Sleep Medicine - Treatments

Treatments

When sleep complaints are secondary to pain, other medical or psychiatric diagnoses, or substance abuse, it may be necessary to treat both the underlying cause and the sleep problems.

When the underlying cause of sleep problems is not immediately obvious, behavioral treatments are usually the first suggested. These range from patient education about sleep hygiene to cognitive behavioral therapy (CBT). Studies of both younger and older adults have compared CBT to medication and found that CBT should be considered a first-line and cost-effective intervention for chronic insomnia, not least because gains may be maintained at long-term follow-up. Sleep physicians and psychologists, at least in the US, are not in agreement about who should perform CBT nor whether sleep centers should be required to have psychologists on staff. In the UK the number of CBT-trained therapists is limited so CBT is not widely available on the NHS.

Behavioral therapies include progressive relaxation, stimulus control (to reassociate the bed with sleepiness), limiting time-in-bed to increase sleep efficiency and debunking misconceptions about sleep.

Pharmacology is necessary for some conditions. Medication may be useful for acute insomnia and for some of the parasomnias. It is almost always needed, along with scheduled short naps and close follow-up, in the treatment of narcolepsy and idiopathic hypersomnia.

Chronic circadian rhythm disorders, the most common of which is delayed sleep phase disorder, may be managed by specifically timed bright light therapy, timed oral administration of the hormone melatonin, and/or chronotherapy. Stimulants may also be prescribed. When these therapies are unsuccessful, counseling may be indicated to help a person adapt to and live with the condition. People with these disorders who have chosen a lifestyle in conformity with their sleeping schedules have no need of treatment, though they may need the diagnosis in order to avoid having to meet for appointments or meetings during their sleep time.

Continuous positive airway pressure (CPAP) machines and oral appliances are used nightly at home to manage sleep-related breathing disorders such as apnea. In some cases, upper airway surgery generally performed by an otolaryngologist/head & neck surgeon or occasionally an oral and maxillofacial surgeon is indicated. In mild cases in obese people, weight reduction may be sufficient. The treatments prevent airway collapse, which interrupts breathing during sleep. A 2001 study published by Hans-Werner Gessmann in the Journal of Sleep Medicine and Sleep Psychology found that patients who practiced a series of electrical stimulations of specific tongue muscles for 20 minutes a day showed a marked decline in sleep apnea symptoms after three months. Patients experienced an average of 36% fewer apnea episodes after successfully completing the treatments.