Cognitive Behavioral
/ Psychological Treatment of Insomnia?
There is extensive research demonstrating the effectiveness of nonpharmacological,
cognitive behavioral (psychological) treatment of insomnia. More than 66 treatment
outcome studies have evaluated the effectiveness of several behavioral
treatments. The results of these studies indicate that psychological
treatments of insomnia produce considerable enhancement in both sleep
patterns and the subjective experience of sleep. All of the psychological
treatments studied produced therapeutic gains superior to placebo therapies.
Patients who were not regular users of sedative hypnotics had greater
levels of sleep improvement (Murtagh & Greenwood, 1995).
A
recent (September 2004, Archives of Internal Medicine) study
conducted at Beth Israel Hospital demonstrated that CBT was MORE
effective than a commonly prescribed medication, Ambien.
Overview
of Sleep problems?
(Based
on the International Classification of Sleep Disorder-ICSD)
• Psychophysiological Insomnia: Insomnia due
to anxiety, nervousness, or body tension.
• Sleep State Misperception: Previously called
pseudoinsomnia. Complaint of insomnia is inconsistent with objective
sleep assessment showing normal sleep.
• Idiopathic Insomnia: This is a life long inability
to obtain needed sleep which is presumably due to neurological dysfunction.
• Inadequate Sleep Hygiene: Sleep is disrupted
by poor daytime habits such as caffeine use or naps.
• Environmental Sleep Disorder: Result of nonconducive
physical environment such as a noisy neighborhood or uncomfortable bed.
• Adjustment Sleep Disorder: Temporary life stressor
disrupt sleep of individuals who generally have no difficulty sleeping.
• Hypnotic-Dependent Sleep Disorder: Chronic
use of sleep medication disrupts sleep.
• Stimulant Dependent Sleep Disorder: Use of
a stimulant medication disrupts sleep.
• Alcohol-Dependent Sleep Disorder: Chronic alcohol
use disrupts sleep.
Types
of Psychological / Behavioral Treatment
•
Relaxation Training: The use of Progressive Muscle
Relaxation (PMR), deep breathing techniques, imagery, and self-hypnosis.
PMR is the most widely researched treatment for insomnia and involves
helping the individual to sequentially tense and relax the body’s
major muscle groups while concentrating on and contrasting sensations
of tension and relaxation. Daily practice of relaxation techniques between
therapy session is essential and tends to enhance the effective of the
treatment.
• Cognitive Therapy: The term cognitive therapy
can be broadly applied to mean interventions that aim to help the individual
identify and correct inappropriate thoughts and beliefs that may contribute
to insomnia. Often includes providing proper information about sleep
norms, age-related sleep changes, reasonable sleep goals, and the influence
of naps and exercise.
• Stimulus Control (SC): SC derives from the
belief that insomnia may be related to the bedroom becoming a poor discriminative
stimulus. That is, the bedroom may have become associated with other
things besides sleep.
• Bedtime Restriction: Sleep-Restriction Therapy
(SRT) is based on the belief that excess time in bed perpetuates insomnia.
This technique consists of limiting a person’s time in bed.
• Sleep Hygiene: Sleep hygiene refers to lifestyle
behaviors and environmental conditions that influence sleep, including
exercise, napping, and diet. A therapist works with an individual to
evaluate the potential influence of these factors and make appropriate
changes.
Falling
Asleep
There is some evidence that relaxation training treatments are the most
effective behavioral treatments for sleep onset problems. However, the
effects for relaxation training may take longer to become evident than
other approaches. Looking at all 66 research studies together indicated
that the average person reduced the time it took them to fall asleep
from 61 to 37 minutes.
Total
Sleep Time
Relaxation training appears to be important to lengthening of sleep.
Relaxation training combined with other approaches may be the most effective
approach to helping individuals lengthen their typically time sleeping.
In the 66 treatment studies, the number of times each person woke during
the night decreased from an average of 1.63 times to .44 times per person,
per night.
Quality
of Sleep
Research suggests that behavioral/psychological treatments for insomnia
have their greatest impact on an individuals own sense of the quality
of their sleep.
Our
clinicians who specialize in treatment of sleep disorders are
Julia Berkman, Ph.D.
and Michael A. Goldberg, Ph.D.
Click here to
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