Sleepeducation.com Research Summary

Study Title

Practice Parameters for the Psychological and Behavioral Treatment of Insomnia: An Update. An American Academy of Sleep Medicine Report

Publication

The November 1, 2006, issue of the journal Sleep

Goal

To provide an updated review of the current scientific research and to give doctors recommendations that should meet the needs of most patients

Importance

Insomnia is a common condition. About one-third of adults have symptoms of insomnia. It is more common in women and older adults. Ongoing insomnia can be related to a reduced quality of life.

These are some common complaints related to insomnia:

• Daytime fatigue
• Memory problems
• Mood disturbances

People with insomnia also tend to miss work more often and have higher health-care costs.

Results

Psychological and behavioral treatments produce positive results for people with ongoing cases of insomnia. These treatments can even help when the insomnia is related to other conditions. These conditions include:

• Cancer
• Pain
• Alcohol abuse
• Some mental problems

Positive results are maintained at follow-up points of up to 12 months.

Older adults with insomnia respond to these treatments as well as younger adults. These treatments also can help older adults stop using sleeping pills.

The research supports using these methods for adults who are 18 years of age and older:

• Stimulus control therapy

You are taught to go to bed only when sleepy. You learn to get out of bed if you are unable to sleep. You only use the bed for sleeping. You wake up at the same time every morning and avoid naps.

• Relaxation training

This method helps you reduce muscle tension. It also helps you get rid of negative thoughts that interfere with your sleep.

• Sleep restriction

You shorten your amount of time in bed to the actual amount of time that you sleep. Then you slowly extend your time in bed as your sleep improves.

• Cognitive behavior therapy

This combines behavioral and psychological methods. It keeps you from repeating actions that hinder your sleep. It also helps you change your thoughts and attitudes about sleep.

• Paradoxical intention

This method helps people who have trouble falling asleep. You are told to remain awake and avoid any effort to fall asleep. It keeps you from trying too hard to fall asleep.

• Biofeedback

This uses visual images or sounds to help you control your muscle tension or mental activity.

• Multicomponent therapy

Combining more than one behavioral method can be effective. It can help address the varying factors that may be related to a case of insomnia.

• Sleep hygiene education

This method often is combined with other behavioral treatments. You learn how to develop healthy sleep habits. You also learn how to create a good sleep environment. Studies have not yet shown if it is effective when it is the only treatment involved.

What it Means to You

Adults with an ongoing case of insomnia should consider these treatment options. Discuss these treatments with your doctor. He or she can help you decide which method may work best for you. Your doctor may refer you to a sleep specialist for more help.

Participants

The study group consisted of 2,246 adults who were 18 years of age and older. Most of the studies involved about twice as many women as men.

Study Design

A task force of experts reviewed scientific studies that were published between 1998 and 2004. A total of 37 studies were included in the review.

Study Methods

Each study was evaluated to determine the quality of its evidence.

Limits of the Study

• There is currently not enough evidence to recommend the use of one treatment over another. Few studies have conducted “head-to-head” comparisons.

• Few studies measure the effectiveness of these treatments for longer than one year.

• There is little evidence to show how these treatments improve daytime functioning and quality of life.

• There is a need for more studies to compare the cost of insomnia treatments.

Lead Author

Timothy Morgenthaler, MD, of the Mayo Clinic in Rochester, Minnesota

Conflicts of Interest

This was not an industry-supported study.

View the study abstract online.

To find a specialist near you who is trained in behavioral sleep medicine, visit the Web site of the American Academy of Sleep Medicine.

Reviewed by David A. Kristo, MD
Updated November 21, 2006