Insomnia non-pharmacological therapy: Difference between revisions
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==Overview== | ==Overview== | ||
==Non-pharmacological therapy== | ==Non-pharmacological therapy== | ||
[[Clinical practice guideline]] by the [[American Academy of Sleep Medicine]] (AASM) noted about [[cognitive therapy|cognitive behavior therapy]] for insomnia: | |||
* “Initial approaches to treatment should include at least one behavioral intervention such as stimulus control therapy or relaxation therapy, or the combination of cognitive therapy, stimulus control therapy, sleep restriction therapy with or without relaxation therapy—otherwise known as cognitive behavioral therapy for insomnia (CBT-I).”<ref name="pmid18853708">{{cite journal| author=Schutte-Rodin S, Broch L, Buysse D, Dorsey C, Sateia M| title=Clinical guideline for the evaluation and management of chronic insomnia in adults. | journal=J Clin Sleep Med | year= 2008 | volume= 4 | issue= 5 | pages= 487-504 | pmid=18853708 | doi= | pmc=PMC2576317 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18853708 }} </ref> | |||
[[Cognitive therapy|Cognitive behavior therapy]] for insomnia has been studied in a [[meta-analysis]] of 20 [[randomized controlled trial]]s that compared a combination of two modalities of CBT-i versus various control therapies. Different modalities of CBT-i were defined as cognitive therapy, stimulus control, sleep restriction, sleep hygiene, and relaxation techniques. The meta-analysis found: | |||
* Sleep onset latency improved by 19 (95% [[Confidence interval|CI]], 142 to 25) minutes | |||
* Wake after sleep onset was reduced by 26 (95% [[Confidence interval|CI]], 15 to 37) minutes | |||
* Total sleep time increased by 8 (95% [[Confidence interval|CI]], 1 to 16) minutes | |||
* Sleep efficiency percentage improved by 10% (95% [[Confidence interval|CI]], 8% to 12%) | |||
Sleep restriction therapy for insomnia has been studied in a [[meta-analysis]] of 4 [[randomized controlled trial]]s that reported "Weighted effect sizes for self-reported sleep diary measures of sleep onset latency, wake time after sleep onset, and sleep efficiency were moderate-to-large after therapy. Total sleep time indicated a small improvement"; however, the authors add "variability in the sleep restriction therapy implementation methods precludes any strong conclusions regarding the true impact of therapy"<ref name="pmid24629826">{{cite journal| author=Miller CB, Espie CA, Epstein DR, Friedman L, Morin CM, Pigeon WR et al.| title=The evidence base of sleep restriction therapy for treating insomnia disorder. | journal=Sleep Med Rev | year= 2014 | volume= 18 | issue= 5 | pages= 415-24 | pmid=24629826 | doi=10.1016/j.smrv.2014.01.006 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24629826 }} </ref>. | |||
====Implementing behavior therapy==== | |||
Behavior therapy may require as many as 16 sessions<ref name="pmid16785771">{{cite journal| author=Wu R, Bao J, Zhang C, Deng J, Long C| title=Comparison of sleep condition and sleep-related psychological activity after cognitive-behavior and pharmacological therapy for chronic insomnia. | journal=Psychother Psychosom | year= 2006 | volume= 75 | issue= 4 | pages= 220-8 | pmid=16785771 | doi=10.1159/000092892 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16785771 }} </ref>. | |||
A shorter number of sessions has been studied: | |||
* "Brief behavioral therapy for insomnia" (BBTI) consists of "a 45 to 60-minute individual intervention session followed by a 30-minute follow-up session 2 weeks later and 20-minute telephone calls after 1 and 3 weeks." Goals of therapy were “reduce time in bed, get up at same time every day regardless of sleep duration, do not go to bed unless sleepy, do not stay in bed unless asleep.” In a trial of 82 older adults (mean age 71.7) BBTI led to a response rate of 67% which yielded a relative benefit increase of 2.7 and number needed to treat in their population of 2.4.<ref name="pmid21263078">{{cite journal| author=Buysse DJ, Germain A, Moul DE, Franzen PL, Brar LK, Fletcher ME et al.| title=Efficacy of brief behavioral treatment for chronic insomnia in older adults. | journal=Arch Intern Med | year= 2011 | volume= 171 | issue= 10 | pages= 887-95 | pmid=21263078 | doi=10.1001/archinternmed.2010.535 | pmc=PMC3101289 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21263078 }} </ref> | |||
[[Cognitive-behavioral therapy]] delivered online may help according to [[randomized controlled trial]]s.<ref name="pmid26827250">{{cite journal| author=Christensen H, Batterham PJ, Gosling JA, Ritterband LM, Griffiths KM, Thorndike FP et al.| title=Effectiveness of an online insomnia program (SHUTi) for prevention of depressive episodes (the GoodNight Study): a randomised controlled trial. | journal=Lancet Psychiatry | year= 2016 | volume= 3 | issue= 4 | pages= 333-41 | pmid=26827250 | doi=10.1016/S2215-0366(15)00536-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26827250 }} </ref><ref name="pmid27902836">{{cite journal| author=Ritterband LM, Thorndike FP, Ingersoll KS, Lord HR, Gonder-Frederick L, Frederick C et al.| title=Effect of a Web-Based Cognitive Behavior Therapy for Insomnia Intervention With 1-Year Follow-up: A Randomized Clinical Trial. | journal=JAMA Psychiatry | year= 2016 | volume= | issue= | pages= | pmid=27902836 | doi=10.1001/jamapsychiatry.2016.3249 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27902836 }} </ref> | [[Cognitive-behavioral therapy]] delivered online may help according to [[randomized controlled trial]]s.<ref name="pmid26827250">{{cite journal| author=Christensen H, Batterham PJ, Gosling JA, Ritterband LM, Griffiths KM, Thorndike FP et al.| title=Effectiveness of an online insomnia program (SHUTi) for prevention of depressive episodes (the GoodNight Study): a randomised controlled trial. | journal=Lancet Psychiatry | year= 2016 | volume= 3 | issue= 4 | pages= 333-41 | pmid=26827250 | doi=10.1016/S2215-0366(15)00536-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26827250 }} </ref><ref name="pmid27902836">{{cite journal| author=Ritterband LM, Thorndike FP, Ingersoll KS, Lord HR, Gonder-Frederick L, Frederick C et al.| title=Effect of a Web-Based Cognitive Behavior Therapy for Insomnia Intervention With 1-Year Follow-up: A Randomized Clinical Trial. | journal=JAMA Psychiatry | year= 2016 | volume= | issue= | pages= | pmid=27902836 | doi=10.1001/jamapsychiatry.2016.3249 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27902836 }} </ref> | ||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
Revision as of 15:35, 3 December 2016
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Overview
Non-pharmacological therapy
Clinical practice guideline by the American Academy of Sleep Medicine (AASM) noted about cognitive behavior therapy for insomnia:
- “Initial approaches to treatment should include at least one behavioral intervention such as stimulus control therapy or relaxation therapy, or the combination of cognitive therapy, stimulus control therapy, sleep restriction therapy with or without relaxation therapy—otherwise known as cognitive behavioral therapy for insomnia (CBT-I).”[1]
Cognitive behavior therapy for insomnia has been studied in a meta-analysis of 20 randomized controlled trials that compared a combination of two modalities of CBT-i versus various control therapies. Different modalities of CBT-i were defined as cognitive therapy, stimulus control, sleep restriction, sleep hygiene, and relaxation techniques. The meta-analysis found:
- Sleep onset latency improved by 19 (95% CI, 142 to 25) minutes
- Wake after sleep onset was reduced by 26 (95% CI, 15 to 37) minutes
- Total sleep time increased by 8 (95% CI, 1 to 16) minutes
- Sleep efficiency percentage improved by 10% (95% CI, 8% to 12%)
Sleep restriction therapy for insomnia has been studied in a meta-analysis of 4 randomized controlled trials that reported "Weighted effect sizes for self-reported sleep diary measures of sleep onset latency, wake time after sleep onset, and sleep efficiency were moderate-to-large after therapy. Total sleep time indicated a small improvement"; however, the authors add "variability in the sleep restriction therapy implementation methods precludes any strong conclusions regarding the true impact of therapy"[2].
Implementing behavior therapy
Behavior therapy may require as many as 16 sessions[3].
A shorter number of sessions has been studied:
- "Brief behavioral therapy for insomnia" (BBTI) consists of "a 45 to 60-minute individual intervention session followed by a 30-minute follow-up session 2 weeks later and 20-minute telephone calls after 1 and 3 weeks." Goals of therapy were “reduce time in bed, get up at same time every day regardless of sleep duration, do not go to bed unless sleepy, do not stay in bed unless asleep.” In a trial of 82 older adults (mean age 71.7) BBTI led to a response rate of 67% which yielded a relative benefit increase of 2.7 and number needed to treat in their population of 2.4.[4]
Cognitive-behavioral therapy delivered online may help according to randomized controlled trials.[5][6]
References
- ↑ Schutte-Rodin S, Broch L, Buysse D, Dorsey C, Sateia M (2008). "Clinical guideline for the evaluation and management of chronic insomnia in adults". J Clin Sleep Med. 4 (5): 487–504. PMC 2576317. PMID 18853708.
- ↑ Miller CB, Espie CA, Epstein DR, Friedman L, Morin CM, Pigeon WR; et al. (2014). "The evidence base of sleep restriction therapy for treating insomnia disorder". Sleep Med Rev. 18 (5): 415–24. doi:10.1016/j.smrv.2014.01.006. PMID 24629826.
- ↑ Wu R, Bao J, Zhang C, Deng J, Long C (2006). "Comparison of sleep condition and sleep-related psychological activity after cognitive-behavior and pharmacological therapy for chronic insomnia". Psychother Psychosom. 75 (4): 220–8. doi:10.1159/000092892. PMID 16785771.
- ↑ Buysse DJ, Germain A, Moul DE, Franzen PL, Brar LK, Fletcher ME; et al. (2011). "Efficacy of brief behavioral treatment for chronic insomnia in older adults". Arch Intern Med. 171 (10): 887–95. doi:10.1001/archinternmed.2010.535. PMC 3101289. PMID 21263078.
- ↑ Christensen H, Batterham PJ, Gosling JA, Ritterband LM, Griffiths KM, Thorndike FP; et al. (2016). "Effectiveness of an online insomnia program (SHUTi) for prevention of depressive episodes (the GoodNight Study): a randomised controlled trial". Lancet Psychiatry. 3 (4): 333–41. doi:10.1016/S2215-0366(15)00536-2. PMID 26827250.
- ↑ Ritterband LM, Thorndike FP, Ingersoll KS, Lord HR, Gonder-Frederick L, Frederick C; et al. (2016). "Effect of a Web-Based Cognitive Behavior Therapy for Insomnia Intervention With 1-Year Follow-up: A Randomized Clinical Trial". JAMA Psychiatry. doi:10.1001/jamapsychiatry.2016.3249. PMID 27902836.