Chronic insomnia treatment
Many people all over the world suffer from insomnia, and seek chronic insomnia treatment. The National Heart, Lung, and Blood Institute Working Group on Insomnia defines insomnia as an experience of inadequate or poor-quality sleep characterized by one or more of the following: difficulty falling asleep, difficulty maintaining sleep, waking up too early in the morning, or unrefreshing sleep. The symptoms of insomnia also include daytime consequences such as tiredness, lack of energy, difficulty concentrating, or irritability. Insomnia can be a symptom of an underlying medical, psychiatric, sleep, or circadian disorder or a disorder in itself (i.e., primary insomnia).
Chronic insomnia is prevalent in 10% of the adult population. Age, sex, medical and psychiatric disease, and shift work all represent an increased risk of chronic insomnia. Although insomnia is typically secondary to a medical, psychiatric, circadian, or sleep disorder, it can also be a primary disorder. Primary insomnia is estimated to occur in 25% of all chronic insomnia patients. While transient insomnia produces sleepiness and impairment in psychomotor performance, chronic insomnia is associated with absenteeism, frequent accidents, memory impairment, and greater health care utilization.
Until recently, the most common chronic insomnia treatment has pharmacological, using sedatives, tranquilizers, and hypnotics. However, several researchers have found that the regular use of these drugs for several weeks may in some cases lead to a loss of effectiveness, disturbance of the quality of sleep with the possibility of psychological dependence (Kales &Kales, 1973; Karacan & Williams, 1971), and thus is not a desired chronic insomnia treatment .
But times have changed. New, non-pharmacological ways to treat chronic insomnia have been developed over time, showing great promise.
A 1999 study entitled ” Nonpharmacologic treatment of chronic insomnia”, performed by Morin and others, reviewed evidence gathered by 48 clinical trials, and concluded that nonpharmacological therapies produce reliable and durable changes in several sleep parameters of chronic insomnia sufferers, thus constituting an excellent chronic insomnia treatment. The data indicate that between 70% and 80% of patients treated with nonpharmacological interventions benefit from treatment. For the typical patient with chronic insomnia, non-pharmacological treatment is likely to reduce the main symptoms of sleep onset latency and wake time after sleep onset. Sleep duration is also increased and sleep quality and patient’s satisfaction with sleep patterns are significantly enhanced. Another important advantage of Nonpharmacologic chronic insomnia treatment over drug treatment is that Sleep improvements achieved with these interventions were found to be sustained for at least 6 months after treatment completion.
Certain types of treatments have been proven as effective treatments for chronic insomnia. These include, among others: Stimulus control, progressive muscle relaxation, paradoxical intention, Sleep restriction, and multifaceted cognitive-behavior therapy.
Stimulus control, a technique developed by Bootzin in 1972 has shown the highest rates of effectiveness in chronic insomnia treatment compared to other behavioral techniques. (Zwart & Lisman, 1979; Lawrence & Tokarz, 1976). the primary goals of the stimulus control technique are to restore the bed to its function as a sleep-inducing signal and conversely to weaken its link as a cue for activities that are incompatible with sleep and finally to acquire a consistent sleep rhythm.
Stimulus control rules include:
1. Go to bed only if you feel sleepy
2. Avoid activities in the bedroom that keep you awake, other than sex
3. Sleep only in your bedroom
4. Leave the bedroom when awake
5. Return to the bedroom only when sleepy
6. Arise at the same time each morning regardless of the amount of sleep obtained that night
7. Avoid daytime napping
Progressive muscle relaxation - is a technique of stress management developed by American physician Edmund Jacobson in the early 1920s . Progressive relaxation involves alternately tensing and relaxing the muscles. The effect of the tension-relaxation sequence is to cause deeper relaxation than would be achieved by simply attempting to relax. Many people use this method as successful chronic insomnia treatment.
Paradoxical intention – Paradoxical Intention is a cognitive treatment approach for sleep-onset insomnia. it is a technique invented by Viktor Frankl, and it involves the insomnia patient deliberately trying to stay awake. It is thought to operate by eliminating voluntary sleep effort, thereby reducing sleep performance anxiety, an aroused state incompatible with sleep.
Sleep restriction- is a new technique, pioneered by Spielman. This chronic insomnia treatment is based on the recognition that excessive time spent in bed is one of the important factors that perpetuates insomnia. Therefore, Sleep restriction therapy aims to reduce the sleeper’s time in bed to be approximately equivalent to his reported sleep time. For example, if a chronic insomnia therapy reports sleeping an average of 5 hours per night, out of 8 hours spend in bed, the initial recommended sleep window (from lights out to final arising time) would be restricted to 5 hours. Periodic adjustments to this sleep window are made subject to sleep efficiency, until an optimal sleep duration is reached.
Multifaceted cognitive-behavior therapy – these are Psychological methods aimed at changing misconceptions about sleep and faulty beliefs about insomnia and its perceived daytime consequences. It can include cognitive procedures such as paradoxical intention or methods aimed at reducing or preventing excessive monitoring and worrying about insomnia and its consequences. cognitive-behavior therapy often includes certain techniques as described above ( e.g – stimulus control, sleep restriction ), as well as requesting the chronic insomnia patient to obey the sleep hygiene rules, which are general guidelines about health practices and environmental factors that may promote or interfere with sleep. Multifaceted cognitive-behaviour therapy is emerging as a very useful chronic insomnia treatment.
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