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Insomnia
Insomnia is a prevalent condition affecting about
10% of the adult population on a chronic basis. It involves
either difficulties falling asleep, staying asleep,
early morning awakenings, or nonrestorative sleep. Insomnia
can occur as a unique disorder, as in primary
insomnia, or may be secondary to an another medical (e.g., cancer) or psychological condition (e.g., depression
or anxiety).
Chronic sleep disturbances are often
associated with negative daytime consequences such as
fatigue and mood disturbance, thus significantly affecting
one’s quality of life. Despite its high prevalence and
potential impact on social or occupational functioning,
only a small portion of individuals with chronic primary
insomnia actually receives any treatment.
For
those who do seek relief for their insomnia, the first interventions
are usually self-initiated and generally involve
medications bought over-the-counter, natural
products, or the use of alcohol. When insomnia is
brought to the attention of physicians, pharmacotherapy
is the most widely used and often the only recommended
treatment option, despite the controversy
existing over the long-term use of hypnotic medications.
In the past 20 years, there has been an increasing
interest in psychological and behavioral factors contributing
to insomnia. This had led to the development
of diverse psychological therapies for insomnia, many
of which have been shown to produce significant and durable effects. However, these interventions remain
underutilized because they are not well known to
health care practitioners and are less easily accessible,
both physically and financially, than pharmacotherapy.
A self-help treatment for insomnia is a valuable alternative
to overcome some of these barriers by making
treatment more accessible, at a low cost, to a larger
number of individuals with insomnia. Self-help treatment
refers to any intervention, either for a psychological
or physical condition, that is implemented with the
assistance of printed material (e.g., books, pamphlets),
audio- or videotapes, or any other medium (e.g., Internet).
It can be implemented with or without guidance
from a health care professional.
Self-Help Treatments for Insomnia
Cognitive Therapy for Insomnia
Poor sleepers tend to entertain faulty beliefs and attitudes
about sleep, which feed into the vicious circle of
insomnia, emotional distress, and more sleep disturbance.
As such, insomnia often becomes a self-fulfilling
prophecy. For instance, the belief that 8 hrs of sleep is
an absolute necessity, or the perception that one is unable
to function after a poor night’s sleep is often
enough to produce anxiety and exacerbate sleep disturbances.
The objective of cognitive therapy is to alter
these types of sleep-related cognitions by challenging
them and replacing them with more adaptive substitutes.
Several clinical procedures, modeled after those
used in treating anxiety and depression, can be used for
changing patients’ misconceptions about sleep.
Such techniques include attention shifting, reappraisal, reattribution
training, and decatastrophizing. Cognitive
therapy is also used to teach patients strategies to cope
more adaptively with residual difficulties that recur occasionally
even after treatment.
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