HJBR Mar/Apr 2021

HEALTHCARE JOURNAL OF BATON ROUGE I  MAR / APR 2021 13 restorative benefits of natural, healthy sleep. In addition, prescription sleep aids work by essentially switching off top brain func- tions to put patients into a state of uncon- sciousness. Sleep is important to several brain functions and how neurons commu- nicate with each other. The brain and body are remarkably active during sleep. Recent studies suggest that sleep plays a house- keeping role in removing toxins that accu- mulate in the brain during waking hours. Currently, there is no pharmacological approach to sufficiently replicate this com- plex set of biological changes. Other research shows a strong associa- tion between sleep aids and a higher risk of death and cancer diagnosis. Sleep aids are habit forming and lose effectiveness over time. When discontinuing sleep medica- tion, patients typically experience a period of withdrawal, during which insomnia can worsen for a few weeks. CLINICAL DIAGNOSIS Correcting sleep disorders begins with a clinical evaluation that includes a thor- ough history and physical examination with emphasis on symptoms that cause sleep disorders or on other medical conditions that may be worse during sleep. Ochsner Sleep Centers in Baton Rouge, NewOrleans and Covington are designed specifically to diagnose and treat sleep disorders. They’re staffed by sleep specialists, physicians with specialty training in sleep disorders. Some sleep disorders are treated with behavioral techniques, while others might require medication. Proper diagnosis and treatment can make a real difference. Patients can greatly improve daytime performance and general health. The results help diagnose the prob- lem and formulate a treatment plan. When appropriate, home sleep stud- ies may be offered. If indicated, however, patients may be scheduled to spend the night in a sleep laboratory for a polysom- nogram. Over a full night of sleep, patients’ breathing pattern, heart rate, oxygen sat- uration, muscle tone and brainwaves are recorded. Clinicians analyze the data to determine the true nature of a patient’s dis- rupted sleep. In some cases, patients are monitored during a series of naps performed the day after to confirm excessive daytime sleepi- ness and unusually quick entry into REM sleep. Nap studies are performed the day after so the quality of the previous night’s sleep can be correctly interpreted. TREATING INSOMNIA The American College of Physicians rec- ommends cognitive behavioral therapy for insomnia, or CBT-I, as a first-line approach for adult patients. In some cases, CBT-I has been shown to be more effective than med- ication, including groups that face higher risk of experiencing insomnia such as preg- nant women, patients with post-traumatic stress disorder and insomnia experienced after cancer treatment. When CBT-I com- ponents are used correctly, as many as 70% to 80% of patients with primary insomnia experience improvement — less time to fall asleep, more time spent asleep and waking up less during sleep. CBT-I explores how patients’ thoughts and behaviors affect sleep. A CBT-I pro- vider guides patients in reframing miscon- ceptions in ways that promote restful sleep. CBT-I typically takes six to eight sessions, though the number depends on the client’s needs. It is a multicomponent treatment, meaning it combines cognitive, behavior and psychoeducational aspects. It is not rec- ommended for people with certain medical conditions that can be made worse by losing sleep such as bipolar disorder and seizures. Cognitive intervention attempts to change inaccurate or unhelpful thoughts about sleep. Insomnia sufferers often have misconceptions or dysfunctional thoughts about sleep, which may lead to behaviors that make sleep more difficult. Prior expe- riences of insomnia, for example, may lead to worry about falling asleep, which leads to excessive time in bed to try to force sleep. It’s a frustrating, nightly cycle that is often difficult to break. Through behavioral intervention, CBT-I patients learn the habits that make sleep- ing more difficult like eating, watching TV or using digital devices. They’re taught relax- ation techniques, stimulus control and sleep restriction. Clients are instructed to get out of bed when they find it difficult to fall asleep, set an alarm for the same time every morning and avoid daytime naps. Sleep compression is a slightly differ- ent approach often used with older peo- ple. Instead of reducing time in bed to the amount of sleep they get on a typical night, their time in bed is gradually reduced until reasonably close to the time they spend actually asleep. Relaxation techniques are aimed at reducing the racing thoughts and tension that often accompany lying awake in bed. These techniques can increase the body’s natural relaxation response, which is help- ful for both the body and mind. CBT-I providers might recommend breathing exercises or progressive muscle relaxation, a technique that involves tens- ing and relaxing different muscle groups. Autogenic training adjusts focus to differ- ent parts of the body to identify specific sensations. Other methods include meditation, guided or self-hypnosis, and biofeedback, which uses technology tomonitor processes like brain waves, heart rate, breathing and body temperature to gainmore control over them.