Insomnia : a clinical guide to assessment and treatment / [edited by] Charles M. Morin and Colin A. Espie.

Format:

Book

Contributor:

Morin, Charles M.

Espie, Colin A.

Sabin W. Colton, Jr., Memorial Fund.

Language:

English

Subjects (All):

Insomnia.

Sleep Initiation and Maintenance Disorders--diagnosis.

Sleep Initiation and Maintenance Disorders--therapy.

Medical Subjects:

Sleep Initiation and Maintenance Disorders--diagnosis.

Sleep Initiation and Maintenance Disorders--therapy.

Physical Description:

xiv, 190 pages : illustrations ; 24 cm + 1 CD-ROM (4 3/4 in.)

Place of Publication:

New York : Kluwer Academic/Plenum Publishers, [2003]

System Details:

System requirements for accompanying CD-ROM: PC; Windows 98 (or higher).

Summary:

Insomnia: A Clinical Guide to Assessment and Treatment describes an evidence-based treatment program for insomnia. It is intended for health care providers who wish to develop competence in the management of insomnia. The book provides a step-by-step description of assessment and treatment procedures that can be administered effectively in various clinical settings (e.g., outpatient clinics, primary care medicine, sleep disorders clinics) and with different subtypes of insomnia. Chapters cover an introduction to sleep, assessment and diagnostic features of insomnia, and a description of interventions such as sleep hygiene and relaxation therapy, behavioral and sleep scheduling procedures, and cognitive strategies. Sleep medication issues related to their indications, risks, benefits, and discontinuation are also addressed. Clinical vignettes, patient's worksheets and handouts, and assessment scales with interpretation guidelines are incorporated to make this book user-friendly and to ensure that it is utilized successfully as a therapy manual even by non-specialists. For maximum convenience the book comes with a CD containing materials that can be reproduced and customized as needed. nsomnia: A Clinical Guide to Assessment and Treatment is an invaluable resource for psychologists, nurses physicians, and allied health professionals, as well as those who work with sufferers of chronic sleep problems.

Contents:

1. The Basics of Sleep 1

The Nature and Organization of Sleep 1

Biopsychosocial Determinants of Sleep 2

Circadian and Homeostatic Factors 2

Age and Maturation 4

Medical Conditions and Drugs 5

Psychosocial Factors 6

Lifestyle and Environmental Factors 7

Sleep Needs 7

The Functions of Sleep 7

Evaluating Individual Sleep Needs 8

The Consequences of Sleep Deprivation 8

Total Sleep Deprivation 9

Partial Sleep Deprivation 9

Insomnia, Sleep Loss, and Daytime Functioning 10

Impact of Insomnia on Psychological Well Being 10

Impact of Insomnia on Physical Health 10

2. Clinical Features of Insomnia 13

Clinical Presentation 13

Concomitant Laboratory Findings and Clinical Features 17

Polysomnographic (PSG) Findings 17

Fatigue and Sleepiness 18

Psychological Profile 18

Neuropsychological Findings 19

Course and Prognosis 19

Insomnia as a Symptom or a Syndrome 20

Differential Diagnosis between Primary and Secondary Insomnia 21

Subtypes of Primary Insomnia 22

Does Your Patient Suffer from Insomnia? 25

3. Assessment and Differential Diagnosis of Insomnia 27

The Assessment of Insomnia 27

The Sleep History 27

The Sleep Diary 30

Informant Report 33

Polysomnography 34

Actigraphy and Other Behavioral Devices 34

Daytime Sleepiness 36

Predisposing, Precipitating and Perpetuating Factors 36

Differential Diagnosis of Insomnia 37

Insomnia 39

Normal Aging 39

Sleep Related Breathing Disorder 39

Restless Legs Syndrome and Periodic Limb Movement Disorder 39

Circadian Disorders 40

Narcolepsy 40

Parasomnias 41

Sleep Problems Associated with Medical/Psychiatric Disorders 41

Extrinsic Sleep Disorders 42

Clinical Formulation of the Sleep Problem 42

4. Sleep Hygiene and Relaxation Therapy 45

Rationale for Sleep Hygiene 46

Practical Instructions for Using Sleep Hygiene Advice 48

Caffeine 48

Nicotine 49

Alcohol 49

Diet 50

Exercise 50

Noise 51

Room Temperature 51

Body Temperature 51

Air Quality 52

Lighting 52

Mattress and Pillows 52

Rationale for Relaxation Therapy 52

Practical Instructions for Using Relaxation Therapy 53

Bedtime Wind-Down 53

Relaxation Training 55

Implementation Issues 56

Clinical Vignette 59

5. Sleep Scheduling 61

Practical Instructions for Using Sleep Scheduling 64

1. Restrict Your Time Spent in Bed 64

2. Establish Your Rising Time 66

3. Establish Your "Threshold Time" for Bed 67

4. Go to Bed Only When You Feel Sleepy 68

5. Follow a 7-Night-per-Week Schedule 68

6. Observe the 15-Minute Rule 69

7. Make Adjustments to Your New Schedule 69

8. Make the Connection between Bed and Sleep 70

9. Avoid Daytime Naps 70

Implementation Issues 71

6. Cognitive Therapy 77

The Role of Dysfunctional Cognitions in Insomnia 77

Rationale and Objectives 80

Principles and Practice of Cognitive Therapy 80

Identifying Dysfunctional Sleep Cognitions 81

Challenging Dysfunctional Sleep Cognitions and Changing them with More Rational Substitutes 84

Practical Recommendations for Changing Beliefs and Attitudes About Sleeplessness 85

Keep Realistic Expectations 85

Revise Attributions about the Causes of Insomnia 85

Don't Blame Sleeplessness for All Daytime Impairments 86

Do not Catastrophise after a Poor Night's Sleep 86

Don't Place Too Much Emphasis on Sleep 86

Develop Some Tolerance to the Effects of Sleep Loss 87

Never Try to Sleep 87

Implementation Issues 93

Supporting Evidence 95

Other Cognitive Approaches 95

Paradoxical Intention 95

Cognitive Control 97

Thought-Blocking 98

7. Sleep Medications 101

Types of Medications Used for Insomnia 101

Benzodiazepine-Receptor Agents 101

Antidepressants 103

Antihistamines 103

Herbal and Dietary Supplements 104

Clinical Benefits, Risks, and Limitations 104

Indications and Contra-Indications 105

Clinical Guidelines on the Appropriate Use of Sleep Medication 106

Combining Psychological and Pharmacological Approaches 108

Clinical Guidelines for Hypnotic Discontinuation 109

The Natural History of Hypnotic-Dependent Insomnia 110

A Step-by-Step Approach to Discontinue Hypnotics 112

Clinical and Practical Issues 116

Evidence for Efficacy of Hypnotic Discontinuation Programs 119

8. Clinical and Treatment Implementation Issues 121

Treatment Implementation Formats: Individual, Group, and Brief Consultations Models 121

Treatment Parameters: Frequency, Timing, and Duration of Treatment 123

Strategies to Promote Compliance 125

Treatment of Special Populations 127

A. Outline Plan for a Sleep History Assessment Comprising Content Areas and Suggested Interview Questions 133

B. Sleep Diary 135

C. The Insomnia Severity Index 137

D. The Epworth Sleepiness Scale 139

E. The Pre-Sleep Arousal Scale 141

F. The Sleep Disturbance Questionnaire 143

G. Sleep Hygiene Practice Scale 145

H. Caffeine Knowledge Quiz 147

I. Transcript of a Relaxation Therapy Session (12-Minute Duration) 149

J. The Sleep Behavior Self-Rating Scale 153

K. Summary of the Sleep Scheduling Treatment Program 155

L. Calculating Current Sleep Requirement for Sleep Restriction 157

M. Self-Monitoring Form of Sleep-Related Thoughts 159

N. Dysfunctional Beliefs and Attitudes about Sleep Scale 161

O. Example of an Automatic Thought Record Used for Cognitive Therapy 167

P. The Glasgow Content of Thoughts Inventory 169

Q. The Glasgow Sleep Effort Scale 171

R. A Medication Withdrawal Schedule Form 173.

Notes:

Includes bibliographical references (pages 175-184) and index.

Local Notes:

Acquired for the Penn Libraries with assistance from the Sabin W. Colton, Jr., Memorial Fund.

ISBN:

0306477505

OCLC:

52160298