Chapter 15 - Brief Behavioral Treatment of Insomnia

Abstract

Brief behavioral treatment of insomnia (BBTI) is indicated for the treatment of insomnia, defined as difficulty falling or staying asleep, early morning awakenings, or complaints of nonrestorative sleep, occurring on more days than not over more than a month, and associated with significant distress or functional impairments. BBTI is similar to standard cognitive behavioral treatment of insomnia (CBT-I) in combining and emphasizing the early implementation of stimulus control and sleep restriction principles and procedures. Education about healthy sleep practices and behaviors that affect sleep quality and consolidation is also provided to patients in BBTI in a way that is comparable to CBT-I. BBTI differs from standard CBT-I in important ways. BBTI uses a reduced number of in-person visits, and a shorter length of the intervention in BBTI (two in-person visits over 4 weeks) compared to CBT-I (six to eight in-person visits over 8 weeks). In addition, BBTI does not systematically address or restructure erroneous beliefs and attitudes about sleep, insomnia, and the potential consequences of poor sleep. BBTI is indicated for the treatment of primary insomnia, or insomnia comorbid with other psychiatric, medical, or sleep disorders. One should take caution in using BBTI with patients with a diagnosis of bipolar disorder or psychotic disorder, as the transient, mild sleep restriction induced by BBTI may exacerbate these conditions. The prescription for time in bed during BBTI with older adults should generally not be less than 6 hours to reduce the risk of falls.