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Saying Goodnight to Sleeping Pillsby Graciela Gutierrez 
Mary Rose, Psy.D., CBSM Linda Dugat hasn't had more than three hours of sleep in one night since she was seven years old, even though she's now planning for her retirement. Dugat knows why she has insomnia. She just doesn't know how to fix it. It started after a traumatic childhood experience. Her father suffered what she thinks was a nervous breakdown. During that time he would wake up at all hours of the night and roam the house aimlessly. "I could hear him mumbling, saying things that didn't make sense," Dugat said. "At that age, not knowing what your father would do next was scary." She began waking up several times a night, a pattern that continued into adulthood, making it increasingly harder for her to fall asleep again. Over the years, doctors prescribed sleep medication or suggested over-the-counter remedies, but none worked. Her quest for effective treatment led her to Dr. Mary Rose, a licensed clinical psychologist and associate professor of medicine at Baylor College of Medicine who uses cognitive behavioral therapy (CBT) to change the way people think about sleep. "Pills won't get rid of the reason why you're not sleeping," Rose said. "They may help you sleep in the short term, but you can't take them forever." Most cases of chronic insomnia are rooted in some form of stress, and patients associate sleep with that anxiety. Rose said that sleeplessness becomes insomnia when people start to think their lack of sleep could somehow ruin their lives—imagining that they could lose their job or cause a fatal accident. Doctors use CBT to better understand the patient's anxieties, fears and the behaviors that have created and perpetuate an unhealthy way of thinking about and responding to sleep. The therapy challenges patients to redesign how they think about sleep, their habits and their sleep environment and encourages patients to give themselves a "reality check." How many times have they caused a fatal accident? How many times have they lost their job? More than likely the answers are "never." In Dugat's case, sleep was associated with fear. She worried that in his confusion, her father might hurt her family. That feeling has stuck with her through the years inducing nightmares and eventually panic attacks. During sessions with Rose, Dugat has learned that sleep is something she deserves, a time to rest, rather than a stressful and fearful event. CBT also uses exercises to make sleep a normal part of a person's life instead of an anxiety filled event. Patients are asked to keep a journal on how much sleep they are getting, which Rose believes can help alleviate some of the stress and identify insomnia triggers. "People usually focus on how long it takes them to fall asleep or that they wake up too early," Rose said. "They aren't looking at how much they actually sleep including naps. Sometimes they are getting adequate sleep time but their sleep feels fragmented." For Dugat, who still wakes up several times a night, following a sleep schedule is the hardest part. Rose has advised her to get out of bed until she is sleepy again. "Lying in bed awake only perpetuates the problem," she said. "The bed should be for sleep and not a place to feel miserable and worry." Rose also works with the patient's doctors to look for health issues or medications that could be causing the insomnia. Dugat was taking medications that kept her awake but no longer takes them. Most doctors don't have the time or experience to diagnose and treat sleep disorders effectively. Most psychologists are knowledgeable and capable of using CBT, but there are fewer than 100 doctors across the country certified in this subspecialty. Rose is the only one in Houston certified in behavior sleep medicine. Both Rose and Dugat said the treatment doesn't work overnight and can take months or even years of follow-up sessions and practice on the patient's part, with results varying. Despite the difficulties, Dugat said the treatment is working—she's gained, on average, an hour of sleep a night. While that may not seem like much, for Dugat and others that suffer from insomnia, it's a sign that things are getting better. "I never imagined I'd reach this point," Dugat said. "I'm just tired of being tired from not sleeping my whole life, and it's finally getting better." |
Patient CarePutting the Pieces Together: Megan's Story When Baby Heart Patients Grow Up Saying Goodnight to Sleeping Pills ResearchFrom a Sister's Illness... A Cancer Crusade EducationCommunity ServiceAlumni & DevelopmentBRASS Connections Help Students Soar College NewsPhysician Hall of Fame: College Receives One-of-a-Kind Signature Collection
People Working Together to Achieve Greatness
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Volume 3, Issue 1, Spring 2007 |
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