Behavioral and cognitive treatments of geriatric insomnia.

Geriatric insomnia is a prevalent problem that has not received adequate controlled evaluation of psychological treatments. The present study evaluated behavioral and cognitive methods, relative to a wait-list control condition, for treating 27 elderly subjects (mean age?=?67 years) with sleep-maintenance insomnia. Both treatment methods, stimulus control and imagery training, produced significant improvement on the main outcome measure of awakening duration. Stimulus control yielded higher improvement rates than either imagery training or the control condition on awakening duration and total sleep-time measures. Sleep improvements were maintained by the two treatment methods at 3- and 12-month follow-ups. The results were corroborated by collateral ratings obtained from significant others. Subjective estimates of awakening duration and sleep latency correlated highly with objective measures recorded on an electromechanical timer. The findings suggest that geriatric insomnia can be effectively treated with psychological interventions and that behavioral procedures are more beneficial than cognitive procedures for sleep maintenance problems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychosocial work stressors in the development and maintenance of insomnia: A prospective study.

This study is aimed at examining whether psychosocial work stressors are related to the development and maintenance of insomnia. A prospective design was used with a baseline and a 1-year follow-up questionnaire (N = 1,530). The results showed that among individuals with no insomnia at baseline, high work demands increased the risk of developing insomnia 1 year later. Among participants with insomnia at baseline, high leader support decreased the risk of still reporting insomnia at follow-up. Finally, low influence over decisions and high work demands were related to the maintenance of insomnia. The results indicate that perceived work stressors are related to the development and maintenance of insomnia. This might have implications for how insomnia is conceptualized as it places work stressors in the model and for how interventions at different stages of insomnia are implemented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapeutic issues in the behavioral treatment of insomnia.

The problem of insomnia is likely to affect many of the patients seen by practicing clinicians. At present, a number of effective behavioral strategies are available for the treatment of patients with chronic insomnia. However, the literature on behavioral insomnia treatment has traditionally focused on the application of specific techniques, giving little attention to the therapeutic issues that may be important to the success of a comprehensive insomnia treatment program. This article discusses those aspects of treatment that are unique to the complaint of insomnia within the context of several basic problems common to most behavioral treatment programs, including compliance, patient cognitions, and the tailoring of treatment to maximize therapeutic effectiveness. Hypotheses regarding the etiology of insomnia complaints are also presented, along with recommendations for further research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

"Music of the Brain" in the treatment of insomnia patients

The effects of "Music of the Brain" which is the new nonpharmacological method of treatment of insomnia were studied. The method is based upon the transformation of EEG signals into the music by using a special algorithm developed by the author. Sleep polygramme was registered and analysed. EEG sites of sleep stages and phases which most satisfied usual criteria were selected and transformed into music. The patient listened to the recorded audio cassette just before sleep. 58 patients with insomnia were divided into 2 groups according clinical, formal, psychological and electrophysiological (polysomnography, EEG) methods which were applied before and after 15-day course of treatment. 1st group (44 individuals) was the main group and the 2nd group (14 patients) was the "placebo" group ("Music of the Brain" of other individual was used in this case). The positive effects of "Music of the Brain" were evaluated in patients with insomnia in more than 80% cases. These effects were marked on the basis of both subjective feeling and objective (psychological and neurophysiological) results. The high effectivity of "Music of the Brain" for patients with insomnia combines with the lack of side effects and complications.     

Psychological treatment of secondary insomnia.

Psychological treatment of insomnia has focused on primary insomnia (i.e., having a psychological origin). Secondary insomnia, sleep disturbance caused by a psychiatric or medical disorder, although it is more common than primary insomnia, has received very little attention as a result of the belief that it would be refractory to treatment. The present study randomly assigned older adults with secondary insomnia to a treatment group, 4 sessions composed of relaxation and stimulus control, or a no-treatment control group. Self-report assessments conducted at pretreatment, posttreatment, and a 3-month follow-up revealed that treated participants showed significantly greater improvement on wake time during the night, sleep efficiency percentage, and sleep quality rating. The authors hypothesize that treatment success was probably due in part to difficulty in diagnostic discrimination between primary and secondary insomnia. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive-Behavioral Therapy for Insomnia: Comparison of Individual Therapy, Group Therapy, and Telephone Consultations.

Forty-five adults with primary insomnia received cognitive-behavioral therapy (CBT) implemented in a group therapy format, in individual face-to-face therapy or through brief individual telephone consultations. The results indicate that CBT was effective in improving sleep parameters with all 3 methods of treatment implementation, and there was no significant difference across methods of implementation. All 3 treatment modalities produced improvements in sleep that were maintained for 6 months after treatment completion. These results suggest that group therapy and telephone consultations represent cost-effective alternatives to individual therapy for the management of insomnia. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Who is a candidate for cognitive-behavioral therapy for insomnia?

Chronic insomnia impacts 1 in 10 adults and is linked to accidents, decreased quality of life, diminished work productivity, and increased long-term risk for medical and psychiatric diseases such as diabetes and depression. Recent National Institutes of Health consensus statements and the American Academy of Sleep Medicine's Practice Parameters recommend that cognitive-behavioral therapy for insomnia (CBT-I) be considered the 1st line treatment for chronic primary insomnia. Growing research also supports the extension of CBT-I for patients with persistent insomnia occurring within the context of medical and psychiatric comorbidity. In the emerging field of behavioral sleep medicine, there has yet to be a consensus point of view about who is an appropriate candidate for CBT-I and how this determination is made. This report briefly summarizes these issues, including a discussion of potential contraindications, and provides a schematic decision-to-treat algorithm. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Barriers to engagement in sleep restriction and stimulus control in chronic insomnia.

Sleep restriction (SRT) and stimulus control (SC) have been found to be effective interventions for chronic insomnia (Morgenthaler et al., 2006), and yet adherence to SRT and SC varies widely. The objective of this study was to investigate correlates to adherence to SC/SRT among 40 outpatients with primary or comorbid insomnia using a correlational design. Participants completed a self-report measure of sleepiness prior to completion of a 6-week cognitive behavioral treatment group for insomnia. At the posttreatment period, they rated their ability to engage in SC/SRT using a survey. Results from standard multiple regression analyses showed that perceiving fewer barriers (i.e., less boredom, annoyance) to engaging in SC/SRT and experiencing less pretreatment sleepiness were each associated with better adherence to SC/SRT. Adherence to SC/SRT was associated with outcome. Implications of these findings are that more work is needed to make SC/SRT less uncomfortable, possibly by augmenting energy levels prior to introducing these approaches. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Treatment of late-life insomnia.

Reviews the book, Treatment of late-life insomnia by Kenneth L. Lichstein and Charles M. Morin (see record 2000-03635-000). Lichstein and Morin have assembled an array of researchers and clinicians addressing problems of insomnia in late life. The book is organized into three parts. Part I provides an excellent overview of assessment strategies, and tackles the problems in defining the crucial constructs involved in this book, namely, insomnia and old age. Part II entails clear and authoritative articles presenting the main cognitive-behavioural and pharmacological treatment approaches. Part III presents topics that would be of interest to anyone dealing with insomnia: discontinuation of sleep medications, secondary insomnia, and insomnia in dementia and in residential care. The authors are to be commended for assembling such a wealth of information on both practical and theoretical issues related to insomnia in late life. The book will undoubtedly prove to be indispensable to both clinicians and researchers in the area. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Primary versus secondary insomnia in older adults: Subjective sleep and daytime functioning.

Most psychological research on insomnia has centered on primary insomnia (PI). Secondary insomnia (SI), though more common than PI, has received little attention because of its presumed unresponsiveness to treatment. The present study recruited older adults with PI, SI, and a comparison group of older adults with no insomnia (NI). Self-report assessments of sleep revealed no significant difference between the 2 insomnia groups. Daytime functioning measures found significant differences in impairment between the 3 groups with SI having the worst daytime functioning, followed by PI, which was worse than NI. Further analyses found substantial independence between sleep and daytime functioning. Implications of these findings for the clinical management of SI are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comorbidity of mental and insomnia disorders in the general population

The co-occurrence of insomnia and mental disorders constitutes the most prevalent diagnosis pattern found in sleep disorder clinics. Yet, there remains a paucity of epidemiological information regarding comorbidity of mental disorders and sleep disorder symptomatology in the general population. The present study showed results based on a large representative French cohort (n = 5,622; 80.7% of the contacted stratified sample). A total of 997 (17.7%) individuals with insomnia complaints were identified and divided into six diagnostic categories: (1) Insomnia related to a Depressive Disorder; (2) Insomnia related to an Anxiety Disorder; (3) Depressive Disorder accompanied by insomnia symptomatology; (4) Anxiety Disorder accompanied by insomnia symptomatology; (5) Primary Insomnia; and (6) isolated insomnia symptomatology. Telephone interviews were conducted using the Sleep-Eval System. Subjects with insomnia related to a Mental Disorder have a longer history of insomnia complaints and are usually younger than those with Depressive or Anxiety Disorders accompanied by insomnia symptoms. Subjects with Insomnia related to a Depressive Disorder experienced more repercussions than any other group. A surprisingly high percentage of individuals with depressive symptomatology had sought independent medical treatment specifically for their sleep problems, which raises the unsettling possibility that many cases of depression go undetected by the general medical community. The distinct predictability of commonly undiagnosed depression leading to chronic depression speaks directly to the imperative that physicians receive additional training in this area of community mental health.     

A Survey of Insomnia Treatment at Canadian Sleep Centres: Is There a Role for Clinical Psychologists?

This survey found that less than 15% of Canadian sleep centres have developed programs for the psychological treatment of insomnia. One in five Canadians suffer from insomnia: the most common sleep complaint confronting health care practitioners. With increasing evidence of the importance of quality sleep for optimal daytime functioning, it is timely to advocate for the development of psychologically-based insomnia programs within Canadian sleep centres. Closer collaboration between clinical psychologists and family physicians in managing insomnia is also required. This paper highlights issues (related to the identification and treatment of sleep disorders) for clinical training of psychologists in Canadian Ph.D. programmes and internship sites. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Alternative medicine

Acupuncture is a simple and useful treatment for insomnia, with a success rate of around 90%. The acupuncture points applied vary depending on the doctor and on the case, but the usual points are Shenmen (HT7) and Anmien (extrapoint). The mechanism of this treatment has not been well elucidated. Acupuncture analgesia may be used as a great indicator, because in both practices needles are inserted in deep tissues as the common stimulation. The possible neuronal integration and transmitter effect in the acupuncture treatment for insomnia are discussed.     

Subjective insomnia without objective findings: A pseudo diagnostic classification?

Subjective insomnia is a complaint of insomnia that is not confirmed by objective sleep disturbance. The prevalence of the disorder had been reported to be 25% of all insomnia patients. If this estimate is correct, then the diagnosis and treatment of insomnia are complicated by a complaint that is difficult to identify without costly diagnostic procedures in specialized facilities. In the present article, I critically examine both the evidence on which the estimated prevalence rate was based and the procedures used to define the disorder. In general, I found that the relevant studies did not determine whether patients recognized that they had slept well in the laboratory, did not consider the relation between the number-of-nights data collected and the probability of a patient's sleeping adequately, did not consider individual differences in sleep requirements, and did not identify sleep disturbance not reflected in standard sleep measurements or carry out detailed screening for psychopathology. I argue that there is insufficient evidence to conclude that the disorder exists. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sommeil, insomnie et psychopathologie.

Sleep plays a critical role in psychological well-being and adaptation. Not surprisingly, sleep disturbance is a frequent problem among individuals facing situational psychological difficulties as well as among those with more chronic psychopathology. This article examines the relationship among sleep, insomnia, and psychopathology. In the first section, we address the issue of comorbidity by examining prevalence rates of sleep disturbances in the general population and among subgroups of individuals with selected psychopathologies and, conversely, rates of psychological symptoms/syndromes among individuals with and without sleep disturbances. The data indicate high rates of psychological syndromes (40%) associated with insomnia among community-based samples, and even higher rates (80%) of sleep disturbances among selected samples of patients with psychopathology. Comorbidity is particularly high among patients with insomnia, major depression, and generalized anxiety disorder. Although insomnia is often a symptom of an underlying psychopathology, longitudinal studies show that it can also be an important risk factor for a new onset major depressive disorder. The second section of this article summarizes the main subjective and EEG sleep impairments in selected anxiety disorders, mood disorders, and schizophrenia. Insomnia is a common clinical feature or even a diagnostic criterion of several of those disorders. Other related symptoms such as fatigue, low energy and poor concentration are shared across insomnia, major depression, and generalized anxiety disorder, suggesting some common mechanisms among those conditions. In addition to subjective sleep complaints, there is also evidence of EEG sleep abnormalities, such as impairment of sleep continuity, reduced slow wave sleep, and altered REM sleep patterns, with the latter two features being more specific to mood disorders. The third section of this article examines the effects of insomnia treatment on co-existing psychological symptoms or disorders and, conversely, the effects of treatment of selected anxiety and mood disorders on sleep. These results indicate that treatments of depression and anxiety may produce some sleep improvements but, in many cases, residual sleep disturbances persist and may actually increase the risk of subsequent relapse. The main implication is that treatment should directly target both co-existing conditions. Additional implications for the treatment and prevention of comorbid sleep disturbances and psychopathology and for future research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Efficacy of cognitive-behavioral therapy for insomnia in women treated for nonmetastic breast cancer.

This study investigated the efficacy of a multimodal cognitive-behavioral intervention for women who had been treated for nonmetastatic breast cancer. Ten participants were enrolled in the treatment protocol in a multiple-baseline design. Intervention time series analyses of daily sleep diary data revealed significant improvements of sleep efficiency and total wake time. These results were corroborated by polysomnographic data. In addition, insomnia treatment was associated with significant improvements of mood, general and physical fatigue, and global and cognitive dimensions of quality of life. These findings suggest that cognitive-behavioral therapy, previously found effective for primary insomnia, is also of clinical benefit for insomnia secondary to cancer. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Depression, hypomania, and dysfunctional sleep-related cognitions as mediators between stress and insomnia: The best advice is not always found on the pillow!

A cognitive mediation model was examined to find out how stress, depression, and hypomania precipitate the occurrence of dysfunctional sleep-related cognitions, which in turn lead to insomnia. A total of 862 participants (639 women, 223 men; M age: 24.67 years, SD = 5.91) completed a series of self-report questionnaires assessing perceived stress, depression, hypomania, dysfunctional sleep-related cognitions, and insomnia. Compared to men, women reported higher levels of stress, depression, and insomnia. Women also suffered from more dysfunctional sleep-related cognitions. All variables were intercorrelated. Structural equation analyses showed that the relationship between stress and insomnia was largely mediated by dysfunctional sleep-related cognitions. Links between depression and insomnia were found to be weak when controlled for stress and dysfunctional sleep-related cognitions. The findings support a cognitive model of insomnia. Stress must be seen as a precipitating factor in the onset and maintenance of insomnia. Consequently, competencies to deal with dysfunctional sleep-related cognitions should be fostered in stress management programs. In turn, stress management should be a primary focus in the treatment of insomnia. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sleep patterns and aging: Comparison of older adults with and without insomnia complaints.

The nature of geriatric insomnia was studied by comparing older adults with (n?=?42) and without (n?=?30) insomnia complaints on measures of sleep, mood, life-style, health, and sleep-requirement expectations. Elderly persons with insomnia complaints reported longer sleep latency and more frequent and longer awakenings and used sleeping aids more often than those without insomnia complaints. Nocturnal sleep time was not a reliable discriminator. Poor sleepers showed greater discrepancies between their current sleep patterns and sleep-requirement expectations than did good sleepers. Elderly insomniacs acknowledged greater symptomatology of depression and anxiety than did good sleepers. Daytime napping and physical exercise were equivalent in both groups. Medical disorders, pain conditions, and drug usage (other than sleep aids) did not distinguish the two groups. Clinical implications for the treatment of geriatric insomnia are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Analysis of stimulus control treatment of sleep-onset insomnia.

Examined the components responsible for the efficacy of the stimulus control treatment of sleep-onset insomnia. 47 college students with sleep-onset insomnia were assigned to 1 of 5 treatment conditions (stimulus control, noncontingent control, countercontrol, temporal control, and waiting list). Ss were instructed not to expect improvement until after the 4th treatment session. Only stimulus control and a treatment violating the associative aspects of stimulus control produced significantly greater improvement in reported latency to sleep onset than the waiting-list condition. Results are discussed in terms of several possible explanations for improvement due to so-called stimulus control treatment for insomnia. (10 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)