Sleep in everyday life

Domain XV · Nature, philosophy, social & rites of passage

What it is

Sleep is an everyday health behaviour, not a psychotherapy. This guide covers what a psychotherapist does with it: asking about sleep as part of routine care, assessing insomnia and spotting other sleep disorders, giving accurate public-health information, delivering cognitive behavioural therapy…

Format

• Format: a few questions at intake and at review.
• NICE describes Sleepio as weekly interactive CBT-I sessions plus sleep diaries, designed to be completed in 6 weeks.

Who practises it, and how they are trained or regulated

• CBT-I is typically four to eight sessions, individual or group, delivered by certified health professionals, mainly clinical psychologists or psychotherapists.
• How change happens, as the CBT-I literature frames it: sleep is regulated by sleep drive and the body clock, and insomnia is kept going by learned arousal in bed, compensatory habits (more time in bed, irregular hours, napping, lying in) and anxious beliefs about sleep. Behavioural components restore the bed as a cue for sleep and consolidate sleep; cognitive components reduce sleep-related worry and unhelpful…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• minimising near-misses. It is working when sleepiness is monitored and acted on.
• pressure to start everything at once. It is working when the client can say what the plan is and why.
• imposing one cultural ideal of sleep. It is working when the plan fits the client's actual life and values.
• using acceptance as a new technique to force sleep. It is working when the client struggles less with nights.
• the same cautions as sleep restriction. It is working when diary and severity scores improve over the shorter course.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.