Behavioral self-management in treating sleep-maintenance insomnia

Abstract

Three controlled case studies are presented to demonstrate the application of behavioral self-management to two subtypes of sleep-maintenance insomnia. Patient 1 suffered from brief but frequent arousals to wakefulness and to NREM Stage 1 sleep. Patient 2 suffered from brief but frequent arousals and extended minutes awake after sleep onset. Patient 3 suffered from an extended latency to sleep onset and also extended minutes awake after sleep onset. The self-management treatment program was designed to teach these patients skills for identifying and modifying environmental, behavioral, physiological, and cognitive conditions related to poor sleep. Results are documented using home and laboratory all-night sleep recordings during treatment and at 3 and 12 months following the end of treatment.

Cluster analysis of insomniacsʼ MMPI profiles: relation of subtypes to sleep history and treatment outcome.

“…Further, treatment results revealed a difference between our groups only in regard to changes in sleep-onset latency; the groups did not differ in regard to the other four outcome measures. Since the behavioral treatments employed herein have proved effective primarily for sleep-onset problems (20)(21)(22)(23), our results seem to reflect an actual difference between our groups in their responses to treatment, rather than merely a difference in their tendencies to report improvement. Consequently the aforementioned etiologic speculations remain valid hypotheses for future investigation.…”

A cognitive-behavioral therapy for sleep-maintenance insomnia in older adults.

“…Various behavioral therapies have been developed for the treatment of insomnia, but the effectiveness of these treatments for sleep maintenance problems remains unclear. Whereas some researchers (Morin & Azrin, 1987, 1988) have found behavioral strategies effective for sleep-maintenance insomnia, others (Davies, Lacks, Storandt, & Bertelson, 1986; Lacks, Bertelson, Sugerman, & Kunkel, 1983; Thoresen, Coates, Kirmil-Gray, & Rosekind, 1981) have shown such treatments to be relatively ineffective. Given the relative prevalence of sleep-maintenance insomnia among older adults, these inconsistent findings are particularly disappointing.…”

Insomnia and Anxiety

“…Some people with insomnia instead try to suppress unwanted thoughts, but suppression attempts have the opposite effect; that is, the unwanted thoughts (and wakefulness) persist even longer (Ree, Harvey, Blake, Tang, & Shawe-Taylor, 2005). This cycle of unwanted recurring thoughts has been described in many different disorders as repetitive thinking (Segerstrom, Tsao, Alden, & Craske, 2000), and the most pertinent types of repetitive thinking in insomnia are rumination and worry (Carney, Edinger, Meyer, Lindman, & Istre, 2006;Thoresen, Coates, Kirmil-Gray, & Rosekind, 1981). The intrusion of this type of thinking has prompted the testing of bedtime arousal-decreasing strategies for processing intrusive material for the day via early evening problem solving or a Pennebaker writing assignment.…”