Cognitive behavior therapy conducted by telephone may ease arthritis-related insomnia

Cognitive behavior therapy conducted by telephone may ease arthritis-related insomnia
Cognitive behavior therapy conducted by telephone may ease arthritis-related insomnia


new study revealed that a talk therapy practice conducted by telephone could help older adults who have arthritis-related insomnia sleep better. The study was published in the Journal of the American Geriatrics Society.

Why does this matter?

Insomnia is a difficulty in falling or staying asleep. It affects more than 14 million Americans aged 65 and older. It may lead to daytime problems such as tiredness or fatigue, poor concentration, and daytime sleepiness.

Osteoarthritis (OA) is the most common form of arthritis. It can cause or worsen sleep problems. Older adults may develop arthritis after years of wear and tear on their joints, often due to normal physical activity or past injuries. About half of Americans over the age of 65 have been told they have arthritis by their healthcare provider.

What is Cognitive Behavior Therapy?

Cognitive behavioral therapy (CBT) is a type of talk therapy. It can be a fast-acting, long-lasting treatment for insomnia in older adults. In fact, studies suggest that CBT is one of the most effective therapies for insomnia. During CBT sessions, you learn to develop new sleep habits and to identify and change any unhelpful sleep habits.

What the Researchers Learned from this Study

The researchers’ interest in this study was inspired by earlier studies that showed strong evidence that  cognitive behavioral therapy is an effective treatment for insomnia. A growing body of evidence suggests that CBT is an especially successful treatment for insomnia that is related to arthritis discomfort.

However, CBT treatment typically requires weekly visits to a therapist’s office, often over several months. For older adults who have insomnia and arthritis, attending therapy sessions in person can be difficult or even impossible.

In this new study, researchers showed that having brief CBT sessions over the telephone was effective for improving arthritis-related insomnia and fatigue over 12 months. They said that the results of their trial showed that telephone CBT reduced the clinical and financial burdens of in-person, arthritis-related CBT insomnia treatment.

Research has shown that telephone CBT can also successfully treat smoking cessation and depression. These results have prompted some health insurance providers to cover CBT phone treatment for certain conditions.

How the Researchers Conducted this Study

The researchers recruited 325 adults aged 60 and over who had moderate to severe insomnia and arthritis pain. The participants were randomly selected to receive one of two treatments. One group received six CBT telephone sessions each week for eight weeks. These participants received coaching on sleep restriction, sleep hygiene, and learned how to restructure their sleep behavior. Participants also got homework assignments to perform.

Participants in the second treatment group received information about sleep and arthritis but did not receive any CBT sleep coaching. Both groups kept sleep diaries.

The researchers collected information on how the participants rated their general health and quality of life according to standard questionnaires. The participants ranked their insomnia status as well as their arthritis pain, stiffness, and ability to function.

After the sessions ended, the researchers said that the people in the CBT group showed improvements in sleeplessness and pain compared to those in the education-only group. They estimated that the cost for the CBT sessions was about $200 per person.

Study Limitations

According to the researchers, no studies exist to show whether CBT for arthritis-related insomnia is a cost-effective treatment. Experts say that there is a strong need for further study in this area. The researchers suggest that further study will help insurers and health care providers decide upon the best treatment decisions and evaluate the cost-effectiveness of CBT telephone treatment for arthritis-related insomnia.

What this Study Means for You

The researchers concluded that phone-delivered CBT significantly improved sleeplessness and pain without increasing total healthcare costs. The researchers said that their findings should encourage healthcare practitioners to consider telephone CBT treatment of insomnia for older adults who also have arthritis.

Nine Tips for Battling Insomnia and Getting a Great Night’s Sleep

Nine Tips for Battling Insomnia
Nine Tips for Battling Insomnia

“I called my mattress a bed of nails. It was a place of anger, torment, frustration, and anxiety that I felt compelled to return to night after night, sometimes spending up to 14 hours there,” says Joseph Pannell.

“Eventually my insomnia became all consuming, it stole my happiness and completely eroded who I was as a person.  But in just 8 weeks through behaviour changes, consistency and habit building CBT-I put an end to over 20 years of misery,” he adds.

 It is literally impossible to make yourself sleep in the short term, explains Joseph in his self-help guide ‘You Can Sleep Too!’ What you can do, the author advises, is to build a strong regulated sleep drive so that you sleep well over the long term. CBT-I uses behavioural techniques such as sleep scheduling and stimulus control to achieve this. In a nutshell, if I had 15 seconds to either help someone sleep or prevent them from ever getting insomnia in the future, I’d tell them this:

“Don’t try to get 7-8 hours of sleep because, like shoe size, there is no one size fits all, and don’t set your bedtime by your watch. Just go to bed when you’re ‘can’t keep your eyes open’ sleepy, get up at the same time everyday, get light ASAP and no matter how well or poorly you’ve slept the previous night, change nothing, do nothing and make no effort to force or try to protect sleep whatsoever. That’s it!”

There are 9 Gold Standard techniques to overcome insomnia the author recommends:

Only go to bed when you are can’t-keep-your-eyes-open sleepy.

Sleep is a drive state. Just as you have a drive to eat when you feel hungry, you also have a drive to sleep when you feel sleepy. It is a common belief that you should set a fixed bedtime. Setting your bedtime by your watch rather than based on how you feel causes you to spend more time in bed trying to force sleep and becoming anxious if it doesn’t come. Go to bed when you physically can’t keep your eyes open, and sleep feels irresistible!

If you are in bed and feeling worried about not sleeping, leave the bedroom.

If you are in bed not asleep, think about how you feel. If you are sleepy, relaxed and just as happy to be in bed awake as you are asleep. Wonderful! If you stay there, do nothing and allow sleep to come, it will. If you start to feel anxious about not sleeping and are trying to make yourself sleep, give yourself permission to leave the bedroom and do something you find relaxing and enjoyable. When you feel sleepy again, return to bed.

Get up at the same time every day.

Getting up at the same time every day is one of the most essential pieces of advice to improve your sleep because a regular wake time anchors your circadian rhythm and homoeostatic sleep drive. Even when you sleep poorly, if you can resist the urge to sleep late so that you can catch up on sleep in the short term, you will see a dramatic improvement in your sleep over the long term.

Get light!

Get plenty of light (natural or artificial) as soon as possible and throughout the first third of your day.

Don’t believe the 8-hour sleep myth.

Objectively measured in a sleep lab, most adults who do not have a sleep problem sleep between 5.5 and 7 hours and overestimate the amount of sleep they actually get by about an hour. Some people may need 8 hours of sleep, but this is not typical. Everybody is different. The amount of sleep you personally need is enough for you to feel happy and refreshed. That’s it!

Spend less time in bed.

People with insomnia typically try to force sleep by spending more time in bed. Doing so serves to increase the amount of time spent in bed awake in an anxious, hyper aroused state; this conditions the brain to see the bed as a place of worry and wakefulness rather than sleep.

The fastest way to regulate your sleep drive and tackle the hyperarousal that can mask your drive to sleep is to spend less time in bed.

Understand what causes and perpetuates insomnia.

Stressful events, ailments and medication can all cause a short-term sleep problem. Normal sleepers have short-term sleep problems too. What causes and allows insomnia to continue are behaviours to try to make yourself sleep and catch up on sleep (napping, sleeping late, going to bed early when you are not sleepy) and your anxiety around sleep (your hyper aroused state).

Insomnia boils down to two problems: unregulated sleep drive and hyperarousal. Your insomnia is not unique. Knowing this with absolute certainty gives you the confidence it can be resolved.

Be mindful of active sleep efforts.

Hot baths, kiwi fruit, meditation, supplements, sleeping on the left side of the bed, sleeping at the north end … These are all active sleep efforts to try to force sleep. Just as it is impossible to turn your hair blue using breathing exercises, it is impossible to make yourself sleep if you are not already sleepy.

Hot baths and breathing exercises feel great, but if you have a laundry list of things you must do in order to sleep, this only increases your anxiety.

Be mindful of avoidance sleep efforts.

If I want to sleep, I can’t go out with friends and drink any alcohol. I can’t go out to a restaurant and eat late. I can’t exercise after a certain time. I can’t, I can’t, I can’t. All of these things mentioned may have an impact on sleep in the short term, but normal sleepers still do them, and they still sleep.

Avoidance sleep efforts limit your life, lead to loss of control and agency over it, and increase the power that insomnia has over you. This will damage your sleep over the long term. If it’s 9 pm and you want to go roller skating, get stuck in!

Exactly how I sleep with fibromyalgia and insomnia

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Would you like to know how to get some sleep? As an insomnia and fibromyalgia veteran who has been extensively researching and trying things out and managed to improve my sleep – I share exactly how I sleep.

Chiari malformation – What are the signs and symptoms of Chiari malformations?




Chiari malformation - - what are the signs and symptoms?

Chiari malformation – – what are the signs and symptoms?




A Chiari malformation, previously called an Arnold-Chiari malformation, is where the lower part of the brain pushes down into the spinal canal.

There are four main types, but type 1, called Chiari I, is the most common.

In someone with Chiari I, the lowest part of the back of the brain extends into the spinal canal. This can put pressure on the brainstem, spinal cord, and obstruct the flow of fluid.

This page focuses on Chiari I malformations.




Are Chiari I malformations serious?

The severity of Chiari malformations can vary from person to person, but generally:

Chiari I malformations aren’t considered life-threatening

some people experience painful headaches, movement problems and other unpleasant symptoms (see below), but many people won’t have any symptoms

there’s a chance of developing syringomyelia (where a fluid-filled cavity called a syrinx develops in the spinal cord), which can damage the spinal cord if not treated promptly

surgery can usually stop the symptoms getting worse and can sometimes improve them, although some problems may remain

Talk to your doctor about what the condition means, what the implications may be for your health and what treatment you may need.

Symptoms of Chiari I malformations

Many people with a Chiari I malformation will not have any symptoms. Sometimes they’re only found after an (MRI) scan of the brain is carried out for another reason.

If symptoms do develop, they can include:

headaches – these are usually felt at the back of the head and may be brought on or made worse by coughing, straining, sneezing or bending over

neck pain

dizziness and balance problems

muscle weakness

numbness or tingling in the arms or legs

blurred vision, double vision and sensitivity to light

swallowing problems

hearing loss and tinnitus

feeling and being sick

difficulty sleeping (insomnia) and depression

If you develop syringomyelia, you may also experience problems using your hands, difficulty walking, pain, and problems with bladder or bowel control.

If you’ve been diagnosed with a Chiari malformation, you should contact your doctor for advice if you develop any new symptoms or your symptoms worsen.

Treatments for Chiari I malformations

Treatment for Chiari I malformation depends on whether you have any symptoms and how severe they are. You might not need any treatment if you don’t have any symptoms.

Painkillers can help relieve any headaches and neck pain.

If your headaches are severe or you have problems caused by the pressure on your spinal cord (such as movement difficulties), surgery may be recommended.

Surgery

The main operation for Chiari malformation is called decompression surgery.

Under general anaesthetic a cut is made at the back of your head and the surgeon removes a small piece of bone from the base of your skull. They may also remove a small piece of bone from the top of your spine.

This will help reduce the pressure on your brain and allow the fluid in and around your brain and spinal cord to flow normally. Read an NHS leaflet about decompression for Chiari malformation (PDF, 111kb).

Other procedures that may be necessary include:

Endoscopic third ventriculostomy (ETV) – a small hole is made in the wall of one of the cavities of the brain, releasing trapped fluid. See treating hydrocephalus for more information.

Ventriculoperitoneal shunting – a small hole is drilled into the skull and a thin tube called a catheter is passed into the brain cavity to drain trapped fluid and relieve the pressure. See treating hydrocephalus for more information.

Untethering – some children with a type 1 Chiari malformation have a tethered spinal cord, which means it is abnormally attached within the spine. Untethering involves separating the spinal cord and releasing tension in the spine. Read an NHS leaflet on tethered spinal cord (PDF, 193kb).

Spinal fixation – some people with Chiari I will have a hypermobility syndrome, such as Ehlers-Danlos syndrome, and may require surgery to stabilise their spine.

The aim of surgery is to stop existing symptoms getting any worse. Some people also experience an improvement in their symptoms, particularly their headaches.

However, surgery sometimes results in no improvement or symptoms getting worse. There’s also a small risk of serious complications, such as paralysis or a stroke.

Talk to your surgeon about the different surgical options and what the benefits and risks of each are.

Causes of Chiari I malformations

The exact cause of Chiari I malformations is unknown. It tends to be present from birth, but is normally only found in adulthood when symptoms develop or when an MRI scan is done.

Many cases are thought to be the result of part of the skull not being large enough for the brain.

Chiari I malformations can also develop in people with a tethered spinal cord, a build-up of fluid on the brain (hydrocephalus), and some types of brain tumour.

Chiari malformations can sometimes run in families. It’s possible that some children born with it may have inherited a faulty gene that caused problems with their skull development.

But the risk of passing a Chiari malformation on to your child is very small. And remember: even if your children do inherit it, they may not experience symptoms.

Insomnia – check if you have it and find out how to treat it!




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Insomnia

Insomnia means you regularly have problems sleeping. It usually gets better by changing your sleeping habits.




Check if you have insomnia

You have insomnia if you regularly:

find it hard to go to sleep

wake up several times during the night

lie awake at night

wake up early and can’t go back to sleep

still feel tired after waking up

find it hard to nap during the day even though you’re tired

feel tired and irritable during the day

find it difficult to concentrate during the day because you’re tired

You can have these symptoms for months, sometimes years.

How much sleep you need

Everyone needs different amounts of sleep. On average we need:

adults – 7 to 9 hours

children – 9 to 13 hours

toddlers and babies – 12 to 17 hours

You probably don’t get enough sleep if you’re constantly tired during the day.

What causes insomnia

The most common causes are:

stress, anxiety or depression

noise

a room that’s too hot or cold

uncomfortable beds

alcohol, caffeine or nicotine

recreational drugs like cocaine or ecstasy

jet lag

shift work




Illnesses and other things that can cause insomnia

How you can treat insomnia yourself

Insomnia usually gets better by changing your sleeping habits.

Do

go to bed and wake up at the same time every day – only go to bed when you feel tired

relax at least 1 hour before bed – for example, take a bath or read a book

make sure your bedroom is dark and quiet – use thick curtains, blinds, an eye mask or ear plugs

exercise regularly during the day

make sure your mattress, pillows and covers are comfortable

Don’t

smoke, or drink alcohol, tea or coffee at least 6 hours before going to bed

eat a big meal late at night

exercise at least 4 hours before bed

watch television or use devices right before going to bed – the bright light makes you more awake

nap during the day

drive when you feel sleepy

sleep in after a bad night’s sleep – stick to your regular sleeping hours instead

How a pharmacist can help with insomnia

You can get sleeping aids from a pharmacy. However, they won’t get rid of your insomnia and they have many side effects.

Sleeping aids can often make you drowsy the next day. You might find it hard to get things done.

You shouldn’t drive the day after taking them.

See a GP if:

changing your sleeping habits hasn’t worked

you’ve had trouble sleeping for months

your insomnia is affecting your daily life in a way that makes it hard for you to cope

Treatment from a GP

Your GP will try to find out what’s causing your insomnia so you get the right treatment.

Sometimes you will be referred to a therapist for cognitive behavioural therapy. This can help you change the thoughts and behaviours that keep you from sleeping.

GPs now rarely prescribe sleeping pills to treat insomnia. Sleeping pills can have serious side effects and you can become dependent on them.

Sleeping pills are only prescribed for a few days, or weeks at the most, if:

your insomnia is very bad

other treatments haven’t worked