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SLEEP
MEDICINE

improve sleep — low hang- state to allow the subconscious mind to surface and take charge. The
ing fruit for the frustrated theory is that if you relax the body enough, the conscious mind will
provider. relax as well and allow the subconscious to emerge. The goal is to allow
CBT-I (Cognitive Be- access to the source of traumas and troubling thoughts, and to implant
havioral Therapy for Insom- new ideas that are more likely to take root. This process takes practice
nia) is a well-recognized and the clients develop variable skills, but it can be quite useful for
intervention, with ample sleep issues. The key is to train the subconscious to respond to a simple,
evidence-based research but specific cue, called an anchor, that can be called on in the midst
documenting positive out- of the crisis. This may be as simple as placing the tips of one's index
comes. Typically requiring finger and thumb together in an "OK" sign. Patients are always able
on average six sessions for to control and remember the experience; they are able to follow only
efficacy, it is especially ben- the suggestions of the hypnotherapist that they see compatible with
eficial for those whose sleep their goals of therapy.
disturbances are due to anx- Neurofeedback (NF), a subcategory of biofeedback, involves training
iety. It is divided into our brain waves to respond appropriately to a given auditory or visual
chronic vs circumstantial, as stimulus. The stimulus, a video or music, is used as positive reinforce-
the therapeutic approach ment when EEG activity corresponds to the training goal. The with-
and goals are distinct. drawal of the positive stimulus is used as negative reinforcement for
Acute CBT-I, when sleep is divergent brainwave function. Typically, between one and 10 EEG elec-
disrupted by a major life trodes are placed (you do not get your head shaved!) depending upon
stressor, must deal with the the therapist's training. Slow waves (11-15 Hz) are the desired level of
grief and trauma simultane- brain activity. Using hypnotherapy as an enhancement to NF – using
ously with the sleep disor- the hypnotic suggestions as the stimulus for appropriate brain wave ac-
der. If the condition tivity – has led to enhanced outcomes over either therapy alone.
becomes chronic, the ap- Acupuncture or acupressure and related techniques have been used
proach is different. Coun- for millennia for sleep disorders. The literature is mixed, as many of the
terproductive thoughts are studies involve concomitant therapies with Traditional Chinese Med-
explored by a series of prob- icine (TCM) or continuance of pharmacologic interventions. For a
ing questions, which attempt to address the emotional content behind troubled patient, when all else has failed, it may be an avenue that
the troubling thoughts. The goal is to counter catastrophizing thoughts proves valuable to explore. Commentary on patient outcome studies
like, "I'll never fall asleep," or "Tomorrow is going to be a terrible day if I indicates that as many "swear at it" as those that "swear by it."
don't get some sleep," with a more positive outcome from a given thought Goodnight. I'll see you in the morning!
process. The intent is to reframe the cognitive scenario to distance the
psyche from fixed expectations of failure to affect a different outcome. I interviewed Margaret Erben, MA LPC and licensed hypnothera-
"You have to change the thinking to change the results.” CBT-I can also pist, and Charlotte Widdick, NP of Root Causes Functional Medicine,
be useful for those attempting to discontinue benzodiazepines and for this article whose contributions were invaluable and essential. I can-
other pharmacologic interventions. This is best accomplished by a not repay the debt of gratitude I owe them.
proactive approach with several sessions before attempting the tapering
process to familiarize the patient with CBT-I to promote a successful Tim Hlavinka, MD, is the Medical Director of Vidamor Medical
outcome upon withdrawal. and has been a member of the Bexar County Medical Society for
It is ironic that medications for sleep fall under the broad category three decades. The father of five and grandfather of four, he firmly
of "hypnotics." Since the days of Franz Mesmer, the utility of inducing believes that the power of collegiality among physicians as great potential
trance-like states for therapeutic interventions has been known, long to bring us lasting and effective changes in healthcare. Dr. Tim is anxious
before modern pharmacology made contributions. Far evolved from to hear your stories.
the "swinging pocket watch" techniques of hucksters and frauds, mod-
ern hypnotherapy uses a variety of techniques to induce a trance-like

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