.  If fatigue is the fuel that drives sleep, then every nap is like stealing some of that sleep fuel from the night.  It is better to push through the sleepy periods during the day and save that fatigue for the night.  Once their sleep improves it will be easier to avoid napping.
  9. 9. Minute 6  Tell them never to go to bed until they are sleepy.  If they go to bed when they are not sleepy they will just lie in bed waiting to get sleepy. This will reinforce their belief that their sleep is “broken”.  If they go to bed when sleepy they have a better chance of falling asleep quickly and staying asleep.
  10. 10. Minute 7     Tell them to spend less time in bed, not more. They should set an earliest bedtime and should not go to bed until they have reached that bedtime and they are sleepy. Each week the earliest bedtime is moved 20 minutes later. When they are falling asleep within 20 minutes and sleeping fairly solidly through the night they can reverse the process and start moving their earliest bedtime 20 minutes earlier each week.
  11. 11. Minute 8 Things Allowed in the Bedroom Sleep Sex Getting dressed and undressed. Things Not Allowed in the Bedroom TV/Radio Computer Talking on phone Texting Exercise Ironing Studying Paying bills Reading!! Meditating Arguing Etc, etc, etc
  12. 12. Minute 9    If they go to bed, or wake up in the middle of the night, and they are not asleep within about 20 minutes, they should get up, get out of the bedroom, and do something relaxing and enjoyable e.g. watch TV, read, listen to a podcast. When they are sleepy they can go back to bed. If they aren’t asleep within another 20 minutes, repeat above.
  13. 13. Minute 10     Explain that these techniques work, but they work slowly. They will not sleep better straight away and, in fact, may sleep worse initially. But the payoff for the reduced sleep in the short term is better sleep in the long term. Teach them the mantra: I am not doing this tonight to sleep better tonight. I may actually sleep worse tonight. I am doing this to sleep better in a month.
  14. 14. A Final Word  Do not dismiss the possibility of using medication out of hand.  Hypnotics carry certain risks.  So does insomnia.  Therefore, the risks and benefits of medication should be weighed up in each individual case, with the patient’s input, before deciding whether to prescribe or not prescribe hypnotics.

×