Sleep Dynamic Therapy

Archive for the ‘Insomnia’ Category

This talk was given in December 2003 at the University of New Mexico Dept of Psychiatry Grand Rounds. The title is the “Limits of Psychiatry in Treating Psychiatric Insomnia.” It reflects our growing interest in the relationships between sleep-disordered breathing and insomnia, particularly in mental health patients. Note the material on nocturia is dated and see Mary Umlauf’s work for a more comprehensive explanation for why sleep breathing patients wake up at night to use the bathroom. In short, the body is deceived into believing that a fluid overloaded state exists and so it must release a natural diuretic to “correct” the problem

The finding that depression symptoms are categorized too broadly has been well known in many clinical circles for a long time. Sleep doctors often see patients given antidepressants for periods of stress that really don’t match up with a diagnosis of depression. The patients themselves are often confused about why they received the prescription. Most importantly, at the end of the article is the commentary about patients’ misunderstandings about negative emotions, that is, do you take a pill to treat negative emotions or do you have something to learn from them? Sleep Dynamic Therapy, which uses sleep-related emotional processing techniques akin to Leslie Greenberg’s work in Toronto, finds that most insomnia patients benefit a great deal from working with their emotions, especially in comparison to what they gain by using sedatives or other medications.

The greater concern I have about these types of warnings is that they rarely discuss the limited efficacy of these drugs in general. They’re not generally ideal solutions for long-term treatment of chronic insomnia.