Current Treatment Options in Neurology

, Volume 10, Issue 5, pp 342–349 | Cite as

Nonpharmacologic treatment of insomnia

  • Melanie K. Means
  • Margaret D. Lineberger
  • Jack D. Edinger
Article

Opinion statement

Insomnia is a widespread and debilitating disorder. Regardless of the initial cause, it may assume a chronic course perpetuated by psychological and behavioral factors. Although sedative-hypnotic medications are the most common treatment for insomnia, they pose certain risks such as adverse effects and dependence. Furthermore, medications target symptoms and fail to address the underlying perpetuating mechanisms.

There are many nonpharmacologic treatment options for insomnia, including cognitive/behavioral methods, relaxation strategies, and complementary and alternative medicine (CAM) approaches. Most CAM therapies lack sufficient scientific evidence to recommend their use. Over the past 30 years, cognitive-behavioral therapies have emerged as the treatment of choice for chronic insomnia. These therapies target behavioral, cognitive, and conditioning factors underlying insomnia, thereby restoring normal sleep-wake functioning. The effectiveness of these therapies is well established. They compare favorably to pharmacologic approaches, with the added benefits of few or no adverse effects and no risk of abuse or dependence. Perhaps most importantly, behavioral insomnia therapies offer a potential cure for the insomnia, instead of the symptom-focused approach provided by medications. Despite the proven success of cognitive-behavioral therapies, they are not widely available to patients with insomnia because of a paucity of behavioral sleep specialists. Efforts are now being made to disseminate these treatments to meet the demand. Emerging therapies hold promise for further refinement and development of successful treatments.

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References and Recommended Reading

  1. 1.
    Ohayon MM: Epidemiology of insomnia: what we know and what we still need to learn. Sleep Med Rev 2002, 6: 97–111.PubMedCrossRefGoogle Scholar
  2. 2.
    Moul DE, Nofzinger EA, Pilkonis PA, et al.: Symptom reports in severe chronic insomnia. Sleep 2002, 25: 553–563.PubMedGoogle Scholar
  3. 3.
    National Institutes of Health: National Institutes of Health State of the Science Conference statement on manifestations and management of chronic insomnia in adults, June 13–15, 2005. Sleep 2005, 28: 1049–1057.Google Scholar
  4. 4.
    Reeder CE, Franklin M, Bramley TJ: Current landscape of insomnia in managed care. Am J Manag Care 2007, 13(5 Suppl): S112–S116.PubMedGoogle Scholar
  5. 5.
    Perlis ML, Smith MT, Pigeon WR: Etiology and pathophysiology of insomnia. In Principles and Practice of Sleep Medicine, edn 4. Edited by Kryger MH, Roth T, Dement W. Philadelphia: Elsevier/Saunders; 2005: 714–725.Google Scholar
  6. 6.
    Morgenthaler T, Kramer M, Alessi C, et al.: Practice parameters for the psychological and behavioral treatment of insomnia: an update. An American Academy of Sleep Medicine report. Sleep 2006, 29: 1415–1419.PubMedGoogle Scholar
  7. 7.
    Morin CM, Bootzin RR, Buysse DJ, et al.: Psychological and behavioral treatment of insomnia: update of the recent evidence (1998–2004). Sleep 2006, 29: 1398–1414.PubMedGoogle Scholar
  8. 8.
    Stepanski EJ, Wyatt JK: Use of sleep hygiene in the treatment of insomnia. Sleep Med Rev 2003, 7: 215–225.PubMedCrossRefGoogle Scholar
  9. 9.
    Bootzin RR: Stimulus control treatment for insomnia. Proc Am Psychol Assoc 1972, 7: 395–396.Google Scholar
  10. 10.
    Spielman AJ, Saskin P, Thorpy MJ: Treatment of chronic insomnia by restriction of time in bed. Sleep 1987, 10: 45–56.PubMedGoogle Scholar
  11. 11.
    Wohlgemuth WK, Edinger JD: Sleep restriction therapy. In Treatment of Late-Life Insomnia. Edited by Lichstein KL, Morin CM. Thousand Oaks, CA: Sage Publications; 2000: 147–166.Google Scholar
  12. 12.
    Smith MT, Huang MI, Manber R: Cognitive behavior therapy for chronic insomnia occurring within the context of medical and psychiatric disorders. Clin Psychol Rev 2005, 25: 559–592.PubMedCrossRefGoogle Scholar
  13. 13.
    McCrae CS, Lichstein KL: Secondary insomnia: a heuristic model and behavioral approaches to assessment, treatment, and prevention. Appl Prev Psychol 2001, 10: 107–123.Google Scholar
  14. 14.
    Hauri PJ: Sleep hygiene, relaxation therapy, and cognitive interventions. In Case Studies in Insomnia. Edited by Hauri PJ. New York: Plenum Publishing; 1991: 65–84.Google Scholar
  15. 15.
    Beck AT, Rush AJ, Shaw BF, et al.: Cognitive Therapy of Depression. New York: Guilford Press; 1979.Google Scholar
  16. 16.
    Belanger L, Savard J, Morin CM: Clinical management of insomnia using cognitive therapy. Behav Sleep Med 2006, 4: 179–202.PubMedCrossRefGoogle Scholar
  17. 17.
    Morin CM: Insomnia: Psychological Assessment and Management. New York: Guilford Press; 1993.Google Scholar
  18. 18.
    Bootzin RR, Rider SP: Behavioral techniques and biofeedback for insomnia. In Understanding Sleep: The Evaluation and Treatment of Sleep Disorders. Edited by Pressman MR, Orr WC. Washington, DC: American Psychological Association; 1997: 315–338.CrossRefGoogle Scholar
  19. 19.
    Borkovec TD, Fowles DC: Controlled investigation of the effects of progressive and hypnotic relaxation on insomnia. J Abnorm Psychol 1973, 82: 153–158.PubMedCrossRefGoogle Scholar
  20. 20.
    Nicassio P, Bootzin R: A comparison of progressive relaxation and autogenic training as treatments for insomnia. J Abnorm Psychol 1974, 83: 253–260.PubMedCrossRefGoogle Scholar
  21. 21.
    Summers MO, Crisostomo MI, Stepanski EJ: Recent developments in the classification, evaluation, and treatment of insomnia. Chest 2006, 130: 276–286.PubMedCrossRefGoogle Scholar
  22. 22.
    Stepanski EJ: Hypnotics should not be considered for the initial treatment of chronic insomnia. J Clin Sleep Med 2005, 1: 125–128.PubMedGoogle Scholar
  23. 23.
    Turner RM, Ascher LM: Controlled comparison of progressive relaxation, stimulus control, and paradoxical intention therapies for insomnia. J Consult Clin Psychol 1979, 47: 500–508.PubMedCrossRefGoogle Scholar
  24. 24.
    Youngstedt SD: Effects of exercise on sleep. Clin Sports Med 2005, 24: 355–365.PubMedCrossRefGoogle Scholar
  25. 25.
    King AC, Oman RF, Brassington GS, et al.: Moderate-intensity exercise and self-rated quality of sleep in older adults. A randomized controlled trial. JAMA 1997, 277: 32–37.PubMedCrossRefGoogle Scholar
  26. 26.
    Morgan K: Daytime activity and risk factors for late-life insomnia. J Sleep Res 2003, 12: 231–238.PubMedCrossRefGoogle Scholar
  27. 27.
    Tworoger SS, Yasui Y, Vitiello MV, et al.: Effects of a yearlong moderate-intensity exercise and a stretching intervention on sleep quality in postmenopausal women. Sleep 2003, 26: 830–836.PubMedGoogle Scholar
  28. 28.
    Cheuk DK, Yeung WF, Chung KF, et al.: Acupuncture for insomnia. Cochrane Database Syst Rev 2007, 3: CD005472.PubMedGoogle Scholar
  29. 29.
    Lin Y: Acupuncture treatment for insomnia and acupuncture analgesia. Psychiatry Clin Neurosci 1995, 49: 119–120.PubMedCrossRefGoogle Scholar
  30. 30.
    Chen HY, Shi Y, Ng CS, et al.: Auricular acupuncture treatment for insomnia: a systematic review. J Altern Complement Med 2007, 13: 669–676.PubMedCrossRefGoogle Scholar
  31. 31.
    Chan K, Ng P, Ng K: The effects of an intervention group with the support of non-pharmacological Chinese medicine on older Chinese adults with insomnia: a pilot study. Int Soc Work 2006, 49: 791–803.CrossRefGoogle Scholar
  32. 32.
    Kuramoto AM: Therapeutic benefits of Tai Chi exercise: research review. WMJ 2006, 105: 42–46.PubMedGoogle Scholar
  33. 33.
    Li F, Fisher KJ, Harmer P, et al.: Tai Chi and self-rated quality of sleep and daytime sleepiness in older adults: a randomized controlled trial. J Am Geriatr Soc 2004, 52: 892–900.PubMedCrossRefGoogle Scholar
  34. 34.
    Vallbona C, Richards T: Evolution of magnetic therapy from alternative to traditional medicine. Phys Med Rehabil Clin N Am 1999, 10: 729–754.PubMedGoogle Scholar
  35. 35.
    Pelka RB, Jaenicke C, Gruenwald J: Impulse magnetic-field therapy for insomnia: a double-blind, placebo-controlled study. Adv Ther 2001, 18: 174–180.PubMedCrossRefGoogle Scholar
  36. 36.
    George MS, Belmaker RH (eds): Transcranial Magnetic Stimulation in Clinical Psychiatry. Arlington, VA: American Psychiatric Publishing; 2007.Google Scholar
  37. 37.
    Rosenberg PB, Mehndiratta RB, Mehndiratta YP, et al.: Repetitive transcranial magnetic stimulation treatment of comorbid posttraumatic stress disorder and major depression. J Neuropsychiatry Clin Neurosci 2002, 14: 270–276.PubMedGoogle Scholar
  38. 38.
    Lundh LG: The role of acceptance and mindfulness in the treatment of insomnia. J Cogn Psychother 2005, 19: 29–39.CrossRefGoogle Scholar
  39. 39.
    Heidenreich T, Tuin I, Pflug B, et al.: Mindfulness-based cognitive therapy for persistent insomnia: a pilot study [letter]. Psychother Psychosom 2006, 75: 188–189.PubMedCrossRefGoogle Scholar
  40. 40.
    Ong JC, Shapiro SL, Manber R: Combining mindfulness meditation with cognitive-behavior therapy for insomnia: a treatment-development study. Behav Ther 2008, 39: 171–182.PubMedCrossRefGoogle Scholar
  41. 41.
    Harris J, Lack L, Wright H, et al.: Intensive Sleep Retraining treatment for chronic primary insomnia: a preliminary investigation. J Sleep Res 2007, 16: 276–284.PubMedCrossRefGoogle Scholar
  42. 42.
    Fricke-Oerkermann L, Pluck J, Schredl M, et al.: Prevalence and course of sleep problems in childhood. Sleep 2007, 30: 1371–1377.PubMedGoogle Scholar
  43. 43.
    Morgenthaler TI, Owens J, Alessi C, et al.: Practice parameters for behavioral treatment of bedtime problems and night wakings in infants and young children. Sleep 2006, 29: 1277–1281.PubMedGoogle Scholar
  44. 44.
    Mindell JA, Kuhn B, Lewin DS, et al.: Behavioral treatment of bedtime problems and night wakings in infants and young children. Sleep 2006, 29: 1263–1276.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Melanie K. Means
    • 1
  • Margaret D. Lineberger
  • Jack D. Edinger
  1. 1.Psychology ServiceDurhamUSA

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