![]() In patients who do not respond to brief behavioural therapy, cognitive therapies for insomnia may be required. As it does not require specialist training and can be delivered in an efficient manner, the Royal Australian College of General Practitioners supports its use by GPs and practice nurses. 19 The therapy consists of two face-to-face sessions, with an assessment and intervention session for 45–60 minutes and a 30-minute follow-up session after two weeks. In a randomised controlled trial of 82 patients there was remission in 36% and a response in 60% of patients after six months of follow-up. These strategies attempt to reduce sleep-related anxiety and a conditioned response around sleep.īrief behavioural therapy for insomnia combines sleep restriction and stimulus control strategies. Strategies include directing patients to only go to bed when sleepy and leaving the bedroom to engage in another activity if they fail to fall asleep or wake during the night. Stimulus control strategies aim to improve sleep quality by implementing a consistent sleep–wake schedule and strengthening cues that promote sleep. A randomised trial involving 45 patients with chronic insomnia reported an improvement in symptoms in 73% of those receiving sleep restriction therapy and sleep hygiene compared with 35% of a control group receiving sleep hygiene alone. Sleep restriction is a behavioural strategy that aims to reduce the time spent awake in bed by matching total time in bed with estimated sleep duration. However, there is limited evidence supporting sleep hygiene as a sole behavioural strategy and patients are at risk of developing maladaptive behaviours around sleep. Sleep hygiene aims to promote healthy behaviours and a conducive environment to improve sleep quality. Implement short relaxation periods at various times during the dayĮncourages thought restructuring around sleep and promotes mindfulnessĬhallenge unhelpful beliefs and attitudes around sleep including the requirement for a certain number of hours of sleep, the health impacts of insomnia and attributional biases attached to inadequate sleep Only return to sleeping position or bed when sleepyĪim to reduce hyperarousal that often underpins insomnia and to improve stress management If unable to fall asleep or waking for prolonged periods during the night, engage in another activity Promotes a consistent sleep–wake schedule and reduces conditioned response around sleepĪvoid naps during the day to increase natural homeostatic sleep drive Lengthen sleep window in 30-minute increments on subsequent reviews depending on progress Maintain a consistent sleep–wake schedule regardless of how much sleep is obtained overnight. Schedule a fixed bed and wake time based on estimated total sleep time, with at least six hours of opportunity for sleep, aiming for no longer than 30 minutes of wakefulness. This reduces the unnecessary amount of time spent in bed awake and increases sleep drive and sleep debt to consolidate sleep on subsequent nightsĪssess patient’s natural time of feeling sleepy and estimated total sleep time overnight (a sleep diary is often helpful in this setting). Avoid caffeine and nicotine before bedtimeĪims to balance estimated total sleep time with opportunity to sleep.Promotes healthy bedtime behaviours and an ideal environment for sleep Insomnia is not attributable to the physiological effects of a substance (e.g. narcolepsy, breathing-related sleep disorder, a circadian rhythm sleep–wake disorder, parasomnia).Ĭoexisting mental disorders and medical conditions do not adequately explain the predominant complaint of insomnia. Is not better explained by, and does not occur exclusively during, the course of another sleep–wake disorder (e.g. Occurs despite adequate opportunity for sleep. early morning awakening with inability to return to sleep.ĭisturbance causes clinically significant distress or impairment (social, occupational, educational, academic, behavioural or other important areas of functioning).įrequency of at least three nights per week.difficulty maintaining sleep (frequent awakenings or problems returning to sleep after awakening). ![]() Dissatisfaction with sleep quality or quantity associated with one or more of the following: ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |