Further research is very unlikely to change the confidence in the estimate of effect. Further research may change the confidence in the estimate of effect and may change the estimate. Further research is likely to change the confidence in the estimate of effect and is likely to change the estimate.
Stimulus control is also often a component of cognitive behavior therapy for insomnia, multicomponent behavior, and brief behavior therapy. Management of insomnia disorder in adults: current state of the evidence. Clinician research summary. Rockville, Md. Accessed May 15, Note: Most studies of pharmacologic interventions were small and of short duration less than three months. Somnolence, unpleasant taste in the mouth, headache, dizziness, dry mouth, rash, anxiety, hallucinations, respiratory infection.
Central nervous system depressant effects and next-day psychomotor impairment Increased central nervous system effects in older adults Sleep-driving and other complex behaviors while not fully awake Worsening depression or suicidal thoughts Falls and severe injuries because of drowsiness Severe anaphylactic or anaphylactoid reactions Possible respiratory depression in persons with severe lung disease or sleep apnea Withdrawal symptoms if abrupt dose reduction or discontinuation.
Abnormal thinking, behavior changes, complex behaviors including sleep-driving, hallucinations Worsening depression or suicidal thoughts in persons with primary depression Severe anaphylactic or anaphylactoid reactions Possible profound sedation, respiratory depression, coma, and death with concomitant opioid use Possible adverse effects in persons with severe lung disease or sleep apnea.
Central nervous system depressant effects and next-day psychomotor impairment Sleep-driving and other complex behaviors while not fully awake Sleep paralysis, hypnagogic or hypnopompic hallucinations, cataplexy-like symptoms Worsening depression or suicidal thoughts Possible respiratory depression in persons with severe lung disease or sleep apnea.
Potential impairment of activities requiring complete mental alertness after drug ingestion Abnormal thinking, behavior changes, complex behaviors including sleep-driving, hallucinations Worsening depression or suicidal thoughts Severe anaphylactic or anaphylactoid reactions Decreased testosterone and increased prolactin levels Possible adverse effects in persons with severe sleep apnea. Central nervous system depressant effects, with impaired alertness and motor coordination that may persist the next day Abnormal thinking, behavior changes, complex behaviors including sleep-driving, hallucinations Potential addictive effects when combined with central nervous system depressants or sedating antihistamines Worsening depression or suicidal thoughts Possible respiratory depression in persons with severe lung disease or sleep apnea.
Insomnia is a common problem addressed by family physicians and accounts for more than 5. This Agency for Healthcare Research and Quality AHRQ review included 59 randomized controlled trials studying psychological interventions in the general adult population, older adults, and adults with pain conditions.
Results included global outcomes, such as improvements in sleep and daytime dysfunction or distress, and sleep outcomes, which assessed specific sleep parameters sleep onset latency, time awake after sleep onset, total sleep time, sleep quality, and sleep efficiency. Duration of insomnia ranged from six months to 19 years, with a duration of more than 10 years in most studies.
Psychological interventions included stimulus control, sleep restriction, relaxation techniques, sleep hygiene education, and CBT for insomnia. CBT for insomnia is a combination of cognitive therapy, behavioral interventions i. There were insufficient data to draw conclusions on the effectiveness of specific interventions alone e.
Improvements were sustained for at least six months. Among older adults and patients with pain conditions, CBT for insomnia improved global outcomes and some sleep outcomes. There was insufficient evidence to assess adverse effects of psychological treatments. There were 38 randomized controlled trials identified that evaluated pharmacologic therapies, including nonbenzodiazepine hypnotics eszopiclone, zaleplon, zolpidem , an orexin receptor antagonist suvorexant , melatonin agonists prolonged-release melatonin, ramelteon , an antidepressant doxepin , and a benzodiazepine hypnotic temazepam.
Most of these studies were of short duration and had a small sample size. Eszopiclone, zolpidem, and suvorexant had the strongest evidence of effectiveness in the general adult population for global and sleep outcomes.
Doxepin had the strongest evidence of effectiveness for global and sleep outcomes among adults 55 years and older.
Ramelteon did not improve global or sleep outcomes in a clinically meaningful way when compared with placebo. Very few benzodiazepine trials met eligibility criteria primarily because of short treatment duration, and data from the included studies were insufficient to assess sleep outcomes.
Adverse events were mixed across studies, with few differences compared with placebo. Psychological and behavioral interventions are considered first-line treatments for insomnia.
The U. Food and Drug Administration has approved pharmacologic therapy for short-term use four to five weeks and suggests that medications not be used for extended periods. If insomnia does not improve after seven to 10 days of pharmacotherapy, the patient should be further evaluated. The authors of this manuscript are responsible for its content. Already a member or subscriber? Log in. Interested in AAFP membership? Learn more. Reprints are not available from the author.
Accessed May Trends in outpatient visits for insomnia, sleep apnea, and prescriptions for sleep medications among US adults: findings from the National Ambulatory Medical Care survey — Sleep-wake disorders. Manifestations and management of chronic insomnia in adults. Evid Rep Technol Assess Summ. Insomnia and health-related quality of life. Sleep Med Rev.
Clinical guideline for the evaluation and management of chronic insomnia in adults. J Clin Sleep Med. Management of chronic insomnia disorder in adults: a clinical practice guideline from the American College of Physicians. Ann Intern Med. Practice parameters for the psychological and behavioral treatment of insomnia: an update. An American Academy of Sleep Medicine report. Teaching relaxation exercises can engender a beneficial sense of contro Nightmare Exposure And Rescripting Imagery rescripting is an effective treatment for intrusive and unwanted memories.
Nightmare Exposure And Rescripting employs similar techniques and c Nightmare Rescripting Audio Nightmare rescripting is an evidence based treatment for nightmares, with medium to large effect sizes on nightmare frequency, distress, intensity, an Peaceful Place Audio The Peaceful Place exercise guides the listener through a short imagery exercise designed to facilitate the visualization of soothing imagery and noti Edmund Jacobsen developed a systematic and lengthy Progressive Muscle Relaxation Audio The Progressive Muscle Relaxation exercise guides the listener through a sequence in which muscle groups are tensed and relaxed.
Progressive Muscle Relaxation Edition 1 Muscle tension is one reaction to stress and anxiety. This exercise includes instructions for Progressive Muscle Relaxation, a technique for promoting The audio col Recognizing Insomnia Insomnia is characterized by difficulty with sleep quality or quantity. Recovering From A Nightmare Audio The Recovering From A Nightmare exercise gives straightforward information, advice, and strategies on how to quickly reorient oneself after a nightmar Relaxed Breathing Exercise 1 Audio Breathing Exercise 1 guides the listener through simple instructions to make their breathing slower, deeper, and more regular.
Relaxed Breathing Exercise 2 Audio Breathing Exercise 2 uses the imagery of inflating a balloon to help the listener make their breathing slower, deeper, and more regular. Relaxed Breathing Exercise 3 Audio Breathing Exercise 3 uses the imagery of breathing air of different colours to help the listener make their breathing slower, deeper, and more regular Relaxed Breathing Exercise 4 Audio Breathing Exercise 4 guides the listener through simple instructions to breathe in a more relaxed fashion.
Sleep Diary Many clients report that their sleep is disturbed, and this can be a cause or consequence of many mental health conditions. This Sleep Diary enables c Sleep Hygiene Audio Sleep hygiene is a commonly utilized treatment option for insomnia and is offered as a stand-alone treatment and as part of multimodal treatments.
Sleep Restriction Sleep restriction is behavioral intervention used in the treatment of insomnia. It is an evidence based treatment for insomnia, both as a standalone t Therapy Blueprint Since the publication of this version of the therapy blueprint we have also developed a more sophisticated version: Therapy Blueprint Universal A th Unhelpful Thinking Styles Human thinking is subject to a number of characteristic biases.
Cognitive restructuring is the process of helping individuals to overcome their biases A new method for measuring daytime sleepiness: the Epworth sleepiness scale. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry research , 28 2 , Cognitive—behavioral therapy for primary insomnia.
Clinical Psychology Review , 25 5 , download archived copy Kyle, S. Towards standardisation and improved understanding of sleep restriction therapy for insomnia disorder: a systematic examination of CBT-I trial content. Sleep medicine reviews , 23 , Sleep and Biological Rhythms , 9 1 , download Sheaves, B.
Adapted CBT to stabilize sleep on psychiatric wards: a transdiagnostic treatment approach. Behavioural and cognitive psychotherapy , 46 6 , Self-help therapy for insomnia: a meta-analysis.
Symptoms Associated with Poor Sleep and Insomnia Insomnia disorder is characterized by a complaint of dissatisfaction with sleep quantity or quality, associated with one or more of: difficult initiating sleep difficulty maintaining sleep early-morning awakening with inability to return to sleep Nightmare disorder is characterized by repeated occurrences of extended, extremely dysphoric, and well-remembered dreams which usually involve efforts to avoid threats to survival, security, or physical integrity.
Psychological Models and Theory of Insomnia A range of psychological models of insomnia are reviewed in detail in Talbot and Harvey Evidence-Based Psychological Approaches for Working with Insomnia Evidence-based psychological approaches for working with insomnia include: sleep restriction therapy stimulus control therapy cognitive behavioral therapy for insomnia CBT-I Resources for Working with Sleep—Wake Disorders Including Insomnia Psychology Tools resources available for working therapeutically with sleep—wake disorders including insomnia include: psychological models of sleep—wake disorders including insomnia information handouts for sleep—wake disorders including insomnia exercises for sleep—wake disorders including insomnia CBT worksheets for sleep—wake disorders including insomnia self-help programs for sleep—wake disorders including insomnia References Bootzin, R.
Stimulus control treatment for insomnia. Proceedings of the American Psychological Association , 7 , — Espie, C. Insomnia: Conceptual issues in the development, persistence, and treatment of sleep disorder in adults. Annual Review of Psychology , 53 , — The attention-intention-effort pathway in the development of psychophysiologic insomnia: A theoretical review. Sleep Medicine Review , 10 4 , —
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