Insomnia Treatment: Training the Body for Better Sleep

UH to offer Cognitive Behavioral Therapy for Insomnia (CBT-I) treatment

Innovations in Pulmonology & Sleep Medicine - Winter 2019

Insomnia disorders are common, affecting as many as 30 percent of adults nationwide, and often co-exist with other medical conditions, such as cancer, cardiopulmonary disease and chronic pain. Adults who have insomnia are also at greater risk for developing diabetes, metabolic syndrome and heart disease.

 Samina Ahmed, PsyD

Because individuals suffering from insomnia have trouble falling asleep, staying asleep or waking up too early, hypnotic medications, such as Ambien, may help. But they can have adverse mental and physical effects, particularly in older adults — who experience insomnia at twice the rate of younger adults. Older individuals are also more likely to have comorbidities and to take other drugs for these conditions.

Cognitive Behavioral Therapy for Insomnia, or CBT-I, has been the gold standard for insomnia treatment for more than a decade, says Samina Ahmed, PsyD, Adult Psychology, University Hospitals Cleveland Medical Center.

“It’s as effective as medications in the short term, and more effective than medications on a long-term basis,” Dr. Ahmed says. “Furthermore, it’s cost effective, there are no side effects and there are no drug interactions to worry about.”

As long as patients are motivated and willing to put in the work, Dr. Ahmed says, CBT-I is at least 70 percent effective in restoring sleep and improving insomnia symptoms.
CBT-I is similar to cognitive behavioral therapy for anxiety and depression, with adaptations specifically for insomnia. For example, patients with insomnia have come to associate their bed as a place to worry and fret. CBT-I teaches them how to break that association and to retrain their body and mind to see the bed as a place for sleeping, says Dr. Ahmed. Patients typically only need four to six sessions to see results.

“It’s not meant to be long term,” Dr. Ahmed says. “I give patients tools. They go home and practice, and they see progress.”

BRINGING NEW EXPERTISE TO UH

Sleep medicine has been a consistent area of interest for Dr. Ahmed during her education and training. She completed a fellowship in behavioral sleep medicine at the Cleveland Clinic after her residency at the Miami VA Hospital.

“As a health psychologist, I work with patients with chronic medical conditions and co-morbid depression and anxiety, which tends to happen when someone is newly diagnosed with cancer or another serious condition,” Dr. Ahmed says. “The common theme, regardless of medical illness, is difficulties with pain management and sleep management. That got me looking into more effective treatment approaches for sleep medicine and what I could offer my patients.”
Despite the effectiveness of CBT-I, many patients do not have access to this therapy. There are simply not enough trained providers in medical and community settings to meet the need. That has now changed for patients at UH.

“I joined UH as the network’s first ever behavioral sleep specialist in hopes of making CBT-I treatment more accessible to a broader population,” Dr. Ahmed says.

REFERRING PATIENTS for CBT-I

Dr. Ahmed is accepting referrals and sees patients on the main campus (Bolwell) and at UH Chagrin Highlands Internal Medicine (Suite 3100), UH Twinsburg Heart health and Vascular Institute (Suite 203) and Medina Heart health and Vascular Institute (Suite 140).

“If you have a newly diagnosed patient with insomnia and medications are not an option, I would be an appropriate referral,” she says. “Likewise, patients with long-standing insomnia who have not responded well to medications, or whose medication needs have increased, may want to consider a behavioral treatment approach.”

Dr. Ahmed can also help older adults who need to discontinue using hypnotic medications or patients with additional sleep difficulties, for example, those with sleep apnea who are using a CPAP and exhibiting signs of insomnia or poor sleep habits.

“I can work with them in terms of adjustment and adherence to CPAP, and address any insomnia issues they might be experiencing,” she says.

Dr. Ahmed is not in central scheduling. To make an appointment for a patient, call Robin Ousley at 216-844-1867. For more information about CBT-I, contact Dr. Ahmed at 216-983-5680.