Sleep is a natural process that should occupy about a third of our time without our needing to pay much attention to it. Sleep disorders have always existed, but the pressures and temptations of modern life can pose many extra threats to sleep. Without enough sleep we are less able to concentrate and to learn, and long-term lack of sleep is associated with a number of health problems. If you are not sleeping well, it may be that therapy could help.
In recent years, scientific knowledge relating to sleep has increased hugely and, growing interest in other areas of learning has added to that understanding. Despite the increased understanding of sleep, medical training still includes very little on sleep or sleep disorders and the same applies to most other health professions. In order to offer evidence-based treatment for patients with disturbed sleep health professionals may need additional training.
Although some people need therapy to improve sleep, everyone can benefit from a better understanding of sleep and the things they can do to maintain a healthy sleep pattern and improve performance. For example, it may be helpful for employers to have a greater awareness of the importance of workers having sufficient sleep. Additionally, because our night-time sleep is so closely associated with daytime activity, it can be important in a wide range of projects to consult a sleep expert.
Andrew Green of Sleep Therapy West offers solutions to all of the above. It can provide therapy for people with sleep difficulties in Bristol and the surrounding area. Although based in Bristol, it is possible to run training events throughout the British Isles and consultancy has no boundaries.
About Andrew Green, BA, DipCOT, MSc, MPhil
I have practised as an occupational therapist, registered with the Health and Care Professions Council (registration no OT15048), in mental health and neuropsychiatry for over 30 years. Since 1999 I have increasingly specialised in managing sleep disorders in general and insomnia in particular. I have attended several training events on sleep disorders, including the International Sleep Medicine Course, passed in 2010.
As well as running training events for other therapists, I have written extensively on sleep and have co-edited two books on sleep, published in 2012 and in 2015. I am involved in a current national initiative to improve and standardise cognitive behaviour therapy for insomnia (CBT-I).
Management of insomnia
Cognitive behaviour therapy for insomnia (CBT-I) is the treatment for insomnia that is recommended by the National Institute for Health and Care Excellence (NICE) and has been shown in numerous studies to be more effective in the long term than medication. It consists of a range of measures that involve changing your habits or changing the way that you think about your sleep. A strategy will be selected according to your particular circumstances after careful assessment.
The first session (which can last up to two hours) will involve, firstly, a detailed assessment of your sleep habits in order to identify problems, or to rule out any other sleep disorder; secondly we will devise an individual plan of action, which will be likely to involve changes of routine that could be quite challenging, or to have a clear rationale for referring elsewhere.
Occasionally, one long session is sufficient for someone to get on course, but most people prefer to have a small number of further sessions (45–60 minutes) to discuss progress. Although it is important to meet in person for the first assessment session, it may be possible to continue therapy by telephone, or online, if travel or other commitments make meeting difficult. However, it is not necessary to have repeated sessions over the course of time. If for any reason CBT-I does not seem to be appropriate for you, I will not recommend more sessions.
Apart from insomnia, many other sleep difficulties can be well managed by medication, assuming that the problem has been diagnosed and treated already. I cannot advise on medication, but there may be additional ways of helping to cope with sleep problems such as excessive sleepiness, parasomnias (such as sleepwalking) and circadian rhythm problems (sleeping at the “wrong” time).
Each person’s problems and circumstances are different and individual plans are needed. These can be made in an assessment meeting. It is not usually necessary to have more than two further sessions.
I have run training events, in locations from the south coast to the north of England, about sleep and sleep problems for occupational therapists and other health professionals in a variety of specialities including rheumatology, CFS/ME and pain management. Some of these have been run in conjunction with the Community Therapists Network and with Pain Training and Education, but events can be arranged by negotiation according to requirements.
In a typical day-long seminar for health professionals the following can be covered:
- The importance of sleep and patients’ requirement for sleep
- The science of normal sleep and natural variation
- Relationships between sleep and daytime activity
- Sleep problems/disorders
- The assessment of sleep and sleep problems, including when to refer
Approaches to the management of sleep problems
Shorter or longer events are possible depending on the content required, and through negotiation they can be tailored, subject to the extent of my knowledge, to the requirements of different audiences.
I have spent many years talking every day of the week to people about their sleep and I have edited two books dealing with all scientific and social aspects of sleep. I am currently researching in preparation for a third book. I am therefore well-placed to advise on a wide range of matters relating to sleep and sleep disorders.
For example, I have participated in or advised on:
- A university research project relating to sleep problems in irritable bowel disorder
- The development of an application concerned with sleep and the hospitality industry
- The clinical supervision of a PhD project relating to sleep
- A study of quality of life of people with narcolepsy
If I am unable to advise in a particular area, I can usually suggest where else to ask.
What I cannot do
I am unable to advise on children’s sleep, or on specialist equipment or bedding to enable a person with a disability (adult or child) to achieve a comfortable position at night.
Although I have experience of working with people with a range of sleep disorders, I cannot advise on respiratory problems in sleep, such as obstructive sleep apnoea.
Other options for therapy
- If you think that you need medication for your sleep problem, you should talk to your family doctor. A short-term course of medication for insomnia can be a solution to a short-term problem.
- If it is low mood or depression that is affecting your sleep, you should first consult your doctor.
- If your sleep is affected by anxiety, you could consider cognitive behaviour therapy. This might be available through local mental health services. In the Bristol area CBT is available privately: for example, http://www.cbtbristol.com/
- If it is your child’s sleep that is of concern, you will want to ensure that a therapist is properly qualified and you might try contacting The Children’s Sleep Charity for advice: http://www.thechildrenssleepcharity.org.uk/
- If you need specialist advice about bedding and the bedroom, contact James Wilson (who also advises the Children’s Sleep Charity) via: http://www.thesleepgeek.co.uk/
- Green A, Hicks J, Weekes R, Wilson S (2005) A cognitive-behavioural group intervention for people with chronic insomnia: an initial evaluation. British Journal of Occupational Therapy 68(11), 518-522.
- Green A, Hicks J, Wilson S (2008) The experience of poor sleep and its consequences: a qualitative study involving people referred for cognitive-behavioural management of chronic insomnia. British Journal of Occupational Therapy 71(5), 196-204.
- Green A (2008) Sleep, occupation and the passage of time. British Journal of Occupational Therapy 71(8), 339-347.
- Green A and Westcombe A (2012) Sleep: multiprofessional perspectives. London: Jessica Kingsley Publishers.
- Green A and Brown C (2015) An occupational therapist’s guide to sleep and sleep problems. London: Jessica Kingsley Publishers.
- “Asleep for ages”: Perspectives on sleep in history
- No Shame for Extreme Night Owls
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