Non-pharmacological Treatment Of Insomnia Research Articles

The efficacy of ball blankets on insomnia in depression in outpatient clinics: A randomised crossover multicentre trial.

Many patients with depression report insomnia symptoms that profoundly affect their health and well-being. Non-pharmacological treatments of insomnia may be preferable for some patients. In this randomised crossover trial, we investigated the efficacy of the Protac Ball Blanket® on insomnia among patients with depression. Included patients (n = 45) were diagnosed with unipolar depression, and with subjective insomnia and poor sleep quality (Pittsburgh Sleep Quality Index Score > 5). Each patient slept 2 weeks with a Protac Ball Blanket® and 2 weeks with a control duvet. Randomisation defined the order of the 2-week sleep periods. Patients served as their own control in this design. The primary outcome was changes in total night-time sleep. Secondary outcomes were sleep-onset latency, number of awakenings, wake after sleep onset, daily use of pro necessitate sedatives and hypnotics, subjective sleep quality (Pittsburgh Sleep Quality Index), insomnia severity (Insomnia Severity Index), symptoms of depression (Hamilton Depression Rating Scale, Major Depression Inventory), symptoms of anxiety (Beck Anxiety Index), and patient-reported outcomes concerning interpersonal sensitivity, neurasthenia, anxiety and depression (Self-Reported Symptom State Scale). Paired two-sided t-tests were used to compare the means of the differences of the outcomes. Protac Ball Blanket® increased total night-time sleep by 12.9 min (95% confidence interval: 1.21-24.63, p = 0.031). Among the secondary outcomes, Protac Ball Blanket® decreased Hamilton Depression Rating Scale by 2.78 (95% confidence interval: -5.44; -0.11, p = 0.042) and Insomnia Severity Index by 2.98 (95% confidence interval: -5.45; -0.50, p = 0.020). No changes were observed in sleep-onset latency, number of awakenings, wake after sleep onset, Pittsburgh Sleep Quality Index, Major Depression Inventory, Beck Anxiety Index, Self-Reported Symptom State Scale, and medication use. The results suggest that some patients may benefit from Protac Ball Blanket® as an add-on non-pharmacological treatment to improve sleep in depression.

Acupuncture combined with traditional Chinese medicine e-aid cognitive behavioral therapy for insomnia (TCM-eCBT-I) for chronic insomnia: study protocol for a randomized controlled trial

IntroductionThe incidence of insomnia is getting higher and higher. Long-term insomnia seriously affects people’s health. Drug use is usually accompanied with adverse events. Both acupuncture and cognitive behavioral therapy for insomnia (CBT-I) have been proven to be safe and effective non-pharmacological treatments for insomnia. As the insomniacs’ bad sleep behavior and wrong cognition have not been effectively corrected, acupuncture has a quick effect, high patient compliance but unstable long-term efficacy, while CBT-I is complex, time-consuming, and expensive; additionally, patient compliance is low, and the number of trained therapists is limited, making it difficult to carry out. Therefore, this study aims to use the insomnia TCM system to construct a convenient and feasible traditional Chinese medicine e-aid cognitive behavioral therapy for insomnia (TCM-eCBT-I) for Chinese people, and combine the advantages of acupuncture and TCM-eCBT-I for maintaining long-term efficacy, and three treatments will be evaluated to provide clinicians with a more effective clinical protocolMethods and analysisThis study is a single-center, open-label, randomized controlled trial. Ninety subjects will be recruited and randomly assigned to three groups: the acupuncture group, the TCM-eCBT-I group, and the acupuncture combined with TCM-eCBT-I group, in a ratio of 1:1:1. We will evaluate the Pittsburgh Sleep Quality Index (PSQI) and Dysfunctional Beliefs and Attitudes About Sleep Scale (DBAS), Insomnia Severity Index (ISI), sleep diary, Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD), and Fatigue Scale-14 Scale (FS-14) scales. All adverse reactions will be assessed through the ADVERSE event table. All outcomes will be evaluated online at 0 weeks, 4 weeks, 8 weeks, 16 weeks, and 28weeks.Ethics and disseminationThis study has been approved by the Institutional Review Board of the Affiliated Hospital of Nanjing University of Chinese Medicine (2020 NL-018-02). Informed consent will be obtained from all the subjects. The results will be shared with sleep researchers, public, and relevant academic institutions through high-impact peer-reviewed publications.Trial registrationChinese Clinical Trial Registry ChiCTR2000032960. Registered on 17 May 2020

Pharmacological and non-pharmacological treatments for insomnia: A protocol for a systematic review and network meta-analysis.

Background:Although nonpharmacological therapies are recommended as first-line treatments for insomnia, they do not widely implement in practice owing to costly or time-consuming. As a result, pharmacotherapy remains to be commonly prescribed for patients with the sleep disorder. Pharmacotherapy for insomnia consists of different types of drugs. Few studies focused on comprehensively evaluating all available drugs for insomnia. Our review aims to compare efficacy and safety of pharmacological and nonpharmacological treatments by synthesizing direct evidence and indirect evidence to help clinicians and patients make informed decisions for insomnia.Methods:We will search the MEDLINE, EMBASE, and Cochrane Register of Controlled Trials between January 2000 and June 12, 2021. Randomized controlled trials of pharmacological and nonpharmacological interventions for insomnia will be included. Study quality will be assessed on the basis of the methodology and categories described in the Cochrane Collaboration Handbook. Eight network meta-analyses were conducted. A Bayesian network meta-analysis would be performed, and relative ranking of agents would be assessed. A node splitting method will be used to examine the inconsistency between direct and indirect comparisons when a loop connecting 3 arms exists.Results:The results of this paper will be submitted to a peer-reviewed journal for publication.Conclusion:The conclusion of our study will provide updated evidence to rank the effectiveness and safety of pharmacological and nonpharmacological interventions for insomnia.Ethics and dissemination:Ethical approval is not applicable, as this study is a network meta-analysis based on published trials.INPLASY registration number:INPLASY202160031

A scoping review of insomnia treatments for people living with HIV

Abstract
 To date, little is known in terms of viable treatments for insomnia in people living with HIV. The primary aim of this scoping review is to identify non-pharmacological treatments for insomnia in people living with HIV (PLWH). A framework by Arksey and O’Malley was used to guide the conduct of this scoping review. Seven studies were identified. Three of the studies used cognitive-behavioral type of treatments versus physical or alternative types of treatment. The most effective treatments with the largest effect sizes were found to be cognitive-behavioral treatments for the sleep outcomes of sleep quantity (1.11-1.91) and sleep quality (1.11-1.91). This review found that cognitive behavioral interventions were found to be the most effective treatments for insomnia for PLWH. Further research would benefit from larger sample size studies in addition to focusing on the determinants of insomnia in PLWH in order to further provide a treatment that is focused on the needs of PLWH. 

Non-pharmacologic treatment of insomnia in primary care settings.

Prevalence of insomnia is higher in females and increases with higher age. Besides primary insomnia, comorbid sleep disorders are also common, accompanying different conditions. Considering the possible adverse effects of commonly used drugs to promote sleep, a non-pharmacologic approach should be preferred in most cases. Although generally considered first-line treatment, the non-pharmacologic approach is often underestimated by both patients and physicians. To provide primary care physicians an up-to-date approach to the non-pharmacologic treatment of insomnia. PubMed, Web of Science, and Scopus databases were searched for relevant articles about the non-pharmacologic treatment of insomnia up to December 2020. We restricted our search only to articles written in English. Most patients presenting with sleep disorder symptoms can be effectively managed in the primary care setting. Primary care physicians may use pharmacologic and non-pharmacologic approaches, while the latter should be generally considered first-line treatment. A primary care physician may opt to refer the patient to a subspecialist for refractory cases. This paper provides an overview of current recommendations and up-to-date evidence for the non-pharmacologic treatment of insomnia. This article emphasizes the importance of cognitive-behavioral therapy for insomnia, likewise, exercise and relaxation techniques. Complementary and alternative approaches are also covered, eg, light therapy, aromatherapy, music therapy, and herbal medicine.

A Review of Insomnia Treatments for Patients with Mild Cognitive Impairment.

Mild cognitive impairment (MCI) impacts approximately 20% of older adults, with many also experiencing sleep disorders, such as insomnia. Given the relationship between sleep and dementia, addressing sleep issues may offer an opportunity to treat reversible causes. There are two primary treatments for insomnia: behavioral-based (cognitive behavioral therapy for insomnia, CBT-I) and pharmacological interventions. Although CBT-I is recommended as first-line treatment for insomnia in older adults, sedative-hypnotics are more likely to be recommended than non-pharmacological treatments given their convenience and accessibility. However, there are significant concerns in prescribing medications to patients with MCI. To explore this disconnect, we reviewed insomnia treatments in older adults with MCI studies and current guidelines of pharmacological therapy. First, we reviewed studies presenting non-pharmacological treatment of insomnia in older adults with MCI. Although the search yielded over 4,000 non-duplicate titles, only one article presented data on non-pharmacological treatment of insomnia in MCI. The literature covering comorbid insomnia, CBT-I, and MCI is sparse. In contrast to review of non-pharmacological studies, studies on the pharmacological treatment of insomnia in older adults were ample. Finally, we reviewed international guidelines for pharmacological treatment of insomnia in cognitive disorders. More widely used pharmacological interventions show short-term effectiveness with problems of recurrence, ineffectiveness in inadvertent or purposeful chronic use, and adverse side effects. Despite evidence regarding adverse consequences, pharmacological treatment of insomnia remains the most common treatment for insomnia. Reflecting on age-related changes in older adults, particularly those with MCI, inappropriate or mismanagement of medication can lead to unnecessary complications. Further research examining effective behavioral-based sleep management options in older adults with cognitive impairment is needed with exploration of improved sleep on cognitive function.

Managing Insomnia Using Lucid Dreaming Training: A Pilot Study

ABSTRACT Objectives/Background: Despite Cognitive Behavioral Therapy for Insomnia (CBT-I) being considered the first-line treatment for insomnia, it is not without its challenges. As such it is worthwhile to consider, and test, alternative or adjuvant management options. Methods/Participants: The aim of the present study was to examine whether Lucid Dreaming Training for insomnia (LDT-I) impacted on insomnia, depressive and anxious symptomology in an open label trial of 48 adults with Insomnia Disorder. Participants completed the Insomnia Severity Index, General Anxiety Disorder-7 and Patient Health Questionnaire at baseline then one month following LDT-I. Training consisted of four modules delivered over a period of two consecutive weeks. Results: The results suggest, albeit preliminarily, that LDT-I may have a place within the non-pharmacological management of insomnia, as there were significant reductions in insomnia severity (t(46) = 8.16,p <.001), anxious symptomology (t(46) = 4.75,p <.001) and depressive symptomology (t(46) = 5.87,p <.001). Further, the effect size in terms of pre-post reductions on ISI scores was large (dz 1.17). Conclusions: Whilst the results are promising, further testing of LDT-I is needed to inform its place amongst the non-pharmacological treatments for insomnia.

Digital Cognitive Behavioral Therapy for Insomnia in Women With Chronic Migraines.

Insomnia commonly co-occurs with chronic migraines (CM). Non-pharmacological treatments for insomnia in CM patients remain understudied. This is a proof-of-concept study, which aims to evaluate the feasibility, acceptability, and preliminary efficacy of a digital cognitive behavioral therapy for insomnia (dCBT-I) for individuals with CM and insomnia (CM-I) in the United States. We recruited 42 females with CM-I symptoms from a U.S.-based observational cohort and from the general population via advertisements. Within a multiple baseline design, participants were randomized to receive dCBT-I after 2, 4, or 6weeks of completing baseline sleep diaries. DCBT-I was scrutinized against benchmarks for completion rates (≥90% to complete dCBT-I), acceptability (≥80% to find dCBT-I acceptable), and posttreatment changes in insomnia symptoms (≥50% indicating a clinically relevant improvement in their insomnia symptoms). As a secondary measure, we also reported percentage of individuals reverting to episodic migraines. Out of 42 randomized, 35 (83.3%) completed dCBT-I within the 12weeks provided. Of these completers, 33 (94.3%) reported being satisfied (n=16) or very satisfied (n=17) with treatment. Additionally, 65.7% of completers responded to treatment as per universally accepted criteria for insomnia. Lastly, 34% of completers reverted from CM to episodic migraine. This study provides evidence for the feasibility and acceptability of dCBT-I in patients with CM-I complaints. Effects of improving insomnia and migraines were suggested. These results indicate that a randomized controlled trial is needed to determine the efficacy of dCBT-I in CM patients.

Treatment of insomnia in elderly patients

Introduction: Insomnia is one of the most common health conditions amongst the elderly population. It causes suffering and numerous health problems for those affected. Objectives: To review published results of common non-pharmacological and pharmacological interventions of insomnia and to discuss their application in older patient groups. Methods: We conducted a systematic literature review for the topic non-pharmacological treatment of Insomnia in Elderly and non-systematic review on the topic of pharmacological treatment using the electronic databases PubMed, PsycInfo, Google Scholar and Web of Knowledge. Only published articles and reviews were included. Results: Sleep education can support the onset of sleep. As a simple and side-effect-free measure, sleep education should be offered to all elderly individuals with sleep-onset insomnia including those living in retirement homes. Stimulus control means that the bed or the bedroom should only be visited, if there is sufficient tiredness, or left, when tiredness is not sufficient, which is very challenging and sometimes impossible due to the decreasing mobility of the elderly, especially under treatment with hypnotics. Sleep restriction can be conducted in a moderate way, reducing the time spent in bed every week for 30 minutes. Light therapy supports the regulation of the circadian body rhythm by exposing the patients to bright artificial light during the day. As a simple measure with only a few side effects, it is suitable when treating elderly individuals in institutions. Digital therapies are an emerging trend in the treatment of sleep disorders and require further empirical investigation of their effectiveness in the treatment of insomnia in the elderly. Non-pharmacological therapy should be the first-line therapy according to guidelines. Prescribing of sleep medication should take into account the period of time until the maximum effective level is reached, the half-life of the preparation, the binding behaviour to receptors and the metabolism of the preparation, which is especially relevant for elderly populations due to polypharmacy. Conclusion and implications: A modified, short cognitive behavioural therapy for insomnia combined with light therapy is the treatment of choice for elderly patients. However, a short-term pharmacological therapy is recommended as a temporary solution to immediately reduce high levels of distress. It is suggested to integrate both therapeutic approaches into a comprehensive therapeutic concept for insomnia in elderly people.

MINDFULNESS INTERVENTIONS AND SLEEP DISTURBANCE: A MINI REVIEW

Background: Sleep disturbance is a growing medical and public health concern with insomnia increasing worldwide. In addition to exacerbating health problems, insomnia may increase psychological vulnerability and proneness to accidents this is a mini narrative review as to the evidence regarding the efficacy of mindfulness-based interventions in the treatment of sleep disturbances such as insomnia in clinical populations. &#x0D; Method: A search of medical, health, and psychological databases was conducted for mindfulnessbased therapies and intervention variants thereof in the treatment of terms that included: mindfulness-based interventions, mindfulness-based stress reduction (MBSR), mindfulness therapies or treatments AND sleep disturbance, insomnia, poor sleep quality, or sleep disorder. &#x0D; Results: Standard protocol mindfulness-based stress reduction (MBSR) interventions and the specific mindfulness-based therapy for insomnia (MBT-I) have been investigated as potential nonpharmacologic treatments for insomnia and sleep disturbance in clinical populations. Additionally, randomized controlled clinical trials have been conducted in this area to determine efficacy of such mindfulness treatment strategies. &#x0D; Conclusion: Accumulating data indicate that mindfulness treatment protocols produce significant sleep outcome benefits with long-term follow-up duration.

Non Pharmacological Treatment of Insomnia in Multiple Sclerosis Patients: A Brief Review

Non Pharmacological Treatment of Insomnia in Multiple Sclerosis Patients: A Brief Review

State of the Art Reviews: Nonpharmacologic Approaches for the Treatment of Insomnia

Insomnia is a common condition resulting in significant clinical and economic consequences. This review discusses the efficacy of nonpharmacologic treatment options commonly recommended for sleep onset and sleep maintenance insomnia. In addition, the efficacy of these approaches as part of a multifaceted intervention and in comparison to that of pharmacologic options is reviewed. The primary literature and review articles on the nonpharmacologic treatment of insomnia were identified through a MEDLINE search between 1966 and August 2006. Articles on the nonpharmacologic treatment of primary insomnia, including clinical trials on the efficacy of individual and combination treatment options, were reviewed. The nonpharmacologic treatment options for insomnia include stimulus control, sleep hygiene educations, sleep restriction, paradoxical intention, relaxation therapy, biofeedback, and cognitive-behavioral therapy. These treatment strategies produce significant changes in several sleep parameters of chronic ...

A Pilot Study on Adolescents With Depression and Insomnia: Qualitative Findings From Focus Groups

Nonpharmacological treatments for insomnia in adolescents with depression are lacking. This qualitative study was a thematic analysis of the unique characteristics of and preferences for an insomnia treatment in a group of depressed adolescents. Fourteen adolescents with insomnia (age range = 14–19, mean = 17, SD ± 1.7; 71% female) and depression completed a 90-min focus group. Information was elicited about sleep disruptions, insomnia’s impact on mood, and preferences for insomnia treatments. Themes included poor daytime functioning affecting sleep, lack of benefit from sleep medication, and bedtime rumination. Most identified sleep diaries as a barrier to treatment regardless of mode of delivery. Participants also preferred an in-person therapy. Insomnia therapy in adolescents should consider the unique characteristics of depression. Larger studies are warranted.

Nonpharmacological Treatments of Insomnia for Long-Term Painful Conditions: A Systematic Review and Meta-analysis of Patient-Reported Outcomes in Randomized Controlled Trials.

Insomnia is a debilitating comorbidity of chronic pain. This study evaluated the effect of nonpharmacological sleep treatments on patient-reported sleep quality, pain, and well-being in people with long-term cancer and non-cancer (e.g., back pain, arthritis, fibromyalgia) pain conditions. We systematically searched Cochrane CENTRAL, MEDLINE, Embase, and PsychINFO for relevant studies. Search period was set to inception of these databases to March 2014. Studies were included if they were: original randomized controlled trials (RCTs); testing a nonpharmacological intervention; that targets sleep; in adults; with painful health conditions; that has a control group; includes a measure of sleep quality; and at least one other health and well-being outcome. Means and standard deviations of sleep quality, pain, fatigue, depression, anxiety, physical and psychological functioning were extracted for the sleep treatment and control groups at baseline, posttreatment and final follow-up. Methodological details concerning the treatment, participants, and study design were abstracted to guide heterogeneity and subgroup analyses. Eleven RCTs involving 1,066 participants (mean age 45-61 years) met the criteria for the meta-analysis. There was no systematic evidence of publication bias. Nonpharmacological sleep treatments in chronic pain patients were associated with a large improvement in sleep quality (standardized mean difference = 0.78, 95% Confidence Interval [0.42, 1.13]; P < 0.001), small reduction in pain (0.18 [0, 0.36] P < 0.05), and moderate improvement in fatigue (0.38 [0.08, 0.69]; P < 0.01) at posttreatment. The effects on sleep quality and fatigue were maintained at follow-up (up to 1 year) when a moderate reduction in depression (0.31, [0.09, 0.53]; P < 0.01) was also observed. Both cancer and non-cancer pain patients benefited from nonpharmacological sleep treatments. Face-to-face treatments achieved better outcomes than those delivered over the phone/internet. Although the body of evidence was small, nonpharmacological sleep interventions may represent a fruitful avenue for optimizing treatment outcomes in patients with chronic pain. PROSPERO registration: CRD42013004131.

Exercise and Sleep in Community-Dwelling Older Adults.

Insomnia and other sleep complaints are highly prevalent in community-dwelling older adults yet often go under detected. Age-related physiological changes may affect sleep, but sleep disturbances and complaints should not be considered normal in this population. Various physiological, psychological, and social consequences have been associated with insomnia and sleep complaints. Treatment options are available so it is imperative to diagnose and treat these individuals to promote healthy aging. Exercise is known to have a wide variety of health benefits, but unfortunately most older adults engage in less exercise with advancing age. This paper describes age-related changes in sleep, clinical correlates of insomnia, consequences of untreated insomnia, and nonpharmacological treatments for insomnia in older adults, with a focus on the relationship between exercise and sleep in community-dwelling older adults with insomnia or sleep complaints. Possible mechanisms explaining the relationship between exercise and sleep are discussed. While the research to date shows promising evidence for exercise as a safe and effective treatment for insomnia and sleep complaints in community-dwelling older adults, future research is needed before exercise can be a first-line treatment for insomnia and sleep complaints in this population.

Non-pharmacological treatment of insomnia

Chronic insomnia, i. e. complaints about prolonged sleep onset, difficulties in maintaining sleep, early morning awakening and associated impairments of daytime functioning afflicts approximately 10 % of the population in most Western industrialized countries. Chronic insomnia can be due to somatic disorders, mental disorders, intake of medications, legal or illicit drugs. One third of all patients with chronic insomnias suffers from primary insomnia, a diagnosis which is given when none of the above mentioned factors can be identified as a causal factor. In medical practice, insomnia usually is treated with hypnotic drugs or other sedative drugs such as antidepressants. In the last 20 years it was shown that cognitive-behavioral therapy for insomnia can be applied successfully independent of causal factors. Cognitive-behavioral treatment for insomnia (CBT-I) encompasses psychoeducation about sleep and sleep hygiene, relaxation techniques, i. e. progressive muscle relaxation, specific behavioral techniques like stimulus control or sleep restriction and cognitive techniques to reduce nocturnal ruminations. Several published meta-analyses from the last two decades showed that these techniques, especially in their combined form, can be considered as evidence-based. It was shown that they are as effective as pharmacological therapy in the short-term and in the long-run even superior to pharmacotherapy. Cognitive-behavioral techniques for the therapy of insomnia can be used very successfully by trained physicians and psychotherapists.

Nonpharmacologic approach to sleep disorders.

Sleep disturbances are common in patients with cancer, occurring throughout the disease trajectory and sometimes well after treatment has concluded. Insomnia often does not occur in isolation; it may be associated with pain, fatigue, depression, and medication usage. Screening for sleep disturbances is an essential part of caring for oncologic patients. The criterion standard for nonpharmacologic treatment of insomnia in these patients is cognitive-behavioral therapy, a multimodal approach using sleep hygiene and education, stimulus control, sleep restriction, and relaxation. Exercise and complementary and integrative medicine have been studied with varying results, and no firm recommendation can be made about their efficacy.

Mindfulness-Based Stress Reduction Compared With Cognitive Behavioral Therapy for the Treatment of Insomnia Comorbid With Cancer: A Randomized, Partially Blinded, Noninferiority Trial

Our study examined whether mindfulness-based stress reduction (MBSR) is noninferior to cognitive behavioral therapy for insomnia (CBT-I) for the treatment of insomnia in patients with cancer. This was a randomized, partially blinded, noninferiority trial involving patients with cancer with insomnia recruited from a tertiary cancer center in Calgary, Alberta, Canada, from September 2008 to March 2011. Assessments were conducted at baseline, after the program, and after 3 months of follow-up. The noninferiority margin was 4 points measured by the Insomnia Severity Index. Sleep diaries and actigraphy measured sleep onset latency (SOL), wake after sleep onset (WASO), total sleep time (TST), and sleep efficiency. Secondary outcomes included sleep quality, sleep beliefs, mood, and stress. Of 327 patients screened, 111 were randomly assigned (CBT-I, n = 47; MBSR, n = 64). MBSR was inferior to CBT-I for improving insomnia severity immediately after the program (P = .35), but MBSR demonstrated noninferiority at follow-up (P = .02). Sleep diary-measured SOL was reduced by 22 minutes in the CBT-I group and by 14 minutes in the MBSR group at follow-up. Similar reductions in WASO were observed for both groups. TST increased by 0.60 hours for CBT-I and 0.75 hours for MBSR. CBT-I improved sleep quality (P < .001) and dysfunctional sleep beliefs (P < .001), whereas both groups experienced reduced stress (P < .001) and mood disturbance (P < .001). Although MBSR produced a clinically significant change in sleep and psychological outcomes, CBT-I was associated with rapid and durable improvement and remains the best choice for the nonpharmacologic treatment of insomnia.

Stress management techniques in primary insomnia: a randomized controlled trial

Introduction Background Insomnia is conceived as the subjective complaint of reduced sleep quantity and/or quality. En order for the diagnosis to be made, this complaint must be present quite frequently (at least three times per week) for a considerable period of time (at least for one month). Psychophysiological factors such as stress are often presumed to play a major role in the onset and maintenance of primary insomnia. The treatment should not only focus on ameliorating sleeplessness, it should also address all those factors that cause and maintain insomnia, turning it to a chronic condition. Non-pharmacological treatments, such as stress management techniques can be easily and inexpensively administered in treatment with good results. The aim of this study is to identify the effectiveness of stress management techniques as a treatment in primary insomnia. Materials and methods This is a two-armed parallel group, randomized controlled trial. Primary insomniacs were randomly assigned to undergo either an 8-week CD-based stress management program ( n = 27) (relaxation breathing, progressive muscle relaxation and guided imagery twice a day) or a control condition ( n = 26) both of the groups took information about insomnia and they participate once in a week in consultative meetings for the treatment of insomnia). Self-reported validated measures were used to evaluate insomnia, quality of sleep and symptoms of depression and anxiety at baseline, at the 4th week and at the end of 8 weeks. Also, we measured perceived stress and ”health locus of control” (through scale which is appropriate to identify what it is responsible for the heath problems of an individual) at baseline and at the end of the 8 weeks. Also, free cortisol, as a biological marker of stress, was measured in saliva samples taken three times a day at baseline, at the 4th week and at the end of 8 weeks. Finally, we measured the satisfaction with the stress management program and the compliance with the therapeutic instructions. Results At the end of 8 weeks of the relaxation program, in the intervention group, we noticed decrease in insomnia and improvement on sleep quality. Also, in this group, we found improvements on perceived stress and salivary cortisol, biological marker of stress. As far as symptoms of depression and anxiety are concerned, there was significant decrease at the end of the relaxation program. Finally, there was no change in health locus of control after the practice of stress management techniques. Conclusion The training of patients with primary insomnia in relaxation techniques contributes to decrease in stress and the symptoms of primary insomnia. Simple techniques such as diaphragmatic breathing, progressive muscle relaxation and guided imagery which are easily applicable, may be regarded as effective and low cost non-pharmacological treatment of insomnia. Acknowledgements I would like to thank Dimitrios Dikeos, Associate Professor of Psychiatry at Eginition Hospital for his help to fullfill this study.

Future outlook of nonpharmacological treatments for insomnia in adults: clinical trial progress

Meta-analyses [1,2], treatment guidelines [3] and a NIH State-of-the-Science Conference statement in 2005 [4] have concluded that the most widely evaluated nonpharmacological treatment for chronic insomnia in adults, cognitive-behavior therapy for insomnia (CBT-I), is efficacious. CBT-I is a multi component treatment consisting of stimulus control therapy, sleep restriction therapy, cognitive therapy, psychoeducation about sleep and sleep hygiene, arousal reduction procedures, such as relaxation and meditation, and methods for changing sleep–wake circadian rhythms such as the scheduling of exposure to bright light. See Bootzin and Epstein [5] for descriptions of the CBT-I components. Both hypnotics and CBT-I improve sleep [2]. An advantage that CBT-I has over the prescription of hypnotics is that following CBT-I, improvement is maintained for as long as 2 years after treatment is discontinued [4]. In contrast, after treatment with hypnotics ends, insomnia symptoms tend to reappear. One major challenge for the use of CBT-I is a shortage of clinicians trained to provide it. This has stimulated a number of new efforts to make CBT-I more available. New directions include: ■ Implementing large-scale training programs for clinicians by national providers such as the Veterans Health Administration;