Sleep disorders are a major problem among many Swedes and a growing dilemma for children and young people. Lina Johansson is a psychologist and shares her advice on sleep problems.
Criteria for the diagnosis of insomnia
Studies show that up to 30 percent of Swedes state that they have difficulty sleeping and that is somewhat more common among women than men. The figures look similar if you look at other developing countries. About one-third who state that they have sleep problems meet the criteria for insomnia.
• The patient experiences problems with not falling asleep, or maintaining sleep, or sleep that does not provide much needed rest.
• Sleep disorder occurs at least three times/week for at least one month.
• Sleep disturbance causes obvious distress to the patient or interferes with his/her daily life.
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Seek help with sleep problems
A common reason for seeking help is that you experience stress and anxiety associated with sleep. At the societal level, we have an increased awareness of the importance of sleep, but the knowledge that you can do something about it is sometimes lacking.
-It is often mentioned how important it is to sleep properly to feel good, but it is not as easy to understand when you need to seek help and that there is treatment, says Lina Johansson, a psychologist at the digital sleep clinic Learning to Sleep.
Lina Johansson has gained most of her clinical experience as a psychologist from child and adolescent psychiatry. She has also worked as a psychologist on child and adolescent rehabilitation, ie with children with various neuropsychiatric disabilities, such as autism.
“A large part of the work was about supporting parents who have a great burden and where sleep often suffers,” says Lina Johansson. As a psychologist, it becomes clear that sleep is essential for us to function and feel good. Sometimes we miss it and focus too much on the symptoms.
Lina Johansson says that it is quite common for patients to believe that work and family work well and that they do not understand why they have sleep problems. It is often the case that the person has previously had a period of high workload, a life crisis or a trauma, which has triggered a sleep disorder.
– Unfortunately, sleep problems can continue even after the triggering factor has disappeared. It is a relatively normal reaction that sleep disorders can occur during shorter periods of high stress. The difficulty lies in getting stuck in a pattern where the body is undergoing a stress attack even before going to bed, due to fear of not being able to fall asleep and worrying about not being exercised the day after.
Treatment for sleep problems
For some, it is enough with so-called sleep school, where you get general tips and advice on sleep hygiene and lifestyle changes. It can be about starting exercise, watching diet, keeping regular sleep times, having dark, silent and cool in the bedroom and giving yourself time for wandering around without screens.
-The blue light deceives body and brain to think it’s day. This inhibits the secretion of the sleep hormone melatonin and makes it difficult for us to fall asleep, points out Lina Johansson. If we spend the last half hour scrolling news in bed, we do ourselves a great bear service.
For others, cognitive behavioral therapy (KBT) is required, which is about deliberately breaking down an incorrect sleep pattern in order to build up a new more well-functioning sleep pattern. The National Board of Health and Welfare recommends KBT in the first place, but when in practice it is a psychological shortage, doctors often prescribe sleep medication first.
– Medicines may be needed initially and in the short term, but in the long term, other help is needed, such as KBT. It is important to know that sleep aids can work in the event of acute problems, but in the long term they tend to lose effect and there is a risk that you develop a psychological dependence and find it difficult to stop. Then you can be helped by KBT treatment and get a more long-term solution to the sleep problems.
Learning to Sleep offers an online KBT treatment for sleep problems. The treatment is based on evidence-based methods and techniques that have been shown to be effective in overcoming sleep problems. During the treatment, telephone meetings are held weekly with a legitimate psychologist. In between, the patient can access material and do home tasks via the digital treatment support.
-Research shows that online-based KBT treatment works well, but to get the best effect, some form of psychology support is needed. People need someone who follows up on what they have agreed to do and provide extra support when needed.
Different types of sleep medicines
• Benzodiazepine-like preparations
• Other sleep drugs such as antidepressants, antihistamine or melatonin.
Learning to Sleep
The online KBT treatment lasts for five weeks. The treatment is largely based on a method called sleep restriction and which has proven to be very effective in combating long-term sleep problems. The method involves deliberately breaking down an incorrect sleep pattern in order to gradually build up a new and more well-functioning sleep. In practice, this means that we reduce the time in bed to correspond only to the time we know the person is sleeping, to minimize waking time in bed. There is a lower limit for sleep restriction of five hours of sleep per night. The purpose is to build a sleep suction in the body so that when you go to bed, the body really wants to sleep. Then sleep improves faster and you get a more qualitative sleep, deep sleep, which is important for recovery. Gradually, you add on a little sleeping time for each week and build up a new sleeping pattern. Parallel to sleep restriction, you also have stimulation control, to break down the erroneous learning that the bedroom may be conditioned with discomfort. If the patient has not fallen asleep within 20 minutes, they should step up and do something else until they feel tired and then go back to bed.
-We also teach relaxation and how to handle any stressful thoughts, says Lina Johansson. Sleep restriction and stimulus control are the biggest and most effective parts of the treatment. As a psychologist, I know that KBT is well suited for specific sleep problems, as it is often a limited problem and where it fits well with a clear and limited treatment.
There are some restrictions to this form of treatment; for example, in chronic and severe pain problems that make it difficult to sleep, Restless legs, suspected sleep apnea, severe psychiatric problems, uncontrolled diabetes or epilepsy. If you have irregular working hours in the form of night shifts, treatment can also be difficult to perform.
Week 1: Digital mapping of the patient’s sleep (diary). Start-up conversation with a legitimate psychologist.
Week 2: Introduce sleep restriction based on the Sunday diary and discussions with a legitimate psychologist.
Week 3: Help with different strategies and problem solving. Talk to a legitimate psychologist.
Week 4: Help about thoughts that arise. Talk to a legitimate psychologist.
Week 5: Finishing and planning for the future. Reflections and conversations with a legitimate psychologist.
Clinical Studies on Learning to Sleep
There are clinical studies showing that Learning to Sleep works in sleep problems. In one study, patients had to fill out a form before the treatment and another form after completion of treatment.
-94 percent got a significantly better sleep and that is a very good result, says Lina Johansson. My experience is that the majority of people are helped and perhaps the most important effect is that people get a sense of security in what they can do to promote their sleep and that they have a routine to come back to, even if setbacks occur. It is known that increased stress affects sleep negatively and with our opportunity for constant connection and stimuli it is no wonder that many young people have problems. Unfortunately, I think sleep problems are increasing in the population and are shrinking in age.
If you are under the age of 18 and have sleep problems, you should primarily contact your health care center who can refer you further if needed.
-For me, it feels incredibly satisfying to work with sleep problems, when you see clear results relatively quickly, says Lina Johansson. It is fantastic fun to help others and see how grateful they are of regaining energy and desire again.