To service growing demand for therapeutic mental health programs Queensland’s largest private mental health facility, Belmont Private Hospital (Belmont) in Brisbane’s south east has introduced a specialised program for insomnia. The Cognitive Behaviour Therapy for Insomnia (CBT-i) day program is a six week program held on Tuesday evenings, with booster sessions at strategic intervals after completion.
What is Insomnia Disorder?
It is classified as disrupted, dissatisfying sleep that occurs at least three nights per week and continues for at least three months despite adequate opportunity for sleep. Long-term patterns of insufficient or unrefreshing sleep can have many causes such as environmental changes, unhealthy sleep habits, shift work, anxiety, depression, pain and medical disorders.
Associate Professor Sandy Sacre, Senior Programs Manager at Belmont and long-standing member of the Australasian Sleep Association attests that insomnia is one of the most common health problems in the general Australian population (between 13 and 33 per cent), and “is certainly the most common sleep disorder.” “It is inextricably linked with mental disorders such as anxiety and depression and in most cases, it is difficult to know which came first”, says Dr Sacre.
According to the 12th annual BEACH Report on General Practice activity in Australia (2009-2010), insomnia was treated in around 95% of cases by GPs prescribing hypnotic medication.
“Indeed, this is often efficacious in the short-term,” says Dr Sacre. “However, Cognitive Behaviour Therapy for Insomnia is more efficacious for insomnia than hypnotic medication, and is shown to be the most effective, objectively measured treatment by numerous randomized controlled trials and meta-analyses.”
“Studies demonstrate significant improvement in sleep latency, total sleep time and sleep efficiency, whilst maintaining change over the long term.”
Belmont’s CBT – i program
The program’s facilitator, Kym Barrett, is a Psychologist and sleep technologist with a comprehensive understanding of CBT, insomnia and other sleep disorders.
Patients attending the program undergo a comprehensive evaluation of sleep patterns, cognitions and behaviour related to sleep at start and end, using sleep diaries and validated questionnaires to measure individual progress and to evaluate the effectiveness of the program as a whole.
Belmont’s program targets maladaptive sleep cognitions and behaviours, and utilises evidence-based therapeutic approaches including relaxation training, stimulus control therapy and cognitive therapy.
“All of these approaches have received the highest ratings in terms of clinical evidence”, states Ms Barrett, citing standards set by the American Academy of Sleep Medicine. We also include psycho-education for sleep hygiene. Although we know that sleep hygiene is not useful as a stand-alone treatment for chronic insomnia, some evidence indicates it may be useful as an adjunct to these other therapies.”
All patients are under the care of a hospital-accredited Psychiatrist who collaborates with the referring Medical Practitioner, particularly in relation to the medical conditions which may be contributing to insomnia, as well as prescribed medications. Participants generally maintain their current medications with a gradual tapering of hypnotics as their sleep behaviours and cognitive approaches to sleep improve.
Patients referred may have a primary diagnosis of Insomnia Disorder with or without co-morbid diagnoses. “This can include depression, anxiety or obstructive sleep apnea which may have been resolved but left patients with residual sleep loss”, says Ms Barrett.