Recent advances in the assessment and treatment of insomnia.

Abstract

Persistent insomnia has multiple potential causes such as medical, pharmacological, life-style, personality, and behavioral factors. Although many poor sleepers use hypnotic medications, a wide array of cognitive-behavioral interventions are available that target somatic and cognitive arousal, dysfunctional thoughts, and learned maladaptive sleep habits. Outcome research conducted over the past decade reveals that the single treatments of stimulus control and sleep restriction produced the best results, reducing self-reported target complaints by 50-60%. Approximately half of insomniacs show reliable change although only about one third become good sleepers. Multicomponent methods offer considerable promise but on the whole have not surpassed results achieved with the simpler stimulus control. Recommended new directions of pursuit include (a) examination of a broader range of insomnia sufferers, (b) use of multimodal assessment and more objective verification of self-reported benefits (c) research on treatments tailored to individual causal and maintaining factors, and (d) further scrutiny of newer interventions like sleep restriction and more comprehensive multifaceted strategies.

Cites (6)

1. Epidemiologic Study of Sleep Disturbances and Psychiatric Disorders: An Opportunity for Prevention?
   Ford, Daniel E. · 1989 · JAMA
2. Insomnia and Its Treatment: Prevalence and Correlates
   Mellinger, Glen D. · 1985 · Archives of General Psychiatry
3. The phenomenology of the pre-sleep state: the development of the pre-sleep arousal scale
   Nicassio, Perry M., Mendlowitz, Debra R., Fussell, Juanita J., Petras, Lynn · 1985 · Behaviour Research and Therapy
4. Knowledge and practice of sleep hygiene techniques in insomniacs and good sleepers
   Lacks, Patricia, Rotert, Monique · 1986 · Behaviour Research and Therapy
5. Assessment of insomnia
   Spielman, A · 1986 · Clinical Psychology Review
6. A cluster analysis of insomnia
   Hauri, Peter J. · 1983 · Sleep

Show all 6 references

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   Bastien, C · 2001 · Sleep Medicine
2. Nonpharmacological interventions for insomnia: a meta-analysis of treatment efficacy
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3. Nonpharmacologic Treatment of Chronic Insomnia
   Morin, Charles M., Hauri, Peter J., Espie, Colin A., Spielman, Arthur J., Buysse, Daniel J., Bootzin, Richard R. · 1999 · Sleep
4. Role of Stress, Arousal, and Coping Skills in Primary Insomnia
   Morin, Charles M., Rodrigue, Sylvie, Ivers, Hans · 2003 · Psychosomatic Medicine
5. A new scale for measuring insomnia: the Bergen Insomnia Scale.
   Pallesen, Stäle, Bjorvatn, Bjørn, Nordhus, Inger Hilde, Sivertsen, Børge, Hjørnevik, Mari, Morin, Charles M. · 2008 · Perceptual and Motor Skills

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