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Primary Insomnia (cont.)

What other therapies treat and cure primary insomnia?

Behavioral therapy: Behavioral therapy is now considered the most appropriate treatment for persons with sleeplessness without any medical, psychiatric, or environment cause.

  • It consists primarily of short-term cognitive behavioral therapies. The focus is primarily on sleep hygiene or factors presumed to cause insomnia. As such, these therapies seek to modify maladaptive sleep habits and to educate persons about healthier sleep practices.

Stimulus control therapy: The purpose of this therapy is to reestablish the connection between the bed and sleep by prohibiting the person from engaging in nonsleep activities while in bed. The following instructions are given:

  • Go to bed only when sleepy.
  • Use the bed and bedroom only for sleep and intimacy.
  • Avoid trying to force sleep (go into another room whenever unable to fall asleep within 20 to 30 minutes, and return to bed only when sleepy again).
  • Get up at the same time each morning regardless of how much one has slept the previous night.
  • Avoid daytime napping.

Sleep restriction therapy: This involves limiting the amount of time the person spends in bed to the actual amount of time the person usually spends sleeping. This results in sleep deprivation, which accumulates and causes more rapid sleep onset on subsequent nights. As sleep improves, the person is allowed to gradually increase time in bed by 15 to 30 minutes.

Relaxation therapies: The person is taught to identify and control tension. Relaxation-based interventions are advised based on the observation that persons with insomnia often display high levels of arousal both at night and during the daytime. The various techniques available to deactivate the arousal system are:

  • The person is taught progressive muscle relaxation through a series of exercises that consist of first tensing and then relaxing each muscle group in a systematic way.
  • The biofeedback technique is a training technique that enables an individual to gain some element of voluntary control over certain body parameters (for example, heart rate, rate of breathing). This technique provides an immediate feedback regarding the levels of tension and teaches a person how to relax in a short time.
  • Imagery training and thought stopping teaches the person how to focus on neutral or pleasant things instead of focusing on racing thoughts.

Cognitive therapy: This consists of identifying person-specific activities associated with thinking that disrupts sleep, challenging their validity, and replacing them with substitutes such as reattribution training (a simple technique that has been used successfully to help persons to recognize that their minds play a part in causing their physical symptoms), reappraisal, and attention shifting.

Paradoxical intention: This method consists of persuading a person to engage in his or her most feared behavior (for example, staying awake). This serves to eliminate performance anxiety so that sleep may come more easily.

What is the outlook for a person with primary insomnia?

The outlook for primary insomnia is good if the person adopts good sleep habits. It is important to note that one's health is not at risk if one does not get 6 to 8 hours of sleep every day and that different people have different natural sleep requirements. However, the following have been associated with insomnia:

  • Increased risk of death is associated with short sleep lengths.
  • Insomnia is the best predictor of the future development of depression.
  • Increased risk exists of developing anxiety, alcohol and drug use disorders, and nicotine dependence.
  • Poor health and decreased activity occur.
  • Onset of insomnia in older persons is related to decreased survival.

Medically reviewed by Jon Glass, MD; American Board of Psychiatry and Neurology

REFERENCE:

Bonnet, M.H., PhD. et al. "Clinical features and diagnosis of insomnia." UpToDate. Updated: Dec 15, 2015.<http://www.uptodate.com/contents/clinical-features-and-diagnosis-of-insomnia>


Medically Reviewed by a Doctor on 8/26/2016
Medical Author:

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Primary insomnia is sleeplessness that is not attributable to a medical, psychiatric, or environmental cause.

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