Insomnia

by Morin, Charles M.; Espie, Colin A.

• ISBN13: 9780306477508
• ISBN10: 0306477505
• Edition: CD
• Format: Hardcover
• Copyright: 2003-06-01
• Publisher: Plenum Pub Corp

Summary

This book describes a concise and up-to-date treatment program for insomnia intended for a range of health care providers. In a user-friendly manner it provides empirically-derived and clinically useful treatment procedures, comprising a cost-effective program that can be applied to large numbers of adults with insomnia. This program fits readily into managed care (U.S.) and local health co-operative systems (U.K.), particularly as it offers an alternative to pharmacotherapy. Chapters cover an introduction to sleep and its disturbance, as well as clear-cut assessment and treatment approaches. Most of the chapters are formatted for consistency and provide regular features in addition to the descriptive text, including clinical vignettes, a checklist of learning outcomes for the clinician, and recommendations for further reading on a given topic. Where applicable, assessment materials are reproduced and interpretation criteria provided. Additional features include guidance notes for the therapist in conducting each session, worksheets for patients to complete, and implementation criteria to increase patient compliance. For maximum convenience to the clinician the book comes with a CD containing materials that can be reproduced and customized for use in the assessment and treatment process.

Author Biography

Dr. Charles M. Morin joined the School of Psychology at Universit+¬ Laval in 1994, after postdoctoral training at the Medical College of Virginia, where he then worked as professor and director of the Sleep Disorders Center (from 1987 to 1994). Dr. Morin directs research on insomnia (subsidies of the National Institute of Mental Health and the IRSC) and co-directs work on the relation between sleep and cognitive and immunological functions (subsidy of the IRSC), and on empirically validated psychotherapies (subsidy of the FCAR). He is also a member of the Office of Direction of the Mental Health Network (Axis Sleep - subsidy of the FRSQ). He is an assistant head of the review for Behavioral Sleep Medicine and part of the editorial board of several scientific reviews. He directs the Center on Sleep Disorders and is a member of the Research Center Universit+¬ Laval Robert-Giffard (CRULRG). He was a director of the doctorate program (Ph.D., clinical orientation), from 1995 to 2000. In 1995, the American Psychological Association (APA) awarded him the Distinguished Early Career Award for his exceptional contribution to health psychology.

Table of Contents

1. The Basics of Sleep	1	(12)
Introduction	1	(1)
The Nature and Organization of Sleep	1	(1)
Biopsychosocial Determinants of Sleep	2	(5)
Circadian and Homeostatic Factors	2	(2)
Age and Maturation	4	(1)
Medical Conditions and Drugs	5	(1)
Psychosocial Factors	6	(1)
Lifestyle and Environmental Factors	7	(1)
Sleep Needs	7	(1)
The Functions of Sleep	7	(1)
Evaluating Individual Sleep Needs	8	(1)
The Consequences of Sleep Deprivation	8	(5)
Total Sleep Deprivation	9	(1)
Partial Sleep Deprivation	9	(1)
Insomnia, Sleep Loss, and Daytime Functioning	10	(1)
Impact of Insomnia on Psychological Well Being	10	(1)
Impact of Insomnia on Physical Health	10	(3)
2. Clinical Features of Insomnia	13	(14)
Introduction	13	(1)
Clinical Presentation	13	(3)
Definition	16	(1)
Concomitant Laboratory Findings and Clinical Features	17	(2)
Polysomnographic (PSG) Findings	17	(1)
Fatigue and Sleepiness	18	(1)
Psychological Profile	18	(1)
Neuropsychological Findings	19	(1)
Course and Prognosis	19	(1)
Insomnia as a Symptom or a Syndrome	20	(5)
Differential Diagnosis between Primary and Secondary Insomnia	21	(1)
Subtypes of Primary Insomnia	22	(3)
Does Your Patient Suffer from Insomnia?	25	(2)
3. Assessment and Differential Diagnosis of Insomnia	27	(18)
Introduction	27	(1)
The Assessment of Insomnia	27	(10)
The Sleep History	27	(3)
The Sleep Diary	30	(3)
Informant Report	33	(1)
Polysomnography	34	(1)
Actigraphy and Other Behavioral Devices	34	(2)
Daytime Sleepiness	36	(1)
Predisposing, Precipitating and Perpetuating Factors	36	(1)
Differential Diagnosis of Insomnia	37	(5)
Insomnia	39	(1)
Normal Aging	39	(1)
Sleep Related Breathing Disorder	39	(1)
Restless Legs Syndrome and Periodic Limb Movement Disorder	39	(1)
Circadian Disorders	40	(1)
Narcolepsy	40	(1)
Parasomnias	41	(1)
Sleep Problems Associated with Medical/Psychiatric Disorders	41	(1)
Extrinsic Sleep Disorders	42	(1)
Clinical Formulation of the Sleep Problem	42	(3)
4. Sleep Hygiene and Relaxation Therapy	45	(16)
Introduction	45	(1)
Rationale for Sleep Hygiene	46	(2)
Practical Instructions for Using Sleep Hygiene Advice	48	(4)
Caffeine	48	(1)
Nicotine	49	(1)
Diet	50	(1)
Exercise	50	(1)
Noise	51	(1)
Room Temperature	51	(1)
Body Temperature	51	(1)
Air Quality	52	(1)
Lighting	52	(1)
Mattress and Pillows	52	(1)
Rationale for Relaxation Therapy	52	(1)
Practical Instructions for Using Relaxation Therapy	53	(3)
Bedtime Wind-Down	53	(2)
Relaxation Training	55	(1)
Implementation Issues	56	(3)
Clinical Vignette	59	(2)
5. Sleep Scheduling	61	(16)
Introduction	61	(1)
Rationale for Sleep Scheduling	61	(3)
Practical Instructions for Using Sleep Scheduling	64	(7)
Objectives	64	(1)
1. Restrict Your Time Spent in Bed	64	(2)
2. Establish Your Rising Time	66	(1)
3. Establish Your "Threshold Time" for Bed	67	(1)
4. Go to Bed Only When You Feel Sleepy	68	(1)
5. Follow a 7-Night-per-Week Schedule	68	(1)
6. Observe the 15-Minute Rule	69	(1)
7. Make Adjustments to Your New Schedule	69	(1)
8. Make the Connection between Bed and Sleep	70	(1)
9. Avoid Daytime Naps	70	(1)
Implementation Issues	71	(6)
6. Cognitive Therapy	77	(24)
Introduction	77	(1)
The Role of Dysfunctional Cognitions in Insomnia	77	(3)
Rationale and Objectives	80	(1)
Principles and Practice of Cognitive Therapy	80	(5)
Identifying Dysfunctional Sleep Cognitions	81	(3)
Challenging Dysfunctional Sleep Cognitions and Changing them with More Rational Substitutes	84	(1)
Practical Recommendations for Changing Beliefs and Attitudes About Sleeplessness	85	(3)
Keep Realistic Expectations	85	(1)
Revise Attributions about the Causes of Insomnia	85	(1)
Don't Blame Sleeplessness for All Daytime Impairments	86	(1)
Do not Catastrophise after a Poor Night's Sleep	86	(1)
Don't Place Too Much Emphasis on Sleep	86	(1)
Develop Some Tolerance to the Effects of Sleep Loss	87	(1)
Never Try to Sleep	87	(1)
Clinical Vignettes	88	(5)
Vignette 1	88	(2)
Vignette 2	90	(2)
Vignette 3	92	(1)
Implementation Issues	93	(2)
Supporting Evidence	95	(1)
Other Cognitive Approaches	95	(6)
Paradoxical Intention	95	(2)
Cognitive Control	97	(1)
Thought-Blocking	98	(3)
7. Sleep Medications	101	(20)
Introduction	101	(1)
Types of Medications Used for Insomnia	101	(3)
Benzodiazepine-Receptor Agents	101	(2)
Antidepressants	103	(1)
Antihistamines	103	(1)
Herbal and Dietary Supplements	104	(1)
Clinical Benefits, Risks, and Limitations	104	(1)
Indications and Contra-Indications	105	(1)
Clinical Guidelines on the Appropriate Use of Sleep Medication	106	(2)
Combining Psychological and Pharmacological Approaches	108	(1)
Clinical Guidelines for Hypnotic Discontinuation	109	(11)
The Natural History of Hypnotic-Dependent Insomnia	110	(2)
A Step-by-Step Approach to Discontinue Hypnotics	112	(4)
Clinical and Practical Issues	116	(3)
Evidence for Efficacy of Hypnotic Discontinuation Programs	119	(1)
Conclusions	120	(1)
B. Clinical and Treatment Implementation Issues	121	(12)
Introduction	121	(1)
Treatment Implementation Formats: Individual, Group, and Brief Consultations Models	121	(2)
Treatment Parameters: Frequency, Timing, and Duration of Treatment	123	(2)
Strategies to Promote Compliance	125	(2)
Treatment of Special Populations	127	(6)
APPENDIXES
A. Outline Plan for a Sleep History Assessment Comprising Content Areas and Suggested Interview Questions	133	(2)
B. Sleep Diary	135	(2)
C. The Insomnia Severity Index	137	(2)
D. The Epworth Sleepiness Scale	139	(2)
E. The Pre-Sleep Arousal Scale	141	(2)
F. The Sleep Disturbance Questionnaire	143	(2)
G. Sleep Hygiene Practice Scale	145	(2)
H. Caffeine Knowledge Quiz	147	(2)
I. Transcript of a Relaxation Therapy Session (12-Minute Duration)	149	(4)
J. The Sleep Behavior Self-Rating Scale	153	(2)
K. Summary of the Sleep Scheduling Treatment Program	155	(2)
L. Calculating Current Sleep Requirement for Sleep Restriction	157	(2)
M. Self-Monitoring Form of Sleep-Related Thoughts	159	(2)
N. Dysfunctional Beliefs and Attitudes about Sleep Scale	161	(6)
O. Example of an Automatic Thought Record Used for Cognitive Therapy	167	(2)
P. The Glasgow Content of Thoughts Inventory	169	(2)
Q. The Glasgow Sleep Effort Scale	171	(2)
R. A Medication Withdrawal Schedule Form	173	(2)
References	175	(10)
Index	185