The Holistic Treatment of Sleep Disorders: Complementary Therapy Concept for Physicians and Psychotherapists

Foreword
Preface
Contents
1 Healthy Sleep
	1.1	Why do We Sleep?—The Evolution Theory
		1.1.1	The Evolutionary Development of Human Sleep
		1.1.2	The Evolutionary Protective Functions of Sleep
	1.2	The Circadian Process
		1.2.1	Homeostasis—Balancing of Fatigue and Wakefulness
		1.2.2	The 2-Process Model
			Background
		1.2.3	Light as a Pacemaker
		1.2.4	Temperature Course and Heat Regulation
		1.2.5	Chronobiology
			Break Times
		1.2.6	The Ultradian Rhythm
	1.3	How do We Sleep?
		1.3.1	The Physiology of Sleep
			Sleep Architecture
			Brain Activity During Sleep
	1.4	The Functions of Sleep
		1.4.1	Regeneration
		1.4.2	The Synaptic Homeostasis “tidying up and Making Room for New Ones”
		1.4.3	Memory Formation
		1.4.4	Emotional regulation
		1.4.5	Immune regulation
		1.4.6	Metabolism
		1.4.7	Calibration
		1.4.8	The Function of Dreams
	1.5	Hormones that Determine Sleep
		1.5.1	Adenosine
		1.5.2	Melatonin
		1.5.3	Cortisol
		1.5.4	Adrenaline and Noradrenaline
		1.5.5	Serotonin
		1.5.6	Dopamine
		1.5.7	Orexin
		1.5.8	Other Messengers
			Gamma-Aminobutyric Acid (GABA)
			Histamine
	References
2 Sleep Disorders
	2.1	Epidemiology
		2.1.1	Risk Factors
	2.2	The Origin of Sleep Disorders
		2.2.1	Mind-Body-Sleep-Dynamics©
			The Model of Mind-body-sleep Dynamics©
			Working with the Model of Mind-Body-Sleep-Dynamics©
		2.2.2	Causes of Sleep Disorders
			Psychological Causes
				Dysfunctional Cognitions
				Dysfunctional Emotions
				Dysfunctional Behavior
			Somatic Causes
			Substances
			Everyday Life and Lifestyle
	2.3	Diagnostics and Classification
		2.3.1	Diagnosis
		2.3.2	Classification
			Insomnia (7A00–7A0Z)
				Subtype Paradoxical Insomnia (Sleep Perception Disorder)
				Differential Diagnosis
			Hypersomnia (7A20–7A2Z)
				Subtype Narcolepsy
			Sleep-related Respiratory Disorders (7A40–7A4Z)
			Circadian Sleep-wake Disorders (7A60–7A6Z)
				Subtype Shift Worker Syndrome
			Sleep-related Movement Disorders (7A80–7A8Z)
				Subtype Restless Legs Syndrome
			Parasomnias (7B00–7B0Z)
				Arousal Disorder in Non-REM sleep (7B00)
					Sleep drunkenness (7B00.0)
					Sleepwalking (7B00.1)
					Pavor Nocturnus (7B00.2)
					Sleep-related Eating Disorder (7B00.3)
					Arousal Disorder in REM Sleep (7B01)
					Recurrent Isolated Sleep Paralysis (7B01.1)
					Nightmares (7B01.2)
			Sleep-wake Disorders, not Otherwise Specified (7B2Z)
		2.3.3	The Diagnostic Process
			Screening
			Anamnesis
			Questionnaires
				The Regensburg Insomnia Scale (RIS)
				The Pittsburg Sleepquality Inventory (PSQI)
				The Epworth Sleepiness Scale (ESS)
			Other Diagnostic Measures
				Diagnostics in the Sleep Laboratory
				Measuring Heart Rate Variability
				Heart Rate Variability in the Therapeutic Process
				Smartwatches, Sleep and Actitrackers
	2.4	Common Comorbidities
		2.4.1	Affective Disorders
		2.4.2	Anxiety Disorders
		2.4.3	Stress and Adjustment Disorders
			Post-traumatic Stress Disorders
		2.4.4	Obsessive-compulsive Disorders
		2.4.5	Addiction Disorders
		2.4.6	Eating Disorders
		2.4.7	Pain Disorders
	2.5	Dealing with People with Sleep Disorders
		2.5.1	Difficult Therapy Situations
			Unrealistic Goals
			The Impatient Patient
			The Patient Who Knows Everything and has Tried Everything
			The Patient Who Questions the Competence of the Therapist
			No Improvement in Well-being
		2.5.2	Common Personality Aspects in People with Sleep Disorders
			Perfectionism
			Excessive Need for Harmony
	References
3 Therapy Concept for the Holistic Treatment of Sleep Disorders
	3.1	Background
	3.2	Formal Structure and Framework Conditions of Therapy
	3.3	Development of the Disorder Model
	3.4	Modules of Cognitive Behavioral Therapy
		3.4.1	Module: Psychoeducation
			Short Overview (Table )
			Background
				Important Facts
				What Sleep Disorders are There?
				The Dynamics of Sleep Disorders
				Sleep Phases
				Awake State
					Stage I (NREM 1)
					Stage II (NREM 2)
					Stage III (NREM)
					REM Sleep
					Homoeostasis
			Procedure
		3.4.2	Module: Medications, Alcohol, and Drugs
			Overview (Table )
			Background
			Procedure
				Development of Motivation
				Possible Physical Detoxification
				Psychological Detoxification
				Aftercare
		3.4.3	 Module: Bed Rest and Sleep Restriction
			Overview (Table )
			Background
			Procedure
		3.4.4	Module: Day Structuring
			Overview (Table )
			Background
			Procedure
		3.4.5	Module: Interpersonal Social Rhythm Therapy
			Overview (Table )
			Background
			Procedure
		3.4.6	Module: Light as Therapy
			Overview (Table )
			Background
			Procedure
		3.4.7	Module: Shift Work
			Overview (Table )
			Background
			Procedure
		3.4.8	Module: Stress Management
			Overview (Table )
			Background
				Stress Type A
				Stress Type B
			Procedure
				Identification and Assessment
				Warning Signs
			Implementation
		3.4.9	Module: Sleep Hygiene
			Overview (Table )
			Background
			Procedure, Rules of Healthy Sleep
		3.4.10	Module: Stimulus Control and Psychohygiene
			Overview (Table )
			Background
			Procedure
		3.4.11	Module: Cognitive Techniques
			Overview (Table )
			Background
			Procedure in General
			Cognitive Disputation and De-catastrophizing
			Dealing with Sleep-Inhibiting Thoughts
			Controlling Rumination
		3.4.12	Module: Behavior Change
			Overview (Table )
			Background
			Procedure
		3.4.13	Module: Perfection and Control
			Overview (Table )
			Background
			Procedure
		3.4.14	Module: Paradoxical Intervention
			Overview (Table )
			Background
			Procedure
		3.4.15	Module: Sleep Deprivation—Wake Therapy
			Overview (Table )
			Background
			Procedure
		3.4.16	Module: Relaxation Techniques
			Overview (Table )
			Background
			Procedure
			Two Short Exercises on Relaxation Techniques
				Exercise 1: Quasimodo
				Exercise 2: Let your Head Hang!
		3.4.17	Module: Sexuality
			Overview (Table )
			Background
			Procedure
	3.5	Nightmare Therapy
		3.5.1	Background of Nightmare Therapy
		3.5.2	Preparation of the Nightmare Therapy
		3.5.3	Module Nightmare Variant 1: Solution of the Dream Conflict in the Waking State
			Overview (Table )
			Background
			Procedure
		3.5.4	Module Nightmare Variant 2: Nightmare Modification
			Overview (Table )
			Background
			Procedure
		3.5.5	Module: Dream(-Trauma) Therapy with Eye Movement Integration (EMI)
	3.6	Third Wave of Behavior Therapy
		3.6.1	Background
			The Behavioral Phase
			The Cognitive Turn
			Third Wave of Cognitive Behavioral Therapy
		3.6.2	Module: Acceptance-Commitment-Therapy of Insomnia (ACT-I)
			Overview (Table )
			Background
				Basic Assumptions of ACT
				Why is ACT so Helpful?
			Procedure—The ACT-Matrix
		3.6.3	Module: Mindfulness
			Overview (Table )
			Background
			Procedure
				Four Short Mindfulness Exercises
		3.6.4	Module: Hypnotherapy
			Overview (see Table )
			Background
			Procedure
				Rapport
				Focusing
				Trance Induction and Deepening
				Pacing
				Leading
				Reframing
				Reorientation
	3.7	Mind-Body-Medicine
		3.7.1	Mind-Body Therapy
		3.7.2	Modules of Body Psychotherapy
			Overview (Table )
		3.7.3	 Module: Yoga-Psychotherapy
			Overview (Table )
			Background
			Diagnosis with Yoga
			Therapy with Yoga
		3.7.4	Module: Meditation
			Overview (Table )
			Background
			Procedure
		3.7.5	Module: Sleep-Promoting Nutrition
			Overview (Table )
			Background
				The Microbiome—The Gut Flora
				Melatonin, Nutrition and Digestion
				Food = Nutrition
				Fasting for a Better Sleep
				Therapeutic fasting
		3.7.6	Module: Movement and Sport
			Overview (Table )
			Background
				Cortisol and Movement/Sport
			Procedure
	3.8	Manual Procedures
		3.8.1	Background
		3.8.2	Hydro- and Thermotherapy
		3.8.3	Acupuncture
		3.8.4	Marmatherapy
	3.9	Neurotherapy
		3.9.1	Therapy Module: Eye Movement Integration (EMI)
			Overview (Table )
			Background
				EMI in Insomnia
				EMI in Nightmares
			Procedure for Eye-Movement Integration
				Preparing the Patient
				Conducting the EMI Session
				Post-Processing
		3.9.2	Module: Polyvagal Therapy
			Overview (Table )
			Background
				Therapeutic Possibilities
				Therapeutic Means of Polyvagal Theory
			Procedure
	3.10	Pharmacotherapy: Opportunities and Risks
		3.10.1	Benzodiazepines
			Overview (Table )
			Background
		3.10.2	Barbiturates
		3.10.3	“Z-Substances” (Non-Benzodiazepines)
			Overview (Table )
			Background
		3.10.4	Melatonin
			Overview (Table )
			Background
		3.10.5	Antihistamines
			Overview (Table )
			Background
		3.10.6	Antidepressants—Off-Label as Hypnotics
			Overview (Table )
			Background
		3.10.7	Neuroleptics—Off-Label as Hypnotics
			Overview (Table )
			Background
		3.10.8	Anxiolytics
		3.10.9	Cannabinoids (Tetrahydrocannabinol, THC)
			Overview (Table )
			Background
		3.10.10	Orexin Receptor Antagonists
			Overview (Table )
			Background
	3.11	Phytotherapeutics
		3.11.1	European Medicinal Plants
			Background
		3.11.2	Ayurvedic Medicinal Plants
			Background
		3.11.3	Herbal Medicines from Traditional Chinese Medicine (TCM)
			Background
	3.12	Dietary Supplements
		3.12.1	Background
		3.12.2	Cannabidiol (CBD)
			Background
			Application and Intake of CBD Oil
	3.13	Placebo
	3.14	Relapse Prevention and Follow-Up
		3.14.1	Relapse Prevention
		3.14.2	Aftercare
	References
Case reports