Sleep Disruption

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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:

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

Helpful links for professionals