Insomnia Shared Medical Appointments

Virginia Mason's insomnia shared medical appointments (SMA) are intended to treat patients experiencing difficulty falling asleep, staying asleep, or both. Before starting, it is important that a comprehensive initial consultation is conducted in order to understand all of the factors that may be contributing to your sleep problems. If you have not yet had a consultation with a sleep physician at Virginia Mason, you will need to schedule an appointment by calling (206) 625-7180. 

Approach

Non-medication, cognitive-behavioral approaches will be used to treat your insomnia. Research has shown that these approaches are effective for different types of insomnia.

Although the treatment is delivered in a group format, we tailor the treatment to your individual situation. Your progress will be monitored closely, and feedback will be given during each session. If you are currently taking a sleep medication, you are not required to discontinue the medication prior to the workshop. If you wish to reduce or discontinue sleep medication, we can help guide your medication withdrawal. The decision on whether or not to discontinue sleep medication is entirely up to you.

Format

Treatment is typically provided in groups of six to 12 patients. Each session lasts approximately one-and-a-half hours. The treatment usually consists of six sessions conducted weekly. Additional individual follow up is available when necessary. It is strongly recommended that you do not miss any sessions because a new treatment component is introduced each week. Each component builds on the previous ones, and the benefits of these components are cumulative.

Cost

Each visit is similar to a traditional physician visit and will be billed to your medical insurance (depending on your plan, you may have to co-pay). We request that you check in at the Front Desk before each visit to ensure that this process goes smoothly.

Location and Time

The insomnia treatment SMA is held at Virginia Mason's Hospital, in Seattle, and some Virginia Mason regional clinics. In Seattle, please check in at the Front Desk of Buck Pavilion Level 1 or Lindeman Pavilion Level 2. The session takes place in one of the Correa Conference rooms (located on the Hospital, Level 4 — enter the cafeteria and go to the area behind the cashiers). Each session begins at 5 p.m. and finishes around 6:30 p.m.

Parking

In Seattle, parking is available in the lots marked as "Visitor Parking."  These lots include the Buck Parking Garage, Lindeman Pavilion Parking Garage and the Benaroya Research Institute Parking Garage. You are responsible for the cost of parking.

Insomnia Treatment SMA Overall Plan

  • Informed consent
  • Review of individual sleep patterns and setting individual treatment goals
  • Sleep diary
  • Sleep education — normal sleep physiology, including sleep homeostasis, circadian rhythm; medical, psychiatric, sleep disorders, substances that can affect sleep
  • Sleep education — understanding insomnia
  • Managing the arousal system
  • Dealing with the racing mind and worry
  • Breathing relaxation practice
  • Restructuring the sleep schedule
  • Learn/re-learn to sleep faster, better and more easily
  • Stimulus control instructions
  • Sleep consolidation
  • Cognitive components — beliefs and attitudes about sleep
  • Mindfulness-based intervention
  • Insomnia as a symptom of stress
  • Continuing to improve sleep and relapse prevention
  • Consolidation of learning
  • What to do when insomnia returns
  • Continuation of care
  • Program evaluation

Insomnia Treatment SMA: Frequently Asked Questions

  1. I have had severe, nightly insomnia for many years. Do you really think a shared medical appointment can help?
  2. Is this insomnia treatment "group therapy"?
  3. Is this treatment a prolonged course on sleep hygiene and relaxation techniques?
  4. I just want to sleep well and do not care if I need medications to help me sleep. Should I participate in shared medical appointments even if it is not my goal is to stop taking medication?
  5. I have sleep apnea with insomnia and have not been able to tolerate CPAP. Can the SMA help in this situation?

1. I have had severe, nightly insomnia for many years. Do you really think a shared medical appointment can help?
The doctors that lead the shared medical appointments at Virginia Mason performed their insomnia training at Stanford University. Stanford has published the results of their insomnia program and 70 percent of the patients that attended their program noted a significant improvement in their symptoms. Most patients have severe insomnia with an average duration of 13 years. At Virginia Mason, about 80 percent of patients note a "significant" benefit and 50 percent that were taking sleep medication were successfully able to stop.

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2. Is this insomnia treatment "group therapy"?
The SMA is a shared medical appointment, and is not group therapy. The reason this treatment is done in a group setting is that some of the recommendations that we make will be difficult. Knowing that others will be attempting these recommendations can be motivating and provide encouragement. Our clinical impression is that treating insomnia in this format is more effective than individual treatment in the traditional office setting.

3. Is this treatment a prolonged course on sleep hygiene and relaxation techniques?
Studies have shown that, by themselves, sleep hygiene and relaxation techniques are not that effective in treating insomnia. Multi-component cognitive behavioral treatment is the most effective treatment for insomnia in long-term studies. In fact, cognitive behavioral treatment has been shown to be significantly more effective than medications in treating insomnia in the elderly at the end of two years. 

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4. I just want to sleep well and do not care if I need medications to help me sleep. Should I participate in this even if it is not my goal is to stop taking medication?
Each patient sets his or her own goals and the Insomnia Treatment SMA is designed to help each patient achieve his or her own individual goals. In some patients, medications will continue to play an important role in treating insomnia. After conducting the Insomnia Treatment SMA for several years, we have set our own goal, which is to help patients become less anxious about their sleep and feel more confident in their ability to sleep better again.

5. I have sleep apnea with insomnia. I have not been able to tolerate CPAP. Can the SMA help in this situation?
This is a situation in which we encourage patients to consider the SMA. Certainly, a physical problem such as sleep apnea can be the cause of awakenings. However, once awake, the conditioned elements of insomnia are generally what perpetuate the insomnia. If we are able to resolve the insomnia and this improves CPAP tolerance, patients generally note significant benefit in daytime well-being.

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