Sleep problems are epidemic in the United States. Many adults complain of poor sleep yet engage in behaviors that are counterproductive to sleep. This article briefly reviews recent research on the treatment of insomnia and discusses application of mental health counseling strategies for treatment. Case studies illustrate the application of current research within counselor areas of expertise in cognitive behavioral therapy and behavioral counseling.
Sleep is essential to physical and mental well-being. The critical interplay between sleep, physical health, and mental functioning is difficult to overstate. Yet though the professional literature and popular media emphasize the importance of sleep, the behavior of many people is detrimental to high-quality, restorative sleep.
Sleep deprivation at its worst is literally torturous; even mild chronic sleep deprivation changes brain chemistry and physiology, leading to deterioration of cognition, memory, and mood (National Institute of Neurological Disorders and Stroke [NINDS], 2007). Published studies support the use of cognitive-behavioral and related strategies to improve sleep quantity and quality (Adachi, Sato, Kunitsuka, Hayama, & Doi, 2008; Ebben & Spielman, 2009; Edinger, 2009; Jacobs, Pace-Schott, Stickgold, & Otto; 2004; Whitworth & Crownover, 2007). The expertise of mental health counselors in techniques considered best practices for many mental disorders corresponds with many interventions for effective treatment for insomnia. Counselors are trained in addressing the intersection of cognition, behavior, and emotional distress; their code of ethics also emphasizes the importance of interdisciplinary consultation in treating complex client problems whenever that is appropriate (American Mental Health Counselors Association, 2010).
THE SLEEP DILEMMA
Sleep problems chronically affect 40 million Americans yearly and another 20 million a year intermittently (NINDS, 2007). Though there is plenty of information available to the public about sound sleep practices, difficulties with sleep persist. This brief review of recent research provides the basis for the interventions described in the case studies.
Sleep Problems and Practices of American Adults
American adults, who tend to report many sleep problems, are often contributors to their own insomnia. The National Sleep Foundation (2010) provides a snapshot of the attitudes, challenges, and habits of American adults regarding sleep: About 40% of those surveyed believe they get "a good night's sleep" most of the time (p. 19), but of these, many rely on alcohol, sleep medications (prescribed or over-the-counter), or both several times a week. During the first decade of this century, the annual number of prescriptions for sleep aids rose at more than twice the rate of total prescriptions (Piskora, 2007). In 2006 more than $4.6 billion was spent on these prescriptions (Piskora, 2007). While prescription drugs are helpful for many, their benefits must be weighed against the possibility of serious side effects and potential interactions with other medications or alcohol (Food and Drug Administration [FDA], 2007). The FDA, which generally approves nonprescription sleep aids for up to two weeks' use, warns that these medications can have varied effects, e.g., sleepiness may persist into the next day, and there is risk of psychological dependence even though they are nonaddictive (FDA, 2007).
The risks of mixing prescription or over-the-counter sedatives with alcohol include dizzy spells, potentially dangerous breathing problems, reduced motor control, and impaired memory (National Institute on Alcohol Abuse and Alcoholism, 2007). The FDA has also emphasized that prescription sleep aids carry the risk of bizarre behaviors while sleeping, a problem that may be exacerbated by alcohol. These behaviors may include leaving the home, driving, eating, and engaging in unusual behaviors (FDA, 2007). …