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This page does not replicate the other information in this handbook but provides additional details or context most relevant to professionals.

Managing insomnia

Neuropsychologist Michael Howard, PhD, lectures to healthcare professionals on understanding and managing sleep disorders. He advocates first determining if presenting insomnia is primary or secondary, for the causes and remedies are different.1Howard M. The sleep-loss epidemic: understanding and managing sleep disorders. INR Seminar presentation, Roanoke Virginia. May 8, 2018.

Primary insomnia is an independent sleep disorder and typically linked to thinking and worrying, two brain processes that prevent the activation system of the brain from responding to normal signals for sleep.

Secondary insomnia is caused by physical or psychosocial events or issues including these:

  • Shift work
  • Job loss
  • Divorce
  • Emotional problems such as depression
  • Environmental conditions such as a warm room
  • Symptoms such as hot flashes, fever or pain

Secondary insomnia is far more common; the best way to manage it is to address the condition/symptom preventing quality sleep.

Immediately resorting to sleep medications for either type of insomnia is typically not optimal, as these medications are effective less than 10% of the time, they compromise one or more of the sleep cycles, and they come with side effects, some serious.

Of most benefit for primary insomnia are the psychological/behavioral/cognitive therapies that change thinking patterns and reduce worrying. Dr. Howard suggests the following steps for patients to manage primary insomnia:

  1. Practice good sleep hygiene ›
  2. Consider further supportive therapies if the following three statements apply:214 Types of Sleep Disorders—and When to Seek Treatment, According to Experts. American Academy of Sleep Medicine. February 29, 2016. Viewed March 23, 2022. Therapies are listed on What approaches can help you manage sleep disruption? ›
    • The insomnia has lasted more than three weeks.
    • It is not improving.
    • It is interfering with your ability to function during the day.
  3. Consider working with or referring to a sleep specialist.3Breus MJ. Do You Need A Sleep Specialist? WebMD. June 7, 2021. Viewed March 23, 2022.
  4. If the sleep specialist determines that primary insomnia is the problem, consider therapies or practices that deal with thinking and worrying that interfere with sleep:
    • Cognitive-behavioral therapy for insomnia (CBT-I) and counseling
    • Specific relaxation and exercise practices
    • Behavioral conditioning

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Laura Pole, MSN, RN, OCNS

Senior Clinical Consultant
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Laura Pole is senior clinical consultant for CancerChoices. Laura is an oncology clinical nurse specialist who has been providing integrative oncology clinical care, navigation, consultation, and education services for over 40 years. She is the co-creator and co-coordinator of the Integrative Oncology Navigation Training at Smith Center for Healing and the Arts in Washington, DC. Laura also manages the “Media Watch Cancer News That You Can Use” listserv for Smith Center/Commonweal. In her role as a palliative care educator and consultant, Laura has served as statewide Respecting Choices Faculty for the Virginia POST (Physician Orders for Scope of Treatment) Collaborative as well as provided statewide professional education on palliative and end-of-life care for the Virginia Association for Hospices and Palliative Care.

For CancerChoices, Laura curates content and research, networks with clinical and organizational partners, brings awareness and education of integrative oncology at professional and patient conferences and programs, and translates research into information relevant to the patient experience as well as clinical practice.

Laura sees her work with CancerChoices as a perfect alignment of all her passions, knowledge and skills in integrative oncology care. She is honored to serve you.

Laura Pole, MSN, RN, OCNS Senior Clinical Consultant

Nancy Hepp, MS

Lead Researcher
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Ms. Hepp is a researcher and communicator who has been writing and editing educational content on varied health topics for more than 20 years. She serves as lead researcher and writer for CancerChoices and also served as the first program manager. Her graduate work in research and cognitive psychology, her master’s degree in instructional design, and her certificate in web design have all guided her in writing and presenting information for a wide variety of audiences and uses. Nancy’s service as faculty development coordinator in the Department of Family Medicine at Wright State University also provided experience in medical research, plus insights into medical education and medical care from the professional’s perspective.

Nancy Hepp, MS Lead Researcher

Last update: May 21, 2024

Last full literature review: January 2022

CancerChoices provides information about u0022integrativeu0022u0022 cancer care. We review u0022complementaryu0022u0022in therapies and u0022self-careu0022u0022 practices to help patients and professionals explore and integrate the best combination of u0022conventionalu0022u0022the and complementary therapies and practices for each person.

Our staff have no financial conflicts of interest to declare. We receive no funds from any manufacturers or retailers gaining financial profit by promoting or discouraging therapies mentioned on this site.