Primary Insomnia (cont.)
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Primary Insomnia Other 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:
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.
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:
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.
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.
Aparna Ranjan, MD
Angela Gentili, MD
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