Treatment Of Chronic Insomnia Research Articles

Efficacy of Bailemian capsule combined with self-help cognitive behavioral therapy in treatment of chronic insomnia

Objective: To evaluate the efficacy of Bailemian capsule combined with self-help cognitive behavioral therapy (CBTI-SH) in treatment of chronic insomnia. Methods: Approved by the Ethics Committee of the hospital, 60 patients with chronic insomnia were randomly divided into two groups, the test group (Bailemian capsule combined with CBTI-SH) and the control group (CBTI-SH alone). Each group contained 30 cases. After 4 weeks for therapy, the sleep quality, mood and adverse reactions of treatment in patients were evaluated by sleep diary, sleep severity index scale (ISI), self-rating anxiety scale (SAS), self-rating depression scale (SDS) and treatment emergent symptom scale (TESS) respectively. The data were statistically analyzed. Results: The total effective rate in the test group was significantly higher than that of the control group (73.3% vs 46.7%, P<0.05). Compared to the control group, the sleep onset latency was significantly shorten [(38.3±13.1) vs (27.5±9.8) min, P<0.05], while the sleep efficiency were increased markedly [(76.6±5.7)% vs (80.5±6.6)%, P<0.05] in the test group. In the test group, the sleep onset latency, the total sleep time, the time in bed and sleep efficiency both improved significantly after treatment [(27.5±9.8) vs (56.2±19.4) min, (334.4±41.6) vs (310.8±31.7) min, (415.6±38.9) vs (446.9±39.9) min, (80.5±6.6)% vs (69.6±4.9)%, all P<0.05], while in the control group, the sleep onset latency, the time in bed and sleep efficiency also improved significantly after therapy [(38.3±13.1) vs (55.2±16.2) min, (430.4±32.6) vs (452.4±34.4) min, (76.6±5.7)% vs (69.9±5.2)%, all P<0.05]. After combined treatment, the SAS and SDS scores [(51.5±6.5) vs (55.0±5.8), (52.0±5.3) vs (55.3±4.4), both P<0.05] both decreased significantly than those of the control group, at the same time, the SAS and SDS scores decreased significantly after treatment in both the test group and the control group [(51.5±6.5) vs (61.5±4.8), (52.0±5.3) vs (60.2±4.5), (55.0±5.8) vs (62.5±3.7), (55.3±4.4) vs (62.2±3.7), all P<0.01]. Conclusion: The efficacy of Bailemian capsule combined with CBTI-SH in the treatment of chronic insomnia is more effective.

Comment caractériser et traiter les plaintes de sommeil dans les troubles bipolaires ?

ObjectivesSleep complaints are very common in bipolar disorders (BD) both during acute phases (manic and depressive episodes) and remission (about 80 % of patients with remitted BD have poor sleep quality). Sleep complaints during remission are of particular importance since they are associated with more mood relapses and worse outcomes. In this context, this review discusses the characterization and treatment of sleep complaints in BD. MethodsWe examined the international scientific literature in June 2016 and performed a literature search with PubMed electronic database using the following headings: “bipolar disorder” and (“sleep” or “insomnia” or “hypersomnia” or “circadian” or “apnoea” or “apnea” or “restless legs”). ResultsPatients with BD suffer from sleep and circadian rhythm abnormalities during major depressive episodes (insomnia or hypersomnia, nightmares, nocturnal and/or early awakenings, non-restorative sleep) and manic episodes (insomnia, decreased need for sleep without fatigue), but also some of these abnormalities may persist during remission. These remission phases are characterized by a reduced quality and quantity of sleep, with a longer sleep duration, increased sleep latency, a lengthening of the wake time after sleep onset (WASO), a decrease of sleep efficiency, and greater variability in sleep/wake rhythms. Patients also present frequent sleep comorbidities: chronic insomnia, sleepiness, sleep phase delay syndrome, obstructive sleep apnea/hypopnea syndrome (OSAHS), and restless legs syndrome (RLS). These disorders are insufficiently diagnosed and treated whereas they are associated with mood relapses, treatment resistance, affect cognitive global functioning, reduce the quality of life, and contribute to weight gain or metabolic syndrome. Sleep and circadian rhythm abnormalities have been also associated with suicidal behaviors. Therefore, a clinical exploration with characterization of these abnormalities and disorders is essential. This exploration should be helped by questionnaires and documented on sleep diaries or even actimetric objective measures. Explorations such as ventilatory polygraphy, polysomnography or a more comprehensive assessment in a sleep laboratory may be required to complete the diagnostic assessment. Treatments obviously depend on the cause identified through assessment procedures. Treatment of chronic insomnia is primarily based on non-drug techniques (by restructuring behavior and sleep patterns), on psychotherapy (cognitive behavioral therapy for insomnia [CBT-I]; relaxation; interpersonal and social rhythm therapy [IPSRT]; etc.), and if necessary with hypnotics during less than four weeks. Specific treatments are needed in phase delay syndrome, OSAHS, or other more rare sleep disorders. ConclusionsBD are defined by several sleep and circadian rhythm abnormalities during all phases of the disorder. These abnormalities and disorders, especially during remitted phases, should be characterized and diagnosed to reduce mood relapses, treatment resistance and improve BD outcomes.

Treatment of chronic insomnia with Bryophyllum pinnatum – Two case reports

Treatment of chronic insomnia with Bryophyllum pinnatum – Two case reports

Exploration of the experience of living with chronic insomnia: A qualitative study

BackgroundChronic insomnia is associated with consequential experience that may affect quality of life. Understanding such experience can be helpful in planning effective interventions for patients with chronic insomnia. ObjectiveThe study aimed to describe and illuminate the experience of living with chronic insomnia. MethodThe study was conducted using a descriptive phenomenology approach. Participants were selected purposefully from patients with chronic insomnia who had been referred to the sleep disorders research center at Kermanshah University of Medical Sciences in Iran in 2014. Data were gathered through in-depth unstructured interviews and analyzed according to the Colaizzi method by means of Husserlian phenomenology. ResultsTwo main themes were found in this study, from which five sub themes were constructed: first, an upset mind, with the subthemes of insomnia as an unpleasant experience and insomnia as a worrying experience; and second, an unwanted new lifestyle with treatment seeking behavior, a boring new daily routine and being overshadowed by depressed mood as the subthemes. ConclusionThe study identified the experience of living with chronic insomnia as a painful one with both mental and practical aspects. The experience also explains how mental engagement and practical outcomes of chronic insomnia may interfere with well-being and quality of life in sufferers. It is recommended that patients' experiences would be considered in assessment and treatment of chronic insomnia. Therefore, therapeutic interventions should pay attention to this area.

Examining the Variability of Sleep Patterns during Treatment for Chronic Insomnia: Application of a Location-Scale Mixed Model.

The purpose of this study was to introduce a novel statistical technique called the location-scale mixed model that can be used to analyze the mean level and intra-individual variability (IIV) using longitudinal sleep data. We applied the location-scale mixed model to examine changes from baseline in sleep efficiency on data collected from 54 participants with chronic insomnia who were randomized to an 8-week Mindfulness-Based Stress Reduction (MBSR; n = 19), an 8-week Mindfulness-Based Therapy for Insomnia (MBTI; n = 19), or an 8-week self-monitoring control (SM; n = 16). Sleep efficiency was derived from daily sleep diaries collected at baseline (days 1-7), early treatment (days 8-21), late treatment (days 22-63), and post week (days 64-70). The behavioral components (sleep restriction, stimulus control) were delivered during late treatment in MBTI. For MBSR and MBTI, the pre-to-post change in mean levels of sleep efficiency were significantly larger than the change in mean levels for the SM control, but the change in IIV was not significantly different. During early and late treatment, MBSR showed a larger increase in mean levels of sleep efficiency and a larger decrease in IIV relative to the SM control. At late treatment, MBTI had a larger increase in the mean level of sleep efficiency compared to SM, but the IIV was not significantly different. The location-scale mixed model provides a two-dimensional analysis on the mean and IIV using longitudinal sleep diary data with the potential to reveal insights into treatment mechanisms and outcomes.

High frequency heart rate variability as predictor of treatment response to cognitive-behavioral therapy for insomnia

Introduction: Although cognitive-behavioral therapy for insomnia (CBTI) is the recommended treatment for chronic insomnia, approximately 40% of insomniacs will show residual or recurrent symptoms. To date, there are few reliable predictors of response to CBTI. High-frequency heart rate variability (HRV) has been proposed as a potential index of vulnerability to insomnia. Materials and methods: Individuals with primary insomnia lasting for at least 6 months were recruited into the study. Pre-treatment sleep evaluation included an overnight polysomnography (PSG), 1 week of actigraphy, 1 week of sleep diary, as well as the completion of the Insomnia Severity Index (ISI) and the Pittsburgh Sleep Quality Index (PSQI). At pre-treatment, patients also had their HRV recorded during a resting baseline period and in response to a worry induction task. Subsequently, patients participated in a 6-week group CBTI conducted by a clinical psychologist. At posttreatment, patients completed a second sleep evaluation including polysomnography, actigraphy, sleep diary, and the ISI and PSQI. Results: Participants exhibited a significant reduction in ISI (p < 0.001), PSQI (p < 0.001), PSG-derived sleep efficiency (p < 0.001), sleep diary-derived sleep efficiency, but not on the actigraphyderived sleep efficiency (p = 0.18). Correlations between baseline HRV and the change scores in each sleep parameter were calculated to evaluate whether HRV predicted treatment response to CBTI. Correlations showed that HRV during rest at pre-treatment predicted prospective increases of actigraphy-derived sleep efficiency (R = 0.77), PSG-derived sleep efficiency (R = 0.57), PSG-derived total sleep time (R = 0.76), and a reduction in the PSQI (R = 0.52) after CBTI. Conclusion: High frequency HRV during waking restfulness predicted treatment response to a group-based CBTI among patients with primary insomnia. If these results are replicated, HRV might be used as a potential tool to identify patients who are less likely to respond to CBTI and who may need a more complex treatment regimen. Acknowledgements: This study was supported by the Canada Research Chair Program, the Canadian Institutes of Health Research (CIHR), the Natural Sciences and Engineering Research Council of Canada (NSERC), the Fonds de Recherche du Quebec – Sante (FRQS), the Sleep Research Society Foundation (SRSF), and Concordia University.

Feasibility and Efficacy of a Self-Management Intervention for Insomnia in Stable Heart Failure.

Chronic insomnia is common among patients with heart failure (HF) and may contribute to fatigue and poor function. However, to date there have been no randomized controlled trials focused on treatment of insomnia or daytime symptoms in this population. The purpose of this study was to examine the preliminary efficacy, feasibility, and acceptability of a self-management intervention (cognitive behavioral therapy [CBT-I]) for insomnia among patients with stable HF. We conducted a pilot randomized controlled trial (RCT) in which patients with stable Class I-III HF (n = 25/52.1% women; mean age = 59 ± 14.8 years) were randomized in groups to CBT-I (n = 29) or an attention control condition (HF self-management with sleep hygiene; n = 19). Participants completed 2 weeks of wrist actigraphy, the insomnia severity index, and measures of fatigue, depression, sleepiness, and functional performance at baseline and follow-up. We computed the size of the effects on the dependent variables and used MANOVA to evaluate the effects of CBT-I on insomnia and fatigue. CBT-I was feasible and acceptable and had a statistically significant effect on insomnia and fatigue, while controlling for the effects of comorbidity and age. CBT-I has short-term efficacy as a treatment for chronic insomnia among patients with stable HF. Future studies are needed to address its sustained effects.

Electroacupuncture in treating residual insomnia associated with depression: lessons learned.

Article AbstractBecause this piece does not have an abstract, we have provided for your benefit the first 3 sentences of the full text.In this issue of The Journal of Clinical Psychiatry, Chung et al present an interesting study on the efficacy of electroacupuncture for the treatment of chronic insomnia associated with depression. The authors found that, after 3 weeks of interventions, there was no difference between electroacupuncture and control interventions in subjective sleep efficacy, defined as percentage of time asleep over total time in bed. Furthermore, within each treatment group, there was essentially no change in objective sleep measures obtained via actigraphy, even though subjective sleep efficacy improved in all treatment arms.The study by Chung and colleagues is novel because it targets a challenging patient population, has 2 meticulously designed control interventions, and uses objective outcome measures.

Open-Loop Neurofeedback Audiovisual Stimulation: A Pilot Study of Its Potential for Sleep Induction in Older Adults.

This pilot study tested the efficacy of a 30-min audio-visual stimulation (AVS) program for the treatment of chronic insomnia in older adults. Chronic insomnia has been conceptualized as entailing increased cortical high frequency EEG activity at sleep onset and during NREM sleep. We hypothesized that an AVS program gradually descending from 8 to 1Hz would potentially reduce the excessive cortical activation that is thought to contribute to difficulties with initiating and maintaining sleep. Accordingly, we conducted an intervention study of AVS using a pre-post design. Eight older adults (88±8.7years) complaining of chronic insomnia self-administered a 30-min AVS program nightly at bedtime for one month. Sleep was assessed at baseline and throughout the 4-week intervention. After using AVS for 4weeks, significant improvement was reported in insomnia symptoms (ISI, p=0.002) and sleep quality (PSQI, p=0.004); with moderate to large effect sizes (Partial Eta2: 0.20-0.55)(Cohen's d: 0.7-2.3). The training effect (self-reported sleep improvement) was observed at the end of week one and persisted through the 1-month intervention. The results from this pilot study suggest that further exploration of AVS as a treatment for insomnia is warranted.

Mindfulness-Based Stress Reduction for Chronic Insomnia in Adults Older than 75 Years: A Randomized, Controlled, Single-Blind Clinical Trial

To assess the effectiveness of mindfulness-based stress reduction (MBSR) for chronic insomnia and combined depressive or anxiety symptoms of older adults aged 75 years and over. A randomized, controlled, single-blind clinical trial. Participants included 60 adults aged 75 years and over with chronic insomnia. Participants were randomly assigned to the eight-week MBSR group or the wait-list control group. Assessments using the Pittsburgh Sleep Quality Index (PSQI), Self-rating Anxiety Sale (SAS), and Geriatric Depression Scale (GDS) were taken at baseline and post-treatment. For each outcome measure, a repeated measures analysis of variance was used to detect changes across assessments. There was a significant time × group interaction for the PSQI global score (P = .006); the MBSR group had a decrease in the PSQI global score (Cohen׳s d = 1.12), while the control group did not (Cohen׳s d = -0.06). Among the PSQI components, there was a significant time × group interaction for daytime dysfunction (P = .048); Cohen׳s d of the MBSR group was 0.76, while Cohen׳s d of control group was -0.04. There was no significant time × group interaction for the SAS score (P = .116), while for the GDS there was a significant time × group interaction (P = .039); the Cohen׳s d value for the MBSR group was 1.20, and it was 0.12 for the control group. This study demonstrated that the MBSR program could be a beneficial treatment for chronic insomnia in adults aged 75 years and older.

Chronic insomnia: treatment methods based on the current "3P" model of insomnia

Authors consider one of the popular models of the pathogenesis of chronic insomnia--"3P" model. It explains the origin and course of insomnia on the basis of interaction of three factors: predisposing, precipitating and perpetuating. The role of each group of factors and its connection to the cerebral hyperarousal state is discussed. Different variants of cognitive-behavioral therapy and pharmacological treatment of chronic insomnia are described.

Efficacy of Viola odorata in Treatment of Chronic Insomnia

Background:Insomnia is the most common sleep disorder that reduces quality of life.Objectives:Due to side effects of hypnotic drug and the increasing demand for alternative medicine substitutes, violet oil (VO) was used in this study. VO is a known medication in Iranian traditional medicine that induces sleep in insomniac patients.Patients and Methods:This study was conducted as an experimental pretest-posttest evaluation on VO efficacy in 50 patients with chronic insomnia in Iranian Traditional Medicine Clinic of Mashhad University of Medical Sciences, Mashhad, Iran. Treatment consisted of intranasal drop of VO, two drops containing 66 mg of VO in each nostril nightly before sleeping for one month. All patients were asked to complete an Insomnia Severity Index (ISI) questionnaire before the start of the trial and after one month of treatment.Results:Improvements in sleep and ISI scores were significantly greater in patients after a month receiving VO drop in comparison with before starting treatment (P < 0.05). A few patients reported some complications about VO consumption, most of which were mild and no serious adverse event was encountered.Conclusions:VO can be presented as a safe, well-tolerated, and effective herbal preparation in patients with chronic insomnia.

Cognitive-behavioral therapy for chronic insomnia.

Psychological and behavioral therapies should be considered the first line treatment for chronic insomnia. Although cognitive behavioral therapy for insomnia (CBT-I) is considered the standard of care [1], several monotherapies, including sleep restriction therapy, stimulus control therapy, and relaxation training are also recommended in the treatment of chronic insomnia [2]. CBT-I is a multimodal intervention comprised of a combination of behavioral (eg, sleep restriction, stimulus control) and cognitive therapy strategies, and psychoeducation delivered in 4 to 10 weekly or biweekly sessions [3]. Given that insomnia is thought to be maintained by an interaction between unhelpful sleep-related beliefs and behaviors, the goal of CBT-I is to modify the maladaptive cognitions (eg, worry about the consequences of poor sleep), behaviors (eg, extended time in bed), and arousal (ie, physiological and mental hyperarousal) perpetuating the insomnia. CBT-I is efficacious when implemented alone or in combination with a pharmacologic agent. However, because of the potential for relapse upon discontinuation, CBT-I should be extended throughout drug tapering [4]. Although the treatment options should be guided by the available evidence supporting both psychological therapies and short-term hypnotic treatment, as well as treatment feasibility and availability, treatment selection should ultimately be guided by patient preference [5]. Despite its widespread use among treatment providers [6], the use of sleep hygiene education as a primary intervention for insomnia should be avoided. Sleep hygiene may be a necessary, but insufficient condition for promoting good sleep and should be considered an adjunct to another empirically supported treatment.

A randomized controlled trial of mindfulness meditation for chronic insomnia.

To evaluate the efficacy of mindfulness meditation for the treatment of chronic insomnia. Three-arm, single-site, randomized controlled trial. Academic medical center. Fifty-four adults with chronic insomnia. Participants were randomized to either mindfulness-based stress reduction (MBSR), mindfulness-based therapy for insomnia (MBTI), or an eight-week self-monitoring (SM) condition. Patient-reported outcome measures were total wake time (TWT) from sleep diaries, the pre-sleep arousal scale (PSAS), measuring a prominent waking correlate of insomnia, and the Insomnia Severity Index (ISI) to determine remission and response as clinical endpoints. Objective sleep measures were derived from laboratory polysomnography and wrist actigraphy. Linear mixed models showed that those receiving a meditation-based intervention (MBSR or MBTI) had significantly greater reductions on TWT minutes (43.75 vs 1.09), PSAS (7.13 vs 0.16), and ISI (4.56 vs 0.06) from baseline-to-post compared to SM. Post hoc analyses revealed that each intervention was superior to SM on each of the patient-reported measures, but no significant differences were found when comparing MBSR to MBTI from baseline-to-post. From baseline to 6-month follow-up, MBTI had greater reductions in ISI scores than MBSR (P < 0.05), with the largest difference occurring at the 3-month follow-up. Remission and response rates in MBTI and MBSR were sustained from post-treatment through follow-up, with MBTI showing the highest rates of treatment remission (50%) and response (78.6%) at the 6-month follow-up. Mindfulness meditation appears to be a viable treatment option for adults with chronic insomnia and could provide an alternative to traditional treatments for insomnia. Mindfulness-Based Approaches to Insomnia: clinicaltrials.gov, identifier: NCT00768781.

Behavioral treatment of chronic insomnia in older adults: does nocturia matter?

To evaluate the impact of nocturia on the therapeutic response of chronic insomnia to behavioral treatment in older adults. Secondary analysis of a randomized clinical trial designed to assess the efficacy of brief behavioral treatment of insomnia (BBTI) vs. an information-only control (IC) in 79 community-dwelling older adults with chronic insomnia. For the current analysis, participants were stratified into 2 groups: those with self-reported nocturia at baseline i.e., ≥ 1 void/night (N = 30; 16 IC, 14 BBTI) and those without nocturia (N = 49; 24 IC, 25 BBTI). We then determined the impact of BBTI on sleep, sleep quality, and nocturia as assessed by self-report, actigraphy, and polysomnography. Individuals without baseline nocturia responded well to BBTI with significant decrease in sleep latency, wake after sleep onset, and total sleep time assessed by sleep diary and actigraphy; these changes were significantly greater than those in the IC group. In comparison, changes in the same sleep parameters among participants with nocturia were not significantly different from the IC control. Although BBTI showed significant improvement in sleep quality in groups with and without nocturia (as assessed by PSQI and sleep diary), the effect size of these improvements was larger in those without nocturia than in those with nocturia (PSQI d = 0.82 vs. 0.53, diary sleep quality d = 0.83 vs. 0.51). These secondary analyses suggest that brief behavioral treatment of insomnia may be more efficacious in improving insomnia in participants without nocturia. Addressing nocturia may improve the efficacy of behavioral insomnia treatment.

Increased Use-Dependent Plasticity in Chronic Insomnia

During normal sleep several neuroplasticity changes occur, some of which are considered to be fundamental to strengthen memories. Given the evidence linking sleep to neuroplasticity, it is conceivable that individuals with chronic sleep disruption, such as patients with chronic insomnia (CI), would experience abnormalities in neuroplastic processes during daytime. Protocols testing use-dependent plasticity (UDP), one of the mechanisms underlying formation of motor memories traces, provide a sensitive measure to assess neuroplasticity in the context of motor training. A well-established transcranial magnetic stimulation (TMS) paradigm was used to evaluate the ability of patients with CI and age-matched good sleeper controls to undergo UDP. We also investigated the effect of insomnia on intracortical motor excitability measures reflecting GABAergic and glutamatergic mechanisms. Human Brain Physiology Laboratory, Johns Hopkins Medical Institutions. We found that patients with CI experienced increased UDP changes relative to controls. This effect was not due to differences in motor training. In addition, patients with CI showed enhanced intracortical facilitation relative to controls, in the absence of changes in intracortical inhibitory measures. This study provides the first evidence that patients with chronic insomnia have an increased plasticity response to physical exercise, possibly due to larger activation of glutamatergic mechanisms. This suggests a heightened state of neuroplasticity, which may reflect a form of maladaptive plasticity, similar to what has been described in dystonia patients and chronic phantom pain after amputation. These results could lead to development of novel treatments for chronic insomnia.

How mindfulness changed my sleep: focus groups with chronic insomnia patients.

BackgroundChronic insomnia is a major public health problem affecting approximately 10% of adults. Use of meditation and yoga to develop mindful awareness (‘mindfulness training’) may be an effective approach to treat chronic insomnia, with sleep outcomes comparable to nightly use of prescription sedatives, but more durable and with minimal or no side effects. The purpose of this study was to understand mindfulness training as experienced by patients with chronic insomnia, and suggest procedures that may be useful in optimizing sleep benefits.MethodsAdults (N = 18) who completed an 8-week mindfulness-based stress reduction (MBSR) program as part of a randomized, controlled clinical trial to evaluate MBSR as a treatment for chronic insomnia were invited to participate in post-trial focus groups. Two groups were held. Participants (n = 9) described how their sleep routine, thoughts and emotions were affected by MBSR and about utility (or not) of various mindfulness techniques. Groups were audio-recorded, transcribed and analyzed using content analysis.ResultsFour themes were identified: the impact of mindfulness on sleep and motivation to adopt a healthy sleep lifestyle; benefits of mindfulness on aspects of life beyond sleep; challenges and successes in adopting mindfulness-based practices; and the importance of group sharing and support. Participants said they were not sleeping more, but sleeping better, waking more refreshed, feeling less distressed about insomnia, and better able to cope when it occurred. Some participants experienced the course as a call to action, and for them, practicing meditation and following sleep hygiene guidelines became priorities. Motivation to sustain behavioral changes was reinforced by feeling physically better and more emotionally stable, and seeing others in the MBSR class improve. The body scan was identified as an effective tool to enable falling asleep faster. Participants described needing to continue practicing mindfulness to maintain benefits.ConclusionsFirst-person accounts are consistent with published trial results of positive impacts of MBSR on sleep measured by sleep diary, actigraphy, and self-report sleep scales. Findings indicate that mindfulness training in a group format, combined with sleep hygiene education, is important for effective application of MBSR as a treatment for chronic insomnia.

Behavioral treatment of insomnia: also effective for nocturia.

To evaluate changes in self-reported nocturia in community-dwelling adults aged 60 and older who received behavioral treatment for chronic insomnia. Secondary analysis of a randomized controlled trial of a behavioral intervention for sleep. Academic medical center. Of the 79 enrollees, this analysis focused on 30 who, in addition to insomnia, also reported at least one nightly episode of waking up to void. The brief behavioral treatment of insomnia (BBTI) group (n = 14) received instructions on reducing time in bed and setting a regular sleep schedule. The information control (IC) group (n = 16) received printed materials. A nurse clinician delivered both interventions. Self-reported nocturnal awakenings to void assessed daily for 14 days at baseline and 4 weeks after the intervention. Participants who reported at least one episode of nocturia per night at baseline were included in this analysis. In individuals with nocturia at baseline, the total number of nocturnal voids over the 14-day assessment period decreased by 6.5 ± 4.8 in the BBTI group and increased by 1.3 ± 7.3 in the IC group (P = .04, effect size 0.82). After adjusting for baseline nocturia episodes, the difference remained significant (P = .05). In older adults with concurrent insomnia and nocturia, behavioral treatment directed solely at insomnia may also improve self-reported nocturia. Behavioral treatment of insomnia should be further investigated for its effect on nocturia in individuals with concurrent insomnia and nocturia.

The Efficacy of Cognitive Behavioral Therapy for Insomnia and Factors Associated with Favorable Outcome

Objectives: Cognitive behavioral therapy for insomnia (CBT-I) is a treatment for chronic insomnia via psychological intervention. CBT-I is as effective as pharmacotherapy for insomnia patients. This study investigates the clinical efficacy of CBT-I and factors associated with good outcome. Methods: 27 patients were included in this study, who visited sleep center from October 2011 to June 2012. All patients underwent baseline polysomnography for diagnosis and completed at least three sessions of CBT-I. The sleep scales and sleep diary were done. The clinical efficacy of CBT-I were evaluated by comparing changes of sleep efficacy (SE) between before and after the treatment based on the sleep diary. We grouped these patients into higher SE group and lower SE group according to their final SE. Then we retrospectively reviewed clinical characteristics and polysomnographic parameters in both groups to elucidate the factors associated with favorable outcome of CBT-I. Results: After CBT-I all patients showed significant improvement of sleep parameters (total sleep time, 181 min vs. 308 min; SE, 40% vs. 74%; sleep latency, 100 min vs. 41 min, wakefulness after sleep onset, 185 min vs. 59 min). There were no differences in sleep scales except Beck Depression Inventory between the higher SE group and the lower SE group. There were no differences in subjective sleep parameters of sleep diary between two groups at baseline. Conclusions: At least three sessions of CBT-I at this center was effective. CBT-I was more effective in patients who were depressive. Keywords: Insomnia, Cognitive behavioral therapy, Polysomnography, Beck Depression Inventory

Insomnia group therapy

Introduction Insomnia is the most frequent sleep complaint, cognitive-behavioral therapy (CBT) is one of its two evidence based therapeutic options. It’s specially indicated in primary insomnia, insomnia associated with other chronic diseases and hypnotic-dependent insomnia patients. Despite this, CBT is not implemented yet in most sleep units in Spain. Group therapy is more efficient than the individual psychotherapy and can be a less expensive alternative. The basic philosophy of this program is that a time-limited intervention, focusing directly on the factors that perpetuate insomnia can be helpful regardless of the initial conditions that have precipitated it.The aim of this work is to describe the experience with the two first groups of CBT in insomnia patients performed at the University Hospital Son Espases, Palma de Mallorca. Materials and methods Subjects: Patients with chronic insomnia, motivated to participate and who had a reference therapist. Method: Each patient did two individual 60 min consultations, 8 weekly group treatment and two booster sessions one and three months after treatment has ended. Individual assessment: 1. Diagnostic and pre-selection consult done by a psychiatrist specialized in sleep disorders using a semi structured sleep clinical questionnaire. 2. Pre-treatment assessment and informed consent signature done by a clinical psychologist. Patient has to complete a pre-group sleep agenda for 1–2 weeks. Assessment tools: Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Beck Depression Scale (BDI), Spielberger Anxiety Scale (STAI E/R). Treatment Phase: Group (5–8 persons) 90 min duration. Pharmacological treatments (i.e. antidepressants) excepted hypnotic drugs were maintained during the length of treatment. Results Initial assessment was performed to 14 patients; all signed the informed consent. Only 8 patients (4 woman and 4 men, from 42 to 78 y) complete all sessions and assessment after treatment. Median scores of evaluation test pre / post treatment of these 8 patients were: PSQI 16,8/12,1; ISI 16,8/13,2; BDI 12,6/9,8; STAI E 31/25; STAI R 32,8/21,5. A notable result is that during group therapy all patients’ abandoned hypnotic drugs they used in everyday or in episodic basis. Conclusion Even the limited number of patients our results supports the efficacy of group psychotherapy, improves insomnia and decreases depressive and anxiety symptoms. We encourage its use in the treatment of chronic insomnia.