Wellness: Don’t Hit Snooze on Clients’ Sleep Struggles
Social Work and Insomnia Treatment in the Digital Age
When it comes to sleep issues, clinicians commonly defer, delay, or even forget to address treatment options with clients. But social workers can immediately leverage digital modalities to bolster efforts to ameliorate clients’ sleep disturbances, thereby improving their overall mental health outcomes.
In 1943, Maslow published A Theory of Human Motivation,1 creating what’s now known as Maslow’s Hierarchy of Needs. His work established the precedent that priority should be given to human physiological concerns before addressing additional presenting needs such as for belonging, love, security, and self-actualization. Many social workers focus on the physiological elements of food, water, shelter, and temperature, but we tend to hit snooze on the significance of sleep, which is another basic human need.
Technology may interrupt sleep, but it also offers resources for improving it. For better and worse, the COVID-19 outbreak in 2019 and its continued longevity have resulted in more frequent use of technology, especially in social work practice. A positive outcome has been a robust influx of digital mediums, interventions, and opportunities for social workers to help clients achieve their goals and their (literal) dreams. As a profession, we must continue to rise to greet technology, advocate for better access to it, improve overall digital literacy, and keep our eyes wide open to the permeating influence it has, and will increasingly have, in our work and in our clients’ lives. Digital access and literacy will undoubtedly increase resources for our clients and energize best practice efforts.
The Need for Zzzzs
Social work is a unique profession in that tethered to our conceptual lens is systems theory, and we understand that sleep is tied to all other elements of being alive. Furthermore, Espie and colleagues3 reflect that we can counter the belief that sleep issues are solely nighttime issues; the nighttime experience of insomnia dominos into our more active waking hours. Sleep issues affect our physical, mental, and behavioral health. According to the National Institute of Health, chronic long-term inadequate sleep can influence the risk of hypertension, diabetes, obesity, depression, heart attack, and stroke. Sleep issues can lead to mood disorders, increased stress, fatigue, and reduced brain performance (ie, concentration and decision-making).
Consideration should be given to rule out medical origins, such as sleep apnea or thyroid issues; this can be achieved by encouraging patients to discuss these problems with their primary medical providers, which may lead to blood tests, sleep studies, and other assessments.
Technology and Digital Treatment for Insomnia
What Social Workers Can Do
With knowledge about digital technology, you can provide Patty with self-guided sleep resources that can also help with anxiety. The free CBT-i Coach smartphone application is a digital resource you recommend. It’s the outcome of a collaboration between the VA’s National Center for PTSD, Stanford School of Medicine, and Department of Defense’s National Center for Telehealth and Technology. You schedule your first follow-up with Patty at your next appointment in two weeks.
Patty returns home and downloads CBT-i Coach. She explores the “Learn” section and quickly identifies one perpetuating factor of her sleep issues—caffeine. Patty often relaxes after dinner with a cup of coffee. She knows that caffeine is a stimulant, but she didn’t realize its effects last for several hours. As recommended in the app, she used the “Tools” section to set a daily reminder for caffeine intake. Patty also tries the “Schedule Worry Time” and “Breathing Tool.”
At your next appointment, Patty reports an improvement in her ability to fall asleep much faster and feel sleepier at bedtime (likely due to less caffeine remaining in her body). A bonus is exposure to anxiety management tools. The CBT-I app’s digital resources, in general, often have tools that help with other problem areas.
Resistance and Barriers
Professional Collaboration Network for Treating Sleep Issues
— Catlin Denis, LCSW, RYT, lives in Houston, and is a clinical social worker at the VA. He is a DSW student at the University at Buffalo, SUNY, and moonlights as a yoga and cycle instructor. His broad and varied research interests include barriers to adjunctive therapies, the intersection of addiction and insomnia, and technology in social work practice.
Acknowledgments: Thanks to Melanie Sage, PhD, MSW; Patricia Huber-Villano, LCSW; and Denise Link, LCSW, for their review and input.
Self-Directed Internet Course: www.thiswayup.org.au/programs/insomnia-program
VA Self-Led Internet Course: www.veterantraining.va.gov/insomnia
Amazon: Halo Rise sleep tracker
Meta Quest 2 Application: TRIPP Drift
Audiobook: Why We Sleep by Matthew Walker
Netflix: Headspace Guide to Sleep
2. Common sleep disorders. Cleveland Clinic website. https://my.clevelandclinic.org/health/diseases/12119-insomnia. Updated December 23, 2020.
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