As in anything that matters, it is important to choose wisely when it comes to your mental and physical health. Dr. Stephanie Silberman is a clinical psychologist who has received extensive training in sleep medicine and psychological disorders.
Symptoms of depression include sadness, feelings of guilt, poor attention and concentration, changes in appetite, fatigue, loss of energy, decreased libido, increased crying, lack of desire to do things that are enjoyable, and lack of pleasure when doing things that you used to enjoy. People with depression may have early morning awakenings and spend more time lying in bed than is needed, thus causing a worsening of insomnia.
If you experience excessive worry, feeling nervous and stressed, difficulty relaxing, feeling scared or fearful, frequent nightmares, obsessive thoughts, or symptoms of panic, then anxiety may be taking a toll on your life. Anxiety may cause trouble falling asleep, especially when it’s difficult for you to relax at night and you experience racing thoughts or worries at bedtime.
Effective treatment for depression and anxiety include cognitive behavioral therapy, which focuses on the behaviors and thought processes that are worsening your symptoms.
Insomnia is a common problem in the United States and other industrialised nations around the world.
It is estimated that up to one-third of the United States population has insomnia.
So what is insomnia, exactly?
Insomnia is typically defined as difficulty either falling asleep, staying asleep, or both.
It can also involve early morning awakenings with trouble falling back to sleep.
It can be caused by stress, anxiety, depression, poor sleep hygiene, environmental factors, certain medical illnesses and medications, or other sleep disorders such as restless legs syndrome, periodic limb movements, sleep apnea, circadian rhythm disorders, shift work disorder, or narcolepsy.
To help you figure out if you have insomnia, read through the following descriptions and see if they apply to you.
Transient insomnia is short-term in nature. It is often due to stressful situations in your life, such as a new job, break-up in a relationship, or the death of a loved one. It can also be caused by illnesses, certain medications, and environmental circumstances. Short-term, or transient, insomnia typically lasts between a few days and a few weeks, but it can still be a time of frustration. It is common to experience transient insomnia at some point in your life and it doesn’t mean that it’s going to last forever. The important thing is not to let it turn into a chronic problem.
Psychophysiological or conditioned insomnia is a learned-type of insomnia that lasts more than a month. People with conditioned insomnia often describe feeling “wide awake” when they get into bed at night, even though they were tired beforehand. You may feel like your mind just “won’t shut off” when you get into bed, and so as a result, you spend a lot of time lying in bed each night but not sleeping. This type of insomnia is reinforced by both your behaviours and thoughts, both of which may be making your sleep problem worse. Poor sleep can then affect your mood, daily functioning, and overall health.
Cognitive-behavioral therapy for insomnia (CBT-I) has been shown to be an effective way of overcoming your insomnia, and it doesn’t involve taking any sleep medications. CBT-I teaches you how to change the thoughts and behaviours that are keeping you up at night so that you can get more refreshing, restorative sleep.
There are over 80 different sleep disorders. Some of the most common include:
Sleep Apnea
Restless Legs Syndrome
Periodic Limb Movement Disorder
REM Sleep Behavior Disorder (RBD)
Narcolepsy
Advanced Sleep-Wake Phase Disorder (aka Advanced Sleep Phase Syndrome)
Delayed Sleep-Wake Phase Disorder (aka Delayed Sleep Phase Syndrome)
Since many sleep disorders have similar symptoms (e.g. excessive daytime sleepiness, difficulty falling asleep at night, frequent awakenings from sleep, etc.), it is highly recommended that persons seeking consultation and treatment for a sleeping difficulty see a Board Certified Sleep Specialist.
For more information on sleep disorders, check out these resources:
Sleep Apnea:
https://www.sleepfoundation.org/sleep-apnea
https://browardsleepdisorders.com/index.html
Restless Legs Syndrome
https://www.sleepfoundation.org/sleep-disorders/restless-legs-syndrome-rls
Periodic Limb Movements
https://www.sleepfoundation.org/articles/periodic-limb-movements-disorder
https://www.webmd.com/sleep-disorders/periodic-limb-movement-disorder
REM Sleep Behaviour Disorder
https://www.sleepfoundation.org/articles/rem-sleep-behavior-disorder
https://www.webmd.com/sleep-disorders/rem-sleep-behavior-disorder
Narcolepsy
https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/fact-sheets/narcolepsy-fact-sheet
https://www.sleepfoundation.org/articles/narcolepsy
http://sleepeducation.org/essentials-in-sleep/narcolepsy/overview-facts
Advanced Sleep-Wake Phase Disorder (aka Advanced Sleep Phase Syndrome)
https://stanfordhealthcare.org/medical-conditions/sleep/advanced-sleep-phase-syndrome.html
Delayed Sleep-Wake Phase Disorder (aka Delayed Sleep Phase Syndrome)
https://www.sleepfoundation.org/articles/what-circadian-rhythm
Dr. Silberman specializes in Cognitive Behavioral Therapy (CBT) for the treatment of psychological and sleep disorders, including depression, panic disorder, generalised anxiety disorder, obsessive-compulsive disorder, post-traumatic stress disorder, insomnia, and other difficulties. Dr. Silberman works with couples having relationship problems, families who aren’t communicating well together, and persons coping with chronic medical illnesses. She also helps those who feel “stuck” in their careers or those who aren’t sure what career path to take by helping them focus on their true interests combined with their skills and abilities. In addition, Dr. Silberman uses CBT for persons wanting to lose weight or quit smoking.
In Cognitive Behavioral Therapy, there is an emphasis on identifying “cognitive distortions”, “automatic thoughts”, and underlying assumptions that lead to an individual having symptoms of depression, anxiety, insomnia, overwhelming stress, marital discord, or other issues. In addition, we work to identify what behaviours are maintaining, or reinforcing, the symptoms. With a CBT approach, the patient and psychologist work together to modify maladaptive thoughts and change problematic behaviours. This leads to a decrease in distressful symptoms, improved coping skills, and improved mental and physical health.
As a board certified sleep medicine specialist, Dr. Silberman specializes in the evaluation and treatment of sleep disorders. For insomnia, the treatment approach used is called CBT-I. Like CBT for other disorders, Cognitive Behavioral Therapy for Insomnia (CBT-I) is an evidence-based approach focused on changing the maladaptive thoughts and behaviours that maintain chronic insomnia. CBT-I can improve one’s mood as well, since there is a significant connection between sleep quality and quantity and an individual’s daytime functioning, mood, and overall well-being.
Research shows that CBT-I is the first line treatment for insomnia and that it is highly effective. Treatment is typically short-term in nature. Through CBT-I, people learn that by changing the behaviours, thoughts, and maladaptive patterns that contribute to poor sleep, they can take control of their symptoms and sleep better without sedative hypnotics. CBT-I is an individualised treatment approach with focus on finding the right sleep-wake schedule to optimize your chances of sleeping, decreasing behaviours that keep you up at night, and learning ways to decrease anxiety and worry during the day and especially at nighttime. CBT-I is a collaborative, active, hands-on approach to insomnia with the goal of improving sleep quality.