Sleep, Sleep Disorders, and Some Behavioral Approaches to Treatment of Insomnia

  • Pam Hyde
  • Vernon Pegram


One would think that sleep is a behavior in the sleep-wake cycle that occurs naturally and effortlessly. Yet a growing number of people find themselves out of synchronization with their natural rhythm of sleeping and waking. According to some estimates, from 20 to 50 million persons in the United States alone (10–25% of the population) subjectively suffer from too much wakefulness (Goldberg & Kaufman, 1978). Excessive daytime sleepiness is also a serious problem for well over 100,000 Americans (Guilleminault, Carskadon, & Dement, 1974). With such a large proportion of the population suffering from sleep-arousal disorders, the recent emphasis in the development of effective nonpharmacological treatments for insomnia becomes more easily understood given the limitations of the present drug therapies.


Sleep Apnea Sleep Disorder Excessive Daytime Sleepiness Relaxation Training Minnesota Multiphasic Personality Inventory 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Agnew, H. W., Jr., Webb, W. B., & Williams, R. L. Comparison of stage four and 1-REM sleep deprivation. Perceptual and Motor Skills, 1967, 24, 851–853.PubMedCrossRefGoogle Scholar
  2. Ascher, L. M., & Efran, J. S. Use of paradoxical intention in a behavioral program for sleep onset insomnia. Journal of Consulting and Clinical Psychology, 1978, 46, 547–550.PubMedCrossRefGoogle Scholar
  3. Aserinsky, E., & Kleitman, N. Regularly occurring periods of eye motility and concomitant phenomena during sleep. Science, 1953, 118, 273–274.PubMedCrossRefGoogle Scholar
  4. Baxter, M. G., & Bauer, M. L. Patterns of prescribing and use of hypnotic drugs in the United States. In A. D. Clift (Ed.), Sleep disturbance and hypnotic drug dependence. New York: Excerpta Medica, 1975.Google Scholar
  5. Beutler, L., Karacan, I., Thomby, J., & Salis, P. J. Personality characteristics in four insomnia subtypes. Sleep Research, 1978, 7, 180.Google Scholar
  6. Bootzin, R R. Stimulus control treatment of insomnia. American Psychological Association Proceedings, 80th Annual Convention, Honolulu, August 1972, 395–396.Google Scholar
  7. Bootzin, R. R., & Nicassio, P. M. Behavioral treatments for insomnia. In M. Hersen, R. Eisler, & P. Miller (Eds.), Progress in behavior modification (Vol. 4 ). New York: Academic Press, 1977.Google Scholar
  8. Borkovec, T. D., & Fowles, D. C. Controlled investigation of the effects of progressive and hypnotic relaxation on insomnia journal of Abnormal Psychology, 1973, 82, 153–158.PubMedCrossRefGoogle Scholar
  9. Borkovec, T. D., Steinmark, S. W., & Nau, S. D. Relaxation training and single item desensitization in the group treatment of insomnia. Journal of Behavior Therapy and Experimental Psychiatry, 1973, 4, 401–403.Google Scholar
  10. Budzynski, T. H. Biofeedback procedures in the clinic. In L. Birk (Ed.), Seminars in psychiatry (Vol. 5). New York: Grune & Stratton, 1973.Google Scholar
  11. Budzynski, T. H., Stoyva, J., & Adler, C. Feedback-induced relaxation: Application to tension headache. Journal of Behavior Therapy and Experimental Psychiatry, 1970, 1, 205–211.CrossRefGoogle Scholar
  12. Butler, R. N., & Lewis, M. I. Aging and mental health: Positive psychosocial approaches ( 2nd ed. ). St. Louis: C. V. Mosby, 1977.Google Scholar
  13. Coates, T. J., & Thoresen, C. E. How to sleep better: A drug-free program for overcoming insomnia. Englewood Cliffs, N.J.: Prentice-Hall, 1977.Google Scholar
  14. Dement, W., & Kleitman, N. Cyclic variation in EEG during sleep and their relation to eye movements, body motility and dreaming. Electroencephalography and Clinical Neurophysiology, 1957, 9, 673–690.PubMedCrossRefGoogle Scholar
  15. Dement, W., & Mitler, M. An introduction to sleep. In O. Petre-Quadens & J. D. Schlag (Eds.), Basic sleep mechanisms. New York: Academic Press, 1974.Google Scholar
  16. Dement, W., Mitler, M., & Zarcone, V. Some fundamental considerations in the study of sleep. Psychosomatics1973, 14(2)89–94.Google Scholar
  17. Elliott, H., Navarro, G., Kokka, N., & Nomof, N. Early phase I evaluation of sedatives, hypnotics, or minor tranquilizers. In F. Kagan, T. Harwood, K. Rickels, A. D. Rudzik, & H. Sorer (Eds.), Hypnotics: Methods of development and evaluation. New York: Spectrum, 1975.Google Scholar
  18. Evans, D. R., & Bond, I. K. Reciprocal inhibition therapy and classical conditioning in the treatment of insomnia. Behaviour Research and Therapy, 1969, 7, 323–325.PubMedCrossRefGoogle Scholar
  19. Feinberg, I., Koresko, R. L., & Heller, N. EEG patterns as a function of normal and pathologi-cal aging in man Journal of Psychiatric Research, 1967, 5, 107–144.PubMedCrossRefGoogle Scholar
  20. Freedman, R., Hauri, P., Coursey, R., & Frankel, B. Behavioral treatment of insomnia: A collaborative study. Proceedings of Biofeedback Society of America, 1978, 204–205.Google Scholar
  21. Garrod, J. W. Absorption, metabolism and excretion of drugs in geriatric subjects. Geron-tologia Clinica, 1974, 16, 30–42.CrossRefGoogle Scholar
  22. Geer, J. H., & Katkin, E. G. Treatment of insomnia using a variant of systematic desensitization: A case report. Journal of Abnormal Psychology, 1966, 71, 161–164.PubMedCrossRefGoogle Scholar
  23. Gershman, L., & Clouser, R. A. Treating insomnia with relaxation and desensitization in a group setting by an automated approach. Journal of Behavior Therapy and Experimental Psychiatry, 1974, 5, 31–35.CrossRefGoogle Scholar
  24. Goldberg, P., & Kaufman, D. Natural sleep. Emmaus, Pa.: Rodale Press, 1978. Guilleminault, C. Cataplexy. In C. Guilleminault, W. C. Dement, & P. Passouant (Eds.)Google Scholar
  25. Narcolepsy: Advances in sleep research (Vol. 3). New York: Spectrum, 1976. Guilleminault, C., & Dement, W. C. (Eds.). Sleep apnea syndromes. New York: Liss, 1978.Google Scholar
  26. Guilleminault, C., Carskadon, M., & Dement, W. C. On the treatment of rapid eye move-ment narcolepsy. Archives of Neurology, 1974, 30, 90–93.PubMedCrossRefGoogle Scholar
  27. Hamburg, D. A., Adams,’ J. E., & Brodie, H. K. H. Coping behaviors in stressful circumstances: Some implications for social psychiatry. In B. H. Kaplan, R. N. Wilson, & A. H. Leighton (Eds.), Further explorations in social psychiatry. New York: Basic Books, 1976.Google Scholar
  28. Hammond, E. C. Some preliminary findings on physical complaints from a prospective study of 1,064,004 men and women. American Journal of Public Health, 1964, 54, 11–23.PubMedGoogle Scholar
  29. Hauri, P. The sleep disorders. Kalamazoo, Mich.: Upjohn Company, 1977.Google Scholar
  30. Hauri, P. Biofeedback techniques in the treatment of chronic insomnia. In R. Williams & I.Google Scholar
  31. Karacan (Eds.), Sleep disorders: Diagnosis and treatment. New York: Wiley, 1978.Google Scholar
  32. Hauri, P. Behavioral treatment of insomnia Medical Times, June 1979, 107, 6, 36–47.PubMedGoogle Scholar
  33. Haynes, S. N., Follingstad, D. R., & McGowan, W. T. Insomnia. Sleep patterns and anxiety level. Journal of Psychosomatic Research, 1974, 18, 69–74.PubMedCrossRefGoogle Scholar
  34. Haynes, S., Woodward, S., Moran, R., & Alexander, D. Relaxation treatment of insomnia Behavior Therapy1974, 5, 555–558.Google Scholar
  35. Henning, J. Drug interactions: Two are not always better than one. Modern Health Care1975, 4(2), 38–42.Google Scholar
  36. Hinkle, J. E., & Lutker, E. G. Insomnia: A new approach. Psychotherapy: Theory, Research and Practice1972, 9, 236–237.Google Scholar
  37. Institute of Medicine. A report of a study: Sleeping pills, insomnia, and medical practice. Washington: National Academy of Sciences, 1979.Google Scholar
  38. Jacobson, E. Progressive relaxation. Chicago: University of Chicago Press, 1938.Google Scholar
  39. Jason, L. Rapid improvement in insomnia following sell-monitoring. Journal of Behavior Therapy and Experimental Psychiatry1975, 6, 349–350.Google Scholar
  40. Johnson, S. M., & White, G. Self-observation as an agent of behavioral change. Behavior Therapy1971, 2, 488–497.Google Scholar
  41. Jouvet, M. Biogenic amines and the states of sleep. Science, 1969, 163, 32–41.PubMedCrossRefGoogle Scholar
  42. Kahn, M., Baker, B., & Weiss, J. Treatment of insomnia by relaxation training. Journal of Abnormal Psychology1968, 73, 556–558.Google Scholar
  43. Kales, A., & Kales, J. Recent advances in the diagnosis and treatment of sleep disorders. In G. Usdin (Ed.), Sleep research and clinical practice. New York: Brunner/Mazel, 1973.Google Scholar
  44. Kales, J., Tan, T. L., Swearingen, C., & Kales, A. Are over-the-counter sleep medications effective? All night EEG studies. Current Therapeutic Research, Clinical and Experimental, 1971, 13, 143–151.Google Scholar
  45. Kales, A., Bixler, E. O., Tan, T. L., Scharf, M. B., & Kales, J. D. Chronic hypnotic drug use: Ineffectiveness, drug withdrawal insomnia, and dependence. Journal of the American Medical Association, 1974, 227, 513–517.PubMedCrossRefGoogle Scholar
  46. Kales, A., Caldwell, A., Preston, T., Healey, J., & Kales, J. Personality patterns in insomnia. Archives of General Psychiatry, 1976, 33, 1128–1134.PubMedCrossRefGoogle Scholar
  47. Kales, A., Caldwell, A., Bixler, E. O., Healey, S., Kales, J. D., & Preston, T. A. Further evaluation of MMPI findings in insomnia: Comparison of insomniac patients and normal controls. Sleep Research, 1978, 7, 189.Google Scholar
  48. Karacan, I., & Williams, R. L. Insomnia: Old wine in a new bottle. Psychiatric Quarterly, 1971, 45, 274–288.PubMedCrossRefGoogle Scholar
  49. Karacan, I., Moore, C., & Williams, R. L. The narcoleptic syndrome. Psychiatric Annals, 1979, 9, 69–76.Google Scholar
  50. Kleitman, N. Sleep and wakefulness. Chicago: University of Chicago Press, 1963.Google Scholar
  51. Knapp, T., Downs, D., & Alperson, J. Behavior therapy for insomnia: A review. Behavior Therapy, 1976, 7, 614–625.CrossRefGoogle Scholar
  52. Loomis, A. L., Harvey, E. N., & Hobart, G. A. Cerebral states during sleep, as stated by human brain potentials. Journal of Experimental Psychology, 1937, 21, 127–144.CrossRefGoogle Scholar
  53. Mendelson, W. B., Gillin, J. C., & Wyatt, R. J. Human sleep and its disorders. New York: Plenum, 1977.Google Scholar
  54. Monroe, L. J. Psychological and physiological differences between good and poor sleepers. Journal of Abnormal Psychology, 1967, 72, 255–264.PubMedCrossRefGoogle Scholar
  55. Montgomery, I., Perkin, G., & Wise, D. A review of behavioral treatments for insomnia. Journal of Behavior Therapy and Experimental Psychiatry, 1975, 6, 93–100.CrossRefGoogle Scholar
  56. National Academy of Sciences, Institute of Medicine. Report of a study: sleeping pills,insomnia, and medical practice. National Academy of Sciences: Washington, 1979.Google Scholar
  57. Nicassio, P. M., & Bootzin, R. R. A comparison of progressive relaxation and autogenic training as treatments for insomnia. Journal of Abnormal Psychology, 1974, 83, 253–260.PubMedCrossRefGoogle Scholar
  58. Oswald, I., Berger, R., Jaramillo, R., Keddie, K., Alley, P., & Plunkett, G. Melancholia and barbiturates. A controlled EEG, body and eye movement study of sleep. British Journal of Psychiatry, 1963, 109, 66–78.PubMedCrossRefGoogle Scholar
  59. Paul, G. L. Physiological effects of relaxation training and hypnotic suggestion. Journal of Abnormal Psychology, 1969, 74, 425–537.PubMedCrossRefGoogle Scholar
  60. Peper, E. Frontiers of clinical biofeedback. In L. Birk (Ed.), Seminars in psychiatry (Vol. 5). New York: Grune & Stratton, 1973.Google Scholar
  61. Raskin, M., Johnson, G., & Rondestvedt, J. W. Chronic anxiety treated by feedback-induced muscle relaxation: A pilot study. Archives of General Psychiatry, 1973, 28, 263–266.PubMedCrossRefGoogle Scholar
  62. Regestein, Q. R. Practical ways to manage chronic insomnia. Medical Times, June 1979, 107, 6, 19–23.PubMedGoogle Scholar
  63. Ribordy, S. C., & Denney, D. R. The behavioral treatment of insomnia: An alternative to drug therapy. Behaviour Research and Therapy, 1977, 15, 39–50.Google Scholar
  64. Richardson, G. S., Carskadon, M. A., Flagg, W., Van Den Hoed, J., Dement, W. C., & Mitler, M. M. Excessive daytime sleepiness in man: Multiple sleep latency measurement in narcoleptic and control subjects. Electroencephalography and Clinical Neurophysiology, 1978, 45, 621–627.PubMedCrossRefGoogle Scholar
  65. Roffwarg, H. P., Dement, W. C., & Fisher, C. Preliminary observation of the sleep-dream pattern in neonates, infants, children and adults. In E. Harms (Ed.), Problems of sleep and dream in children. New York: Pergamon, 1964.Google Scholar
  66. Schultz, J. H., & Luthe, W. Autogenic training. New York: Grune & Stratton, 1959.Google Scholar
  67. Schwartz, D., Wang, M., Leitz, L., & Goss, M. Medication errors made by elderly, chroni- cally ill patients. American Journal of Public Health, 1962, 52 (12), 2018–2029.PubMedCrossRefGoogle Scholar
  68. Shealy, R. C. The effectiveness of various treatment techniques on different degrees and duration of sleep-onset insomnia. Behaviour Research and Therapy, 1979, 17, 541–546.PubMedCrossRefGoogle Scholar
  69. Steinmark, S. W., & Borkovec, T. D. Active and placebo treatment effects on moderate insomnia under counterdemand and positive demand instructions. Journal of Abnormal Psychology, 1974, 82, 157–165.CrossRefGoogle Scholar
  70. Sunshine, A., Zighelboim, & Laska, E. Hypnotic activity of diphenhydramine, methapyrilene, and placebo. Journal of Clinical Pharmacology, August-September 1978, 18 (8–9), 425–431.Google Scholar
  71. Teutsch, G., Mahler, D. L., & Brown, C. R. Hypnotic efficacy of diphenhydramine, methapyrilene, and pentobarbital. Clinical Pharmacology and Therapeutics, 1975, 17, 195–201.PubMedGoogle Scholar
  72. Turner, R. M. A statistical and methodological analysis of behavior therapy treatment for insomnia. Unpublished doctoral dissertation, Temple University, 1977.Google Scholar
  73. Williams, R. L., Karacan, I., & Hursch, C. EEG of human sleep: Clinical applications. New York: Wiley, 1974.Google Scholar
  74. Wolpe, J. The practice of behavior therapy. New York: Pergamon, 1969.Google Scholar

Copyright information

© Plenum Press, New York 1982

Authors and Affiliations

  • Pam Hyde
    • 1
  • Vernon Pegram
    • 2
  1. 1.Neurosciences ProgramUniversity of AlabamaBirminghamUSA
  2. 2.Neurosciences Program and the Department of PsychiatryUniversity of AlabamaBirminghamUSA

Personalised recommendations