Robert Meganck Illustration
All Shannon Marston wanted to do was sleep. A wife, the mother of a 10-year-old boy and a third-grade reading and science teacher, she had been struggling to sleep through the night for about five years. By last summer, she was sleeping only in rare patches.
"I was probably awake more than I was asleep during the night," says Marston, 39, of Lawrenceville. She would wake up crying out of sheer exhaustion and often stay awake watching the clock. After a negative thyroid test and failed attempts with sleeping pills, she was referred to the VCU Center for Sleep Medicine in October. After being observed overnight, she was diagnosed with severe insomnia, a disorder that affects about one in three Americans.
Insomnia can result from poor sleep habits — sometimes developed during a crisis or period of stress — or a medical condition such as sleep apnea, or even from a genetically inherited trait. The effects range from mild sleeplessness (three or more times per month) to daily, severe insomnia. "Their brain doesn't generate normal sleepiness and does not allow them to sustain sleep," says Dr. David J. Leszczyszyn, director of the VCU Center for Sleep Medicine.
Marston was referred to Dr. Bruce Rybarczyk, Ph.D., director of VCU's clinical psychology program. "He and I both agreed that I should not be taking medication to go to sleep, that it should be something that comes natural," she says.
Rybarczyk specializes in treating insomnia through cognitive behavioral therapy (CBT), a medicine-free approach that has emerged in the past two decades. Though proven successful (about 70 percent effective nationwide for complex insomnia patients), Rybarczyk says the treatment is not widely practiced.
Marston agreed to try the treatment strategy, which began with removing all sleep medications and keeping a detailed sleep diary. With cognitive behavioral therapy, patients are then sent into "sleep boot camp," which prescribes voluntary sleep restriction. After seeing the average hours of sleep from a patient's diary, sleep is limited to that number of hours. Rybarczyk says this allows patients to reach levels of drowsiness they have not experienced in a long time.
Marston says her second week in sleep boot camp was brutal, but she saw results. Rather than tossing and turning, she would instantly fall asleep from her set hours of 1 to 6 a.m. Each week, Rybarczyk prescribed an additional half hour of sleep.
She also was instructed to use her bed strictly for sleep. "We do not permit TV in the bedroom," Rybarczyk says. Marston says she stopped reading and grading papers on her bed. Four to five weeks later, she was falling asleep quickly and sleeping through the night. "I just felt like I was in heaven," she says.
Until about five years ago, insomnia was thought of as a secondary disorder, the direct effect of something else going on within the patient. "What we found is quite interesting, that while [something] may have triggered the beginning of insomnia, as time moved on and weeks and months turned into years, the actual disorder is a behavioral one," says Rybarczyk, who has personally battled insomnia.
In these cases, patients are "psyching themselves out of their ability to sleep," Leszczyszyn says, and fear trying to sleep.
Dr. Michael Polsky of Pulmonary Associates of Richmond, which has its own Sleep Disorders Center, says that although conditions such as sleep apnea (when a person's upper airway collapses, obstructing breathing) must be treated medically, CBT is often an effective option. Treating insomnia without medication "is almost always better, but it needs to be embraced by the patient."
And with CBT, if patients have a rough patch in their sleeping, they have the tools to correct it on their own. "We check with people a year and two years down the road," Rybarczyk says, "and 90 percent of that group is still going strong two years out."
Five Tips for Better Sleep
- Stay on schedule. Go to bed and wake up about the same time — even on weekends.
- Move it. Regular aerobic exercise (except near bedtime) improves sleep quality and helps you doze off quickly.
- Tune out. Don't watch TV, do paperwork or eat snacks in bed.
- Last call. Stop drinking caffeine after noon and avoid alcohol near bedtime.
- No naps. Save your sleep for night.