How can we define sleep?
It is a primary need, present not only in mammals but also in primitive species such as jellyfish, which is associated with a temporary lowering of the level of consciousness and biological function. It is also a "behavioral state," with species-specific characteristics (for example, the stereotyped posture of humans in sleep is different from that assumed in other species). More importantly, it is a key ally of our health!
What are its functions?
Since we spend about a third of our lives sleeping, Alain Reichtshaffen argues that: "If sleep were not an absolutely vital function, it would be the biggest mistake the evolutionary process has ever made."
Indeed, we see how it supports the immune system, protecting against infection, for example, and promoting immunological memory. It also restores physical and psychological functions and consolidates learned information. Numerous substances and hormones, such as growth hormone, are also produced during our rest. In the hours of sleep also the concentration of cortisol (the "stress hormone") is lowered and beta-amyloid protein, which is associated with neurodegenerative diseases, is disposed of.
Factors and processes that regulate sleep
Two processes interact regulating sleep, contributing to evening sleepiness and propensity to wakefulness during daylight hours: the circadian process and the homeostatic process. The first regulates the alternation between sleep and wakefulness by relating to external stimuli (such as light, darkness, social interactions, mealtimes). The second defines that the time it takes to fall asleep is inversely proportional to the duration of the previous waking period.
Sleep is also influenced by age: its quality and quantity, for example, is deficient in adolescents and the elderly. The biological factors of chronotype and hypnotype explain preferences about bedtime-wakefulness and the greater or lesser need for hours of sleep. We also see an important influence given by gender: women sleep on average 28 minutes more than men but, due to sleep fragmentation, sleep is less restorative. The female gender is also more prone to incur the most common Sleep Disorder: Insomnia.
When sleep is not there: The Sleeplessness Disorder
The most well-known and frequent sleep disorder is certainly that of Insomnia. It is a stress-related issue whose symptoms are reported, according to some estimates, by about ⅓ of the population. It is also defined as a "24-hour disorder," which is thus not only associated with nighttime symptoms (such as difficulty initiating or maintaining sleep), but also with clinically significant distress or impairment of daytime functioning. Indeed, it leads to repercussions on work performance, but also on mnemonic, neurological, and especially emotional performance. In fact, the comorbidity between insomnia and other psychological disorders is very high, particularly with anxiety and depression. It is associated with increased frequency of aggressive and/or impulsive behavior, but also with increased alcohol use.
Thus, the literature reports numerous risks related to sleep deprivation, on physical and mental health in addition to errors made during motoring performance (it is estimated that about ⅕ of driving accidents are given by issues related to rest such as reduced attentiveness or increased impulsivity in actions, as well as microsleep given by a phase shift or a previous inability to fall asleep during the most suitable hours for sleep).
It thus becomes clear how insomnia is a societal-level problem connected with a high cost.
The treatment of choice: Cognitive Behavioral Therapy
Current European guidelines indicate psychological intervention as the first choice for the treatment of Insomnia. It follows a protocol that aims to accommodate nocturnal symptomatology with the goal of increasing the duration, continuity and quality of sleep, but also reducing the emotional, cognitive and social distress that characterizes wakefulness.
Among the techniques used we find that of relaxation: based on the hypothesis that insomnia can be determined and sustained by a 'cognitive or somatic hyper-activation, the aim is to facilitate the de-activation process necessary for falling asleep.
Treatment can be conducted in-person or online, in groups or individually. The group component allows for the perception of sharing the problem, as well as the possibility for patients to experiment and exchange information about any techniques found to be useful for falling asleep or consolidation of the same, in a space that allows listening without judgment.
The school of sleep
Within the "Life Clinic Health Connections" center, customized prevention-intervention pathways aimed at individual or group patients will be offered.
The methodology will be inspired by CBT-Insomnia, the Cognitive Behavioral pathway recognized as the "gold-standard treatment" for the aforementioned Sleep Disorder.
GROUP CBT-I
A self-administration questionnaire is issued at the time of enrollment to be shown to neurologist and psychologist on an individual basis with sessions of about ½ hour per patient to be arranged by appointment. At the end of the meeting, the following will be issued:
- no.1 anxiety disorder screening questionnaire (STAI-Y1)
- no.1 depressive disorder screening questionnaire (BDI-2)
- no.1 "Sleep Diary"
Screening questionnaires are to be completed and turned in on the same day.
The "Sleep Diary" will need to be reproduced and completed for each week of the course. It will serve to acquire objective data with respect to the Patient's sleep, monitoring its changes.
This assessment meeting is instrumental in defining the group, in order to outline the sleep characteristics of each person and the goals for its improvement.
The group CBT-I treatment proposes, after the individual assessment, 8 meetings on a weekly basis, with between 6 and 10 participants.
The meetings will be conducted by both neurologist (mainly meetings 2-3) and psychologist (4-5-6-e-7).
The first and the last, follow-up/closure of the protocol, will be proposed by both professionals.
In the relationship with the Other, transformative mechanisms are activated within the group given by the:
To stimulate these conditions, and produce empowerment given by the relationship between participants, each group meeting will begin with the sharing of the sleep diary and exercises done at home in connection with the previous session. Positive or negative features of sleep will be highlighted together, looking for applicable and shareable solutions.
Indeed, experimentation with the techniques described during the sessions is motivated by the group movement, increasing treatment compliance and limiting avoidance.
Meeting schedule:
1) Get-to-know-you meeting, in which the course that will be taken together is explained. Individual goals, which each participant has defined with the psychologist or neurologist, will also be shared.
2) Psychoeducation + sleep hygiene = In this phase, the underlying rationale for the demands of the various encounters are explained, so as to create greater treatment compliance. Sleep-relevant behaviors are also prescribed, as well as instructions for proper organization of the sleep-wake cycle.
3) Pharmacotherapy: why traditional doesn't work! - the need to identify specific problems or related diseases that may affect sleep - the pharmacological "weaning" program.
4) Relaxation and Arousal System= The purpose of relaxation techniques is to facilitate the natural evening wind-down process necessary for falling asleep. Appropriate times to reflect on concerns may be assessed.
6) Stimulus Control + Sleep Programming= the technique aims to have the room stimulus re-associated with the conditioned activity of sleeping alone, through prompts that build an appropriate pre-sleep routine. By virtue of each individual's sleep diary reports and hypnotype, a sleep schedule is proposed that outlines specific time windows within which lying down is recommended in order to achieve greater continuity and depth of sleep.
6 and 7) Cognitive Restructuring= techniques under cognitive restructuring aim to identify dysfunctional sleep cognitions ( which according to the literature support maladaptive sleep behaviors) and challenge them.
8) Follow-up meeting allows the effect of the course on the individual's sleep to be evaluated, and suggestions and cautions to be drawn up for the proper management of the sleep-wake cycle over a lifetime.
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