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Cognitive–behavioral therapy (CBT) programs that combine specific single therapies have been shown empirically to be effective in the treatment of primary insomnia. These multicomponent programs may be delivered in either an individual or a group format, and the duration of treatment may be up to 8 weekly sessions. Gains for patients with insomnia receiving CBT were maintained at a 2-year follow-up; these results were superior to those from pharmacotherapy. Although CBT has been recommended for patients with primary insomnia, data have shown its effectiveness in patients with secondary insomnia. In secondary insomnia, a primary medical or psychiatric disorder is assumed to be causing the insomnia. Individual behavioral therapies for insomnia may include sleep restriction therapy, stimulus control therapy, and relaxation therapy. Sleep restriction therapy increases homeostatic sleep drive by decreasing the time in bed available for sleep. The sleep–wake schedule is manipulated on the basis of the amount of sleep achieved over the previous several nights until an optimal schedule is determined. Stimulus control therapy seeks to break the negative conditioning associated with the bedroom environment by requiring that patients not spend time in bed when they are wide awake. They are instructed to leave the bedroom, engage in relaxing activities, and return to bed only when drowsy. Many relaxation therapies are used for insomnia, including progressive muscle relaxation, guided imagery, and autogenic training. Cognitive therapy for insomnia is aimed at modifying patients' unrealistic expectations about their sleep as well as their irrational fears about the consequences of poor sleep. Forms and Questionnaires Standard Interview Format for the Evaluation of Insomnia |
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