Insomnia Clients may be Wary of Talk Therapy

By John Thomas
January 6, 2015



Insomnia clients may be wary of talk therapyDon’t expect clients seeking help for insomnia and other sleep disorders to have much faith in psychological treatments, a roomful of psychologists was told during the annual meeting of the Kentucky Psychological Association here.

“Patients will wonder if those sleeping pills they have been taking for years haven’t worked, why would talking to a psychologist about their problem possibly work?” said Ryan G. Wetzler, Psy.D., director of behavioral sleep medicine at an insomnia treatment facility in Louisville.

Still, insomnia patients undergoing cognitive behavioral therapy have an 80 percent success rate, and it is considered even in the medical community the first line of treatment for sleeplessness, Wetzler said.

“And we do it in short_term therapy. Usually four or five treatments is enough time to treat someone’s underlying anxiety problems that are keeping them awake at night and resulting in no longer depending on sleeping pills that are probably not working anyway,” he added.

Wetzler pointed to the results of several studies that showed that the effectiveness of CBT over the use of sleeping medication. In more than one study, the placebo did better than the sleeping pill. He also noted that the negative effects of using sleeping medication resulted in more harm than good, including the effect on memory.

In which case, he said, “maybe the best that can be said about sleeping pills is they make you forget the reason you feel so bad when you get up in the morning is because you slept so badly.” There is no evidence, Wetzler added, that therapy and sleeping medication work better than therapy alone.

Sleeplessness affects about every part of the body and leads to pain, digestive ailments, respiratory difficulties, hypertension, heart attacks and other illnesses. He said one of the reasons for the nation’s obesity epidemic is not being able to get to sleep. “If I can’t go to sleep, maybe if I get up and eat something, it will help” is a common reaction.

The elderly, too, are affected negatively with sleep loss, but it’s often caused by boredom, Wetzler said. “They are bored, so they go to bed at 7 p.m. and when they wake up at 2 a.m., they wonder why they can’t sleep.”

Practitioners interested in what Wetzler called the growing field of sleep therapy need to become familiar with the theory of circadian rhythms and how melatonin works to induce sleep. One of the first things persons with sleeping problems should learn to do is to wake up and get out of bed every day at the same time.

He said one of the hardest groups to work with is people who work swing shift. “I always ask them if there is any way you can get off of shift work and go to work the same time every day,” Wetzler said.

In the area of sleep apnea, one of the biggest obstacles is getting people to wear certain devices that change the position of the tongue in the mouth and reorients the chin in an unnatural position.

“But,” he explained, “these devices work 100 percent of the time for people who use them. Certain phobias and fear of choking, however, make it difficult or impossible for some to use the devices.

Wetzler said insomnia and similar sleeplessness problems are probably less than 200 years old and reflect the changes society has undergone with the decline of agricultural-type pursuits and the increase in anxiety-producing lifestyles.

“If I lived in a farming community,” he said, “I wouldn’t be very busy.” Around 350 Kentucky psychologists attended the annual three-day convention held at the Galt House.

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