The Role of Behavioural Treatment in the Management of Insomnia
Arthur J. Spielman
Insomnia is a highly prevalent complaint among the general public that can affect an individual's health, performance and quality of life. Despite its broad effects, patients' help-seeking rate is very low. One possible reason for this is the patients' lack of knowledge about treatment options for insomnia. In order to facilitate understanding and appreciation of the behavioural treatments of insomnia, this article offers an overview of clinical indications, procedures, and expected short term and long term effects of various effective behavioural treatments for insomnia. Treatments discussed include: 1. stimulus control instructions that eliminate the maladaptive association between bedtime cues and anxiety 2. sleep restriction therapy that enhances central sleep mechanisms by systematically curtailing the amount of time in bed 3. relaxation techniques that promote sleep by reducing physiological tension and cognitive arousal 4. biofeedback protocols that produce relaxation or enhance sleep regulation through the feedback of physiological measures 5. cognitive therapies that facilitate sleep onset by alleviating pre-sleep cognitive arousal 6. sleep hygiene that improves sleep by avoiding habits and activities interfering with sleep; and 7. chronotherapy and light therapy that facilitate sleep regulation based on the principles of circadian rhythmicity.
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