There is a wealth of evidence to suggest that cognitive behavioural therapy (CBT) is an effective treatment for insomnia. Prof Marcantonio Spada looks at the role that occupational health professionals have in promoting and facilitating access to this treatment.
Disturbed sleep, ranging from mild to severe insomnia, is and has always been a common problem. When insomnia first emerges – which can be a consequence of a physical or psychological condition (for example, anxiety or low mood) – it can quickly escalate, as individuals will tend to start worrying about the impact it will have on performance, particularly at work.
Some may take short-term measures to “normalise” the initial sleep disturbance (or mild insomnia in many cases) and to cope with emerging worries. This may include the use of alcohol, benzodiazepines (for example, Xanax) and sleeping pills (for example, Zopiclone). These forms of self-medication will eventually lead to an exacerbation of insomnia as they negatively affect sleep “architecture”. Discontinuing the use of alcohol and benzodiazepines will also cause, for many, a rebound in insomnia and a possible worsening of insomnia.
Good sleep hygiene is vital for the performance of all workers, but especially for those in safety-critical roles, where disturbed sleep can pose a danger.
Occupational health professionals have a role in educating staff about insomnia and how to tackle it. For example, they may consider presenting a series of tips to help employees manage insomnia in a more effective manner. Education on sleep hygiene, particularly surrounding the use of technology close to bedtime, is crucial, as are reduction in alcohol use and the increase in physical activity during the day. Sleep restriction principles, improving the sleep environment, and relaxation training and techniques can also be of great help.
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It is important to note that insomnia may be secondary to physical conditions and psychological distress, such as depression, which will need to be identified and OH support provided.
CBT has excellent evidence to support it as an intervention for insomnia. The sooner irrational beliefs and maladaptive behaviours are tackled, the better and quicker the recovery to normal sleep patterns will be achieved. Part of the journey is also to understand that sleep patterns change over life and that it is more to do with stopping to worry about sleep than the actual quality of sleep one may be experiencing.
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In the age of remote and hybrid working, a mixture of in-person and remote CBT can be carried out. What we learned from the pandemic is that clients like virtual CBT because it can save time and is equally effective as an in-person appointment. It also means that clients can have access to specialist support that may otherwise not be available face-to-face.
We should not underestimate the impact of insomnia on wellbeing, performance and health. It is an urgent matter to deal with as it can escalate and become a perseverative problem quickly. Identifying and helping to address underlying causes of insomnia is vital to supporting treatment.
