Winter 2017

What is Insomnia

Insomnia is a common sleep disorder that can make it hard to fall asleep, hard to stay asleep, or cause you to wake up too early and not be able to get back to sleep. It is frequently accompanied by fatigue and impairs our functioning or causes distress. People with insomnia report low mood, irritability, poor concentration and memory.

What is CBT-I

Cognitive behavioral therapy for insomnia is a structured program that helps you identify and replace thoughts and behaviors that cause or worsen sleep problems with habits that promote sound sleep. CBT-I helps you overcome the underlying causes of your sleep problems.

The behavioral part of CBT-I helps you develop good sleep habits and avoid behaviors that keep you from sleeping well. Depending on your needs, your sleep therapist may recommend some of these CBT-I techniques

• Stimulus control therapy. This method helps remove factors that condition your mind to resist sleep. For example, you might be coached to set a consistent bedtime and wake time and avoid naps, use the bed only for sleep and sex, and leave the bedroom if you can’t go to sleep within 20 minutes, only returning when you’re sleepy
• Sleep restriction. Lying in bed when you’re awake can become a habit that leads to poor sleep. This treatment reduces the time you spend in bed, causing partial sleep deprivation, which makes you more tired the next night. Once your sleep has improved, your time in bed is gradually increased
• Sleep hygiene. This method of therapy involves changing basic lifestyle habits that influence sleep, such as smoking or drinking too much caffeine late in the day, drinking too much alcohol, or not getting regular exercise. It also includes tips that help you sleep better, such as ways to wind down an hour or two before bedtime
• Sleep environment improvement. This offers ways that you can create a comfortable sleep environment, such as keeping your bedroom quiet, dark and cool, not having a TV in the bedroom, and hiding the clock from view.
• Relaxation training. This method helps you calm your mind and body. Approaches include meditation, imagery, muscle relaxation and others
• Remaining passively awake. Also called paradoxical intention, this involves avoiding any effort to fall asleep. Paradoxically, worrying that you can’t sleep can actually keep you awake. Letting go of this worry can help you relax and make it easier to fall asleep.
• Biofeedback. This method allows you to observe biological signs such as heart rate and muscle tension and shows you how to adjust them. Your sleep specialist may have you take a biofeedback device home to record your daily patterns. This information can help identify patterns that affect sleep

The most effective treatment approach may combine several of these methods. Cognitive behavioral therapy for insomnia can benefit nearly anyone with sleep problems. CBT-I can help people who have primary insomnia as well as people with physical problems, such as chronic pain, or mental health disorders, such as depression and anxiety. What’s more, the effects seem to last. And there is no evidence that CBT-I has negative side effects. CBT-I requires steady practice, and some approaches may cause you to lose sleep at first. But if you stick with it, you’ll likely see lasting results. There are a number of websites and apps that can help with this and one in particular is an app called CBT-I coach which should be used in conjunction with seeing a therapist

Belinda Holmes M.S.W. is a Registered Social Worker who provides therapeutic services to individuals, couples and families through the EAP and privately. Her areas of strength in clinical practice include assisting clients with PTSD, trauma, depression, anxiety, stress management, addictions and grief.

Often one of the most misunderstood terms within the workplace, employee accommodation can mean many things but most commonly refers to a request from an employee to be either temporarily or permanently accommodated in the workplace due to an injury, illness or disability in order to be able to fulfill their essential duties. While employee accommodation is commonly used for disabilities it may also be requested as a result of family status Employee Accommodation is a requirement under the Canadian and Ontario Human Rights Code and the Ontario Disabilities Act. What does “accommodate” mean? It’s a change or adjustment to the job or work environment or the way the work is done that will allow an individual with a temporary or permanent disability to perform job functions. This can be as simple as an ergonomic assessment or as complicated as a bundling of job duties or providing alternative work hours or reduced work hours. Each party involved in the process has rights and responsibilities. It is the employee’s right to be accommodated and the employer’s responsibility to provide that accommodation; however, it is the employer’s right to decide what the accommodation will be and the employee’s responsibility to provide all necessary information and actively cooperate in the process. In unionized nvironments, it is the employee’s right to have representation; however, it is the unions’ responsibility to cooperate with the employer in the process. Accommodation is a balancing act that weighs the rights of the employee and the rights of an employer. Accommodation is not limitless and is required only to the point of “undue hardship” for the organization. Unfortunately, there is no set definition for what undue hardship means and it is affected by the size of the organization, health and safety considerations, facilities available, operational costs to accommodate, collective agreements and the nature of the work being done. It’s important for an employer to make serious efforts to accommodate, to include the employee, their representative, human resources and functional experts and to document the process. To prove undue hardship, the employer must show that it has considered all possibilities.