Tackling sleep problems in epilepsy with cognitive behavioural therapy

Epilepsy Society: Cognitive behavioural therapy is a talking therapy that helps you manage problems by changing the way you think and behave. Cognitive behavioural therapy for insomnia (CBT-i) is about changing the way you think about sleep and then addressing any dysfunctional sleep habits and anxieties. People think that insomnia is not fixable without drugs, that they will never re-establish a healthy sleep/wake balance. But this is almost never the case, even with conditions such as epilepsy. The important thing to remember is that whatever causes insomnia, it is not a barrier to it getting better.

We see many people with epilepsy in our clinics and CBT-i can be very helpful. However, because the treatment can lead to a brief period where people sleep a bit less before they sleep more, and a reduction in sleep time can trigger seizures for some people with the condition, the therapy has to be taken at a slower pace and should always be managed by a healthcare professional, as described below.
At our clinics, we  teach CBT-i through five 90-minute group therapy sessions. These are not traditional group sharing sessions, but rather teaching sessions.

How we think about sleep

We begin by changing the way people think about sleep. People think that if they don't sleep, their body won't recover from the day and that the insomnia will shorten their lifespan. But there is very little evidence to suggest that this is the case and just knowing that insomnia is not going to kill them, often reduces anxiety considerably.
People who are struggling with sleep  often have a fantasy that 'good' sleepers sleep all night, every night and are awake and alert all day, every day. But even good sleepers can wake up several times a night and will have an occasional run of sleepless nights. No-one is alert and lively all day every day.
Then there is the myth of the eight hour sleep. This is hammered into us from the time that we are children and it can be difficult to break that concept down. But the truth is that the amount of sleep that is right for us varies from individual to individual. We each need the amount of sleep that will allow us to feel alert most of the time, most days of the week.

Good sleeping habits

Our behavioural techniques begin with two golden rules.

• Make sure you have a cut off point for caffeine intake
• Keep your bedroom cool.

The traditional cut off time for caffeine is 4pm but if you are having trouble sleeping, I would recommend bringing that forward to 1 or 2pm.
It is a myth that a warm, cosy room is good for sleeping. At night your body wants to lose heat. Warmth is disruptive. The ideal temperature for your bedroom is 18 degrees celsius. You should be warm and cosy under your duvet but a little nippy if you go to the bathroom. This enables you to regulate your body temperature.
To continue reading this article and to find out more about filling up your body's sleep fuel tank and improving quality of sleep in the latest edition of our magazine Epilepsy Review.
Dr Hugh Selsick is a consultant psychiatrist working in sleep medicine, based at the Royal London Hospital for Integrated Medicine.