Margie Gale, a Mental Health Clinical Nurse Specialist in Vanderbilt's Work/Life Connections-EAP, talks about a 5-step evidence-based treatment for problems with sleep called Cognitive Behavioral Therapy for Insomnia (CBTI).
Rosemary Cope: Welcome to this edition of the Vanderbilt Health and Wellness wellcast. I'm Rosemary Cope with Work/Life Connections. I am here today with my colleague, Margie Gale. Margie is a Mental Health Clinical Nurse Specialist with over 30 years of nursing experience. Many of us experience trouble sleeping at one time or another. But if sleeping problems are a regular occurrence and interfere with your daily life, you may be suffering from a sleep disorder. They can take a serious toll on your mental and physical health, but you don't have to live with a sleeping problem. Cognitive behavioral therapy for insomnia, sometimes called CBTI, is an effective treatment for chronic sleep problems. Margie, can you tell our listeners what CBTI is and how it works?
Margie Gale: Cognitive behavioral therapy for insomnia is an approach to helping people with sleep. It is a five-session clinical protocol that has been well researched and is accepted by most sleep professionals as well as Harvard Medical School and University of Stanford, which had the first sleep center, and it outlines a course of educating people about the facts about sleep and then teaches a group of skills that allows people to apply them to follow what I like to call "The Laws of Sleep."
Rosemary Cope: How does that work?
Margie Gale: A person comes in and has an assessment so that we screen out any medical problems that may be attendant, which are ... usually people have already done that before they come in, but if we need to, I will refer people. I always recommend that people have a primary care provider for sleep or for any reason. That's a first step and as I go through, I get a portrait of how they have trouble sleeping. Is it sleep onset? Do they wake up at night? Are there distractions? For people here at Vanderbilt, are they working the night shift? We have lots of night shift workers. And we gather that information and then we begin a plan with session one of teaching about the facts about sleep.
Rosemary Cope: Session one is the facts about sleep. What are the other sessions?
Margie Gale: So, it's not that we are just teaching facts about sleep and you are just supposed to get your mind straight, but as we do that, we make it very simple to ... people can either use paper or use an app, and actually the app was highlighted in last year's "Go for the Gold" video, "Rest for Success." The CBTI-Coach was developed by Stanford University Medical Center in conjunction with the U.S. Department of Defense to help our veterans who have sleep problems. So, it was already paid for by your taxes and people use either one or the other, and then after one week of using that, and they don't have to be perfect and get the data every single day, but having information. We, here at Vanderbilt, we know we use data to inform what we develop and plan and do next. It is very helpful. The person comes in, brings their information, and I use a calculator and we do number crunching. If the person works the night shift, we actually make a picture on an Excel spreadsheet and get a picture where people go, "Oh, that's my sleep," and they kind of have an "ah-ha" moment, and we begin to plan from there, shifting how they are sleeping and how they use their bedtime but also then developing and teaching them very specific skills. This is a very skill-based program. It doesn't mean you have to be perfect, but everyone can learn the skills, but they need to know what they are. The research has now been done. A book by the person, the sleep psychologist who trained me in Boston at Harvard, is Greg Jacobs, who wrote the book, Say Goodnight to Insomnia, it's all evidence based, but I do recommend people can read that but they probably want some help to go along with it. We learn skills and slowly over time that really helps people get better and better. It breaks the cycle of difficulty sleeping.
Rosemary Cope: Wouldn't it be easier for me to just take a pill?
Margie Gale: People have often tried that and what we have found is there is almost no medication that helps with sleep in the same way that working within what we already know about the biology and the research about sleep. That gives us the best program whatsoever. However, there really is a place for medication to break up the cycles of sleep. That's one of the other reasons why I highly recommend that people get a primary care provider so that should they want to use some of those non-addictive medications that could help them occasionally or to break it up at the beginning, they get success, we begin to look at the numbers of how they are sleeping more effectively, more efficiently. That gives them hope. They get excited about it and they start sleeping better and better and then they can begin to wean themselves off of the medication under the direction of their medical provider, be it a physician or a Nurse Practitioner.
Rosemary Cope: Well, that sounds hopeful. Does CBT work for everybody?
Margie Gale: It pretty much works for most people. I actually was trained in Boston six years ago and have worked with people from every position here at Vanderbilt and it has been very beneficial. I would say that we have figured out solutions for every person who has come to me so far.
Rosemary Cope: Excellent. So, how long does it take for me to change my sleep patterns?
Margie Gale: Sometimes people can get improvement within a couple of weeks and especially if a person is suffering. So, I tell people - suffering is necessary in life, but misery is optional. When somebody is really miserable, we try to break it up with some medication and then work on the skills that opens up that door to learning some new things, and then they can wean themselves off the medication, but within two weeks to three weeks, people find some improvement. If they have had many years of having difficulty, it may take a little bit more time. We are getting ready ... another counselor here who has also gotten trained in CBTI, Maggie Reynolds, we are offering a new course for a group of people to make it more accessible. You can call our office and ask if you want to begin to get on a wait list. And it's, of course, no charge because we are a benefit to Vanderbilt.
Rosemary Cope: Excellent idea. If I want to know some more about CBTI, are there websites or other resources where I can get some information about that along with maybe considering this great course?
Margie Gale: The first thing I would do is watch that "Go for the Gold" video that is still online called "Rest for Success" that was put out with Health and Wellness and Health Plus. At the end it has some resources, some reading, and the apps, but I would also recommend that a person, if you are serious ... we are going to be sleeping, hopefully, seven to eight hours and that drives the other 16 hours. Get Greg Jacob's book, Say Goodnight to Insomnia. Try the app, CBTI-Coach, and call us or send us messages. We are here to help people out because we have found the research tells us some really good approaches to dealing with sleep. Don't suffer.