Rybarczyk’s early work, prior to joining VCU, tested CBT in patients with arthritis, heart disease and lung disease. “But chronic insomnia starts with a trigger but then worsens and perpetuates by the same mechanisms involved in all insomnias, essentially a disconnection of the natural sleep system.” “We thought that the patients already contending with a primary medical or psychiatric disorder would not benefit from CBT because we had to resolve the triggering problem – be it night terrors of PTSD, or pain in arthritis, or chemotherapy side effects for cancer patients,” Rybarczyk said. ![]() ![]() At that time, researchers believed that insomnia present within another medical disorder or psychiatric disorder was entirely different than when insomnia occurred in the context of another medical or psychiatric disorder. Much of the early CBT-I-related research focused on chronic insomnia in the otherwise healthy population. Before patients begin the intervention, they gain an in-depth education about the sleep system – something Rybarczyk refers to as the “owner’s manual for sleep.” The treatment, which involves extensive talk therapy has several treatment components, including an initial reduction in sleep to increase sleep drive and retrain normal sleep.ĬBT-I also serves as a method for eliminating time spent in bed while awake to weaken the association between being in bed and having anxiety about not falling asleep. In the 1990s, several sleep experts across the country, including one VCU faculty member and one VCU alumni, made significant strides in the development of CBT-I, a drug-free approach to the treatment of insomnia. The VCU professor is o ne of only two Richmond-area behavioral sleep medicine specialists. Nationally, there are approximately 300 certified or trained clinicians in behavioral sleep medicine and the need for more professionals in the specialty is dire. We need more education for health professionals, more easy to access treatments for more straightforward cases and behavioral treatment specialists for more complex ones, and the help of primary care professionals to make the referrals on a regular basis,” he said.Īccording to Rybarczyk, the development of behavioral sleep medicine as a specialty has only taken place in the past 10 years. “People are in desperate need of help of behavioral treatment when they have chronic insomnia. Through the VCU Center for Psychological Services and Development and his private practice, he and his students treat patients with chronic insomnia using CBT-I. But, here we have sleep – something we spend a third of our lives pursuing that is as essential as air and water – yet we’re so far behind understanding sleep problems,” said Bruce Rybarczyk, Ph.D., clinical psychologist and leading insomnia expert in the VCU College of Humanities and Sciences. ![]() “It is amazing how much knowledge we have gained of in other even more complex systems of the human body, such as gastrointenstinal and cardiovascular functioning, and how to fix problems in those systems when they occur. Helping pave the way is a team of researchers and alumni at Virginia Commonwealth University, many of which have led some of the pioneering work in sleep research and contributed to the development of new avenues for treatment. The beginning of the field of sleep medicine is often associated with the discovery that there are two distinctly different types of sleep – non-dream sleep and dream sleep, which is also known as REM sleep.Įxperts are only now beginning to ask scientific questions and dig deep to advance the knowledge of behavioral sleep medicine, a new discipline that focuses on modifiable behavioral and psychological factors in sleep disorders. ![]() The science of sleep is a relatively new field and there remains much to explore. Cognitive-behavioral therapy for insomnia (CBT-I) may not be a well-known approach for the treatment of the sleep disorder, but that may soon change as research advances the understanding of its benefits and effectiveness.
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