Academic journal article The Israel Journal of Psychiatry and Related Sciences

Non-Pharmacalogical Treatments of Insomnia

Academic journal article The Israel Journal of Psychiatry and Related Sciences

Non-Pharmacalogical Treatments of Insomnia

Article excerpt

Abstract: Insomnia is a prevalent and complex disorder to treat. This article reviews the prevalence, etiology, diagnosis and treatment of insomnia. With regard to treatment, there now exists an extensive literature demonstrating that compared with pharmacological treatments a range of non-pharmacological therapies are of proven clinical efficacy and durability. These include, for example, stimulus control therapy, bedtime restriction therapy, relaxation therapy, cognitive therapy and bright light therapy. These therapies are summarized and evaluated. It is recommended that therapists consider non-drug treatments based on cognitive-behavioral principles when managing a patient with insomnia.

Insomnia is a broad term, includes a variety of complaints, is difficult to define, and can better be described as a disorder than a disease state. It can be characterized by two broad sets of complaints, those related to reduced sleep quality and quantity and those associated with impaired daytime functioning (1-3). Indicators of reduced sleep quality and quantity are a history of non-restorative sleep, delayed sleep initiation, poor sleep maintenance, early morning awakening and mistimed sleep (e.g., an irregular sleep-wake pattern, delayed sleep onset times and waking up earlier than desired). In addition, patients may report cognitive arousal, especially a racing mind. Indicators of impaired daytime functioning are a history of reduced mood (e.g., fatigue, tiredness, irritability, and dysphoria), reduced cognitive functioning (e.g., loss of motivation, reduced concentration, impaired memory, and mental slowness), reduced work performance (e.g., decreased productivity and daytime sleepiness) and reduced social functioning (e.g., social avoidance and reduced social confidence). Under current classification systems, a history of reduced sleep quality and quantity together with impaired daytime functioning is necessary for the diagnosis of insomnia (4, 5). The classification systems also distinguish between those insomnias that are primary - usually a diagnosis by exclusion - and secondary, that is, the sleep disturbance occurs in the presence of another mental, medical or sleep (e.g., sleep apnoea) disorder, or due to the direct effects of a substance. This review will examine the treatment of primary insomnia using non-- pharmacological therapies that have been empirically validated in the literature. These will be described in brief and current evidence discussed along with prevalence, etiology and treatment issues. Because of the overlap between sleep-onset insomnia and, likewise, early morning awakening insomnia with sleep disorders arising from circadian rhythm abnormalities, such as delayed sleep phase syndrome and advance sleep phase syndrome respectively, the non-pharmacological treatment of insomnias with an underlying circadian component will also be discussed.

Prevalence of Insomnia

The prevalence of insomnia in the community is high. It is estimated that up to 35% of the population report acute insomnia while 9-12% of individuals report inadequate sleep on a chronic basis (e.g., 3-6). Certain subgroups appear to be at particular risk for insomnia. In general, prevalence rates are reported to be higher in the aged, females, shiftworkers, individuals with obsessive and anxious personality traits and patients with a medical or psychiatric history (for review, 6). In the case of medical patients, Bixler et al. (7) report that 19% of out-patients complain of chronic insomnia. Chronic insomnia is a well documented complaint in a range of medical problems and is especially prominent in patients with gastro-esophageal reflux, pain, and respiratory impairment (e.g., 7-9). It is also a prominent complaint in psychiatric patients. Berlin et al. (10) report a prevalence rate of 72% in patients referred for psychiatric evaluation. The converse has also been observed. Buysse et al. (11) report that 35-44% of all patients presenting with insomnia to a sleep specialist suffered from a concomitant psychiatric disorder. …

Search by... Author
Show... All Results Primary Sources Peer-reviewed

Oops!

An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.