Marc Schoen, Ph.D.
Assistant Clinical Professor, UCLA's School of Medicine
Hypnotherapy for sleep disturbance is commonly believed to be driven by the power of suggestion -- where suggestions are given to the client to feel tired or sleepy at bedtime. Yet, hypnotherapy can be substantially more than direct suggestions for sleepiness. In its greatest form, hypnosis has the ability to recondition the entire sleep process. It can be used to retrain the client's reactions to negative or intrusive thoughts, early awakenings, stress and even the tendency to resist sleep.
Common concerns expressed by clients seeking hypnosis for insomnia is that they might be resistant to hypnosis and will dislike relinquishing control, or that they will not be able to sit still or quiet their mind enough to benefit. The apprehensions they hold about hypnosis are commonly the very same dynamics that are operative in impeding their sleep process. But this is where hypnosis particularly shines, for the process of embracing the trance state is parallel to the welcoming in of the sleep state. Rather than being obstructive to the hypnosis treatment, these sleep and hypnosis resistances now become part of the treatment -- rather than remaining outside of it. The goal is not to extinguish these unconscious oppositions, but instead to alter the client's reaction to them. In this way, these resistances become sleep enhancing rather than sleep disruptive.
With our culture's growing sense of having to be "on" 24 hours a day, the pressures of remaining alert, attentive and awake can be suffocating. There is often a pressure to delay or resist fatigue and sleepiness in order to complete our work demands. The unintended consequence is that we are teaching the mind and body to resist its natural rhythms. When it is time to go to bed and switch gears, the mind and body have been trained to resist letting go to the sleepy feeling, a process that I call sleep resistance. Over time, the process of going to sleep becomes a signal to wake up, and increasingly, associated with significant frustration and anticipatory anxiety.
In addition to developing a healthy sleep hygiene routine, hypnosis can be used to restore the client's ability to switch gears from a cerebrally active mind that resists sleep to one that is receptive to the sleep process. In this case hypnosis is used to influence both the physical and mental experience of going to sleep. By using hypnosis to modify the wind-up associated with the pre-sleep ritual, the routine is now conditioned to elicit a state of relaxation.
The pre-sleep rituals -- such as a nightly shower, brushing teeth, television or climbing into bed -- are now altered to facilitate a gradual shifting from an alert to a relaxed or sleepy state. Additionally, hypnosis can be helpful in restructuring negative or distracting thoughts; thoughts that are sleep obstructive can be transformed and conditioned to be sleep facilitative. Since it is difficult to quell negative or distracting thoughts, it is possible to imbue them with either a neutral or a soporific effect whenever the client thinks about them.
Pertinent to the issue of intrusive bedtime thoughts is the common misperception that it is imperative to silence conscious thoughts in order for the sleep process to unfold. In actuality, the sleep process unfolds even in the presence of conscious activity. By giving the client practice going in and out of the hypnotic trance while entertaining intrusive thoughts, the client learns to experience consciousness as part of the sleep process rather than outside of it.
The fact that the hypnotic process can mimic the sleep process has particular value in dealing with the early awakening form of insomnia; the condition in which individuals find it difficult to return to sleep after awakening in the middle of the night. To address this condition, hypnosis is used to induce a sleepy relaxed state in the client. While in this relaxed zone, the client is repeatedly awakened from the sleep like trance, a process which duplicates the early awakenings at night time. Next, by following these interruptions with a subsequent induction into the hypnotic sleep state, the wake-ups now become a stimulus for returning to sleep. Thus, rather than the wake-ups being associated with protracted periods of non-sleep and frustration, they are now associated with another opportunity to return to sleep.
I also find it helpful to record a hypnosis CD for clients to listen to at bedtime. This CD is comprised of those suggestions that have been facilitative in inducing a hypnotic sleep state in my meetings with the client. This CD has several goals. First, it helps the client disengage from an active cerebral mind and physical state to a frequency that is more conducive to sleep. Second, the CD serves as a transitional object, extending the hypnosis interventions to the client's sleep process outside of our sessions. Third, as the CD is continually paired with falling asleep, the hypnotic CD over time becomes a stimulus for precipitatingsleep.
Since a number of clients begin treatment with a heavy reliance on sleep medications, hypnosis can be a valuable tool in altering their physical and psychological dependence on these medications. Therapy sessions can be used to give clients experience in becoming relaxed and sleeping without medications. This can boost their confidence in their own inner resources while lessening their psychological reliance on external solutions.
Further, hypnosis can influence the client's physical dependency on sleep medications. Hypnotic suggestions can be aimed at affecting how the client reacts to the sleep medications. In this scenario, suggestions are given so that the act of taking less of a medication is now experienced as taking more of the medication. Gradually, this procedure can be utilized to reduce the amount of the medication required by the client. Finally, the power of the sleep medications can be conditioned and transferred to the sleep CD, which allows the sleep CD to exert more power over the sleep process.
For most individuals, reconditioning the sleep pattern can happen in as little as three meetings, while five to seven meetings are more typical. In those cases where there is a previous trauma related to sleep or a heavy dependency on multiple sleep medications, more extensive treatment may be necessary. Additionally, hypnotic interventions tend to work better for more acute insomnia episodes as opposed to chronic insomnia that emanates from childhood or early adulthood.
In summary, since so few visits are necessary to determine whether hypnotic interventions can be a productive intervention for insomnia, hypnosis is worth considering where more traditional forms of intervention have not been successful. For cases in which it is evident that the insomnia is a function of negative conditioning, hypnotic interventions may be of particular value due to their powerful reconditioning properties.