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Using Behavioral Therapies in Primary Care

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Primary Care Sleep Medicine

Abstract

Sleep disturbances, and especially insomnia, are prevalent and prominent complaints among primary care patients. Behavioral interventions for several sleep disturbances are available and efficacious; behavioral insomnia interventions rival pharmacologic interventions in both effectiveness and expediency. Several barriers exist to the delivery of such behavioral interventions in the primary care setting including stigma associated with what may be perceived as mental health treatment, the patient’s readiness to change and engage in treatment, and provider time constraints. Chief among these barriers is the limited availability of staff trained to deliver behavioral sleep intervention effectively. Many of these barriers can be addressed by utilizing recent developments in the delivery of behavioral sleep interventions as well as by thoughtful planning of how to structure or restructure practices to accommodate this service. Indeed, the continued adaptation of sleep interventions to primary care settings may enhance overall dissemination efforts, resulting in greater availability of treatment for sleep-related difficulties on a large scale.

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References

  1. National Sleep Foundation. Sleep apnea and sleep. National Sleep Foundation. http://www.sleepfoundation.org/article/sleep-related-problems/obstructive-sleep-apnea-and-sleep. Accessed 8 Aug 2013.

  2. Netzer NC, Hoegel JJ, Loube D, et al. Prevalence of symptoms and risk of sleep apnea in primary care. Chest. 2003;124:1406–14.

    Article  PubMed  Google Scholar 

  3. Shochat T, Umphress J, Israel AG, Ancoli-Israel S. Insomnia in primary care patients. Sleep. 1999;22:S359–65.

    PubMed  Google Scholar 

  4. Ohayon MM, Caulet M, Lemoine P. Comorbidity of mental and insomnia disorders in the general population. Compr Psychiatry. 1998;39:185–97.

    Article  CAS  PubMed  Google Scholar 

  5. Taylor DJ, Lichstein KL, Durrence HH, Reidel BW, Bush AJ. Epidemiology of insomnia, depression, and anxiety. Sleep. 2005;28:1457–64.

    PubMed  Google Scholar 

  6. Pigeon WR. Treatment of adult insomnia with cognitive-behavioral therapy. J Clin Psychol. 2010;66:1–13.

    Article  Google Scholar 

  7. Pigeon WR, Bishop TM, Marcus JA. Current pharmacological and nonpharmacological options for the management of insomnia. Clin Med Insights Ther. 2013;5:151–62.

    Article  CAS  Google Scholar 

  8. Leshner A. NIH state-of-the-science conference statement on manifestations and management of chronic insomnia in adults. NIH Consens State Sci Statements. 2005;22:1–30.

    Google Scholar 

  9. Morin CM, Culbert JP, Schwartz SM. Nonpharmacological interventions for insomnia: a meta-analysis of treatment efficacy. Am J Psychiatry. 1994;151:1172–80.

    CAS  PubMed  Google Scholar 

  10. Bootzin RR, Nicassio P. Behavioral treatments for insomnia. In: Hersen M, Eisler RH, Miller PM, editors. Progress in behavior modification. New York, NY: Academic; 1978. p. 1–47.

    Google Scholar 

  11. Morgenthaler TI, 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;29:1415–9.

    PubMed  Google Scholar 

  12. Bootzin RR, Perlis ML. Nonpharmacologic treatments of insomnia. J Clin Psychiatry. 1992;53:37–41.

    PubMed  Google Scholar 

  13. Morin CM. Cognitive-behavioral approaches to the treatment of insomnia. J Clin Psychiatry. 2004;65:33–40.

    PubMed  Google Scholar 

  14. Irwin MR, Cole JC, Nicassio PM. Comparative meta-analysis of behavioral interventions for insomnia and their efficacy in middle-aged adults and in older adults 55+ years of age. Health Psychol. 2006;25:3–14.

    Article  PubMed  Google Scholar 

  15. Murtagh DR, Greenwood KM. Identifying effective psychosocial treatments for insomnia: a meta-analysis. J Consult Clin Psychol. 1995;63:79–89.

    Article  CAS  PubMed  Google Scholar 

  16. Morin CM, Azrin NH. Behavioral and cognitive treatments of geriatric insomnia. J Consult Clin Psychol. 1988;88:748–53.

    Article  Google Scholar 

  17. Morin CM. Insomnia: psychological assessment and management. Cambridge, UK: Guilford; 1993.

    Google Scholar 

  18. Spielman A, Saskin P, Thorpy MJ. Treatment of chronic insomnia by restriction of time in bed. Sleep. 1987;10:45–56.

    CAS  PubMed  Google Scholar 

  19. Perlis ML, Jungquist C, Smith MT, Posner D. Cognitive behavioral treatment of insomnia: a session-by session guide. New York, NY: Springer; 2009.

    Google Scholar 

  20. Montgomery P, Dennis JA. Cognitive behavioural interventions for sleep problems in adults aged 60+. Cochrane Database Syst Rev. 2003;1, CD003161. doi:10.1002/14651858.CD003161.

    PubMed  Google Scholar 

  21. Epstein DR, Sidani S, Bootzin RR, Belyea MJ. Dismantling multicomponent behavioral treatment for insomnia in older adults: a randomized controlled trial. Sleep. 2012;35:797–805.

    PubMed Central  PubMed  Google Scholar 

  22. Pigeon WR, Crabtree V, Scherer MR. The future of behavioral sleep medicine. J Clin Sleep Med. 2007;3:69–75.

    Google Scholar 

  23. Hunter CL, Goodie JL, Oordt MS, Dobmeyer AC. Integrated behavioral health in primary care: step by step guidance for assessment and intervention. Washington, DC: American Psychological Association; 2009.

    Google Scholar 

  24. Manber R, Carney C, Edinger J, et al. Dissemination of CBT-I to the non-sleep specialist: protocol development and training issues. J Clin Sleep Med. 2012;8:209–18.

    PubMed Central  PubMed  Google Scholar 

  25. Epstein RM, Duberstein PR, Feldman MD, et al. “I didn’t know what was wrong:” how people with undiagnosed depression recognize, name and explain their distress. J Gen Intern Med. 2010;25:954–61.

    Article  PubMed Central  PubMed  Google Scholar 

  26. Stecker T, Fortney J, Hamilton F, Sherbourne CD, Ajzen I. Engagement in mental health treatment among veterans returning from Iraq. Patient Prefer Adherence. 2010;4:45–9.

    Article  PubMed Central  PubMed  Google Scholar 

  27. Lang AJ. Mental health treatment preferences of primary care patients. J Behav Med. 2005;28:581–6.

    Article  PubMed  Google Scholar 

  28. Maguen S, Cohen G, Cohen BE, et al. The role of psychologists in the care of Iraq and Afghanistan veterans in primary care settings. Prof Psychol Res Pr. 2010;41:135–42.

    Article  Google Scholar 

  29. Shim R, Rust G. Primary care, behavioral health, and public health: partners in reducing mental health stigma. Am J Public Health. 2013;103:774–6.

    Article  PubMed Central  PubMed  Google Scholar 

  30. Epstein DR, Babcock-Parziale JL, Haynes PL, Herb CA. Insomnia treatment acceptability and preference of male Iraq and Afghanistan combat veterans and their healthcare providers. J Rehabil Res Dev. 2012;49:867–78.

    Article  PubMed  Google Scholar 

  31. Stinson K, Tang NKY, Harvey AG. Barriers to treatment seeking in primary insomnia in the United Kingdom: a cross-sectional perspective. Sleep. 2006;29:1643–6.

    PubMed  Google Scholar 

  32. Aloia MS. Understanding the problem of poor CPAP adherence. Sleep Med Rev. 2011;15:341–2.

    Article  PubMed  Google Scholar 

  33. Miller WR, Rollnick S. Motivational interviewing: preparing people for change. 2nd ed. New York, NY: The Guilford Press; 2002.

    Google Scholar 

  34. Aloia MS, Arnedt JT, Riggs RL, Hecht J, Borrelli B. Clinical management of poor adherence to CPAP: motivational enhancement. Behav Sleep Med. 2004;2:205–22.

    Article  PubMed  Google Scholar 

  35. Espie CA, MacMahon KMA, Kelly HL, et al. Randomized clinical effectiveness trial of nurse-administered small-group cognitive behavior therapy for persistent insomnia in general practice. Sleep. 2007;30:574–84.

    PubMed  Google Scholar 

  36. Germain A, Moul DE, Franzen PL, et al. Effects of a brief behavioral treatment for late-life insomnia: preliminary findings. Sleep Med. 2006;2:403–6.

    Google Scholar 

  37. Edinger JD, Sampson WS. A primary care friendly cognitive behavioral insomnia therapy. Sleep. 2003;2:177–82.

    Google Scholar 

  38. Schutte-Rodin S, Broch L, Buysee DJ, et al. Clinical guideline for the evaluation and management of chronic insomnia in adults. J Clin Sleep Med. 2008;4:487–504.

    PubMed Central  PubMed  Google Scholar 

  39. Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991;14:540–5.

    CAS  PubMed  Google Scholar 

  40. Buysee DJ, Reynolds CF, Monk TH, et al. The Pittsburgh sleep quality index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28:193–213.

    Article  Google Scholar 

  41. Bastien C, Vallieres A, Morin CM. Validation of the insomnia severity index as an outcome measure for insomnia research. Sleep Med. 2001;2:297–307.

    Article  PubMed  Google Scholar 

  42. Carney CE, Buysse DJ, Ancoli-Israel S, et al. The consensus sleep diary: standardizing prospective sleep self-monitoring. Sleep. 2012;35:287–302.

    PubMed Central  PubMed  Google Scholar 

  43. Von Korff M, Glasgow RE, Sharpe M. ABC of psychological medicine—organising care for chronic illness. BMJ. 2002;325:92–4.

    Article  Google Scholar 

  44. Espie CA. Stepped care: a health technology solution for delivering cognitive behavioral therapy as a first line insomnia treatment. Sleep. 2009;32:1549–58.

    PubMed Central  PubMed  Google Scholar 

  45. van Straten A, Cuijpers P. Self-help therapy for insomnia: a meta-analysis. Sleep Med Rev. 2009;13:61–71.

    Article  PubMed  Google Scholar 

  46. Pigeon WR, Funderburk J. (epub ahead of press). Delivering a brief insomnia intervention to depressed VA primary care patients. Cogn Behav Pract. doi: 10.1016/j.cbpra.2013.10.007.

    Google Scholar 

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Author information

Authors and Affiliations

  1. Center for Integrated Healthcare, Syracuse VA Medical Center, 800 Irving Ave, Syracuse, NY, 13210, USA

    Todd M. Bishop M.S.

  2. Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, 400 Fort Hill Ave, Canandaigua, NY, 14424, USA

    Wilfred R. Pigeon Ph.D.

  3. University of Rochester Medical Center, 300 Crittenden Blvd. – Box PSYCH, Rochester, NY, 14642, USA

    Wilfred R. Pigeon Ph.D.

Authors
  1. Todd M. Bishop M.S.
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  2. Wilfred R. Pigeon Ph.D.
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Corresponding author

Correspondence to Todd M. Bishop M.S. .

Editor information

Editors and Affiliations

  1. Sleep Disorders Center, Pueblo, Colorado, USA

    James F. Pagel

  2. Department of Population Health, New York University School of Medicine / Center for Healthful Behavior Change, New York, New York, USA

    S. R. Pandi-Perumal

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Bishop, T.M., Pigeon, W.R. (2014). Using Behavioral Therapies in Primary Care. In: Pagel, J., Pandi-Perumal, S. (eds) Primary Care Sleep Medicine. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1185-1_8

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  • DOI: https://doi.org/10.1007/978-1-4939-1185-1_8

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  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-1184-4

  • Online ISBN: 978-1-4939-1185-1

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