SLEEP RESTRICTION TREATMENT OF CHRONIC INSOMNIA

Abstract

Insomnia is one of the most frequent complaints made to physicians. Dissatisfaction with present pharmacotherapy has led to the development of alternative treatments. Hypnotics and sedatives however remain the mainstay of insomnia treatment because of a lack of effective alternative therapy. This study describes the methods and results of a new treatment for chronic insomnia that involves restricting available sleep time and altering time spent in bed according to the individual progress of each patient.;Thirty-five subjects (18M/17F) complaining of insomnia at a major Sleep Disorders Center agreed to participate in this treatment program. All subjects completed a two-week sleep diary to establish pre-treatment baseline values. Treatment consisted of prescribing individual sleep-wake schedules by setting time spent in bed equal to the average reported sleep time during the baseline period. Subjects monitored their sleep-wake behavior on logs for eight weeks of treatment and reported their Time in Bed (TIB) and Sleep Time daily to a telephone answering machine. When subjects maintained a Sleep Efficiency Index (Sleep Time/TIB x 100) of 90 percent or greater for an average of five days the individual sleep schedule was extended by setting the retiring time 15 minutes earlier.;By the end of treatment, sleep latency was decreased by 29.9 minutes (p < 0.0005) and wake time was decreased by 109.5 minutes (p < 0.0005). Sleep time was increased 23.2 minutes (p < 0.01) and sleep efficiency showed an increase of 20 percent (p < 0.0005).;Subjects were divided into two groups post-hoc based upon their reported sleep time during baseline. Those with an average of less than five and a half hours of sleep nightly improved to a greater extent that those with greater than five and a half hours of reported sleep. The latter group also demonstrated higher psychopathology on the MMPI. Both groups reported symptomatic improvement of their insomnia complaint.;The sleep restriction treatment is an effective therapy for chronic and severe insomnia. The mild sleep loss at the start of treatment may serve to reduce arousal as well as to increase the need for sleep. The consolidation of the nocturnal sleep pattern enables a reduction in the night-to-night variability of sleep, lessening the anticipatory anxiety regarding sleep and reducing the opportunity for maladaptive conditioning to occur.