A Behavioral Perspective on Insomnia Treatment

Spielman, Arthur J.; Caruso, Lauren S.; Glovinsky, Paul B.

doi:10.1016/s0193-953x(18)30532-x

Cited by 966 publications

(640 citation statements)

References 42 publications

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“…As noted by Spielman et al [34], it is likely that it is the interaction of individual vulnerability with specific triggers in the environment that serves to produce chronic insomnia. The high variability in the High FIRST group suggests that the predisposition to insomnia may lie on a continuum and that a specific cut point for such a construct may be less important than the degree of inherent vulnerability.…”

Section: Discussionmentioning

confidence: 99%

Stress-related sleep disturbance and polysomnographic response to caffeine

et al. 2006

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Background and purpose-To determine the sleep response to caffeine in individuals vulnerable to stress-related sleep disturbance as measured by polysomnography.Patients and methods-Eleven healthy individuals without insomnia scoring low (4 women, mean age=32.64 ± 15.46 years) and 10 healthy individuals also without insomnia scoring high (6 women, mean age=34.20 ± 13.73 years) on a measure of vulnerability to stress-related sleep disturbance were studied in a laboratory protocol. A moderate-low dose of caffeine (3 mg/kg) was administered 1 h prior to lights-out and compared to a counterbalanced control night with each condition separated by 1 week. Standard polysomnographic measures were assessed (i.e. total sleep time, sleep efficiency, latency to persistent sleep, and sleep stage percentages) for both control and caffeine nights.Results-There were no between-group differences in sleep on the control night. Importantly, individuals reporting vulnerability to stress-related sleep disturbance had significantly prolonged latency to persistent sleep in response to the caffeine challenge (interaction; P <0.05).Conclusion-Normal sleepers with an identified vulnerability to stress-induced sleep disturbance exhibited greater objectively verifiable sleep-reactivity in response to a caffeine challenge compared to non-vulnerable individuals. These results suggest that the construct of individual differences in vulnerability to sleep disturbance applies to a pharmacological 'stressor' (i.e. caffeine) as well as to previously assessed stressors such as a first-night effect. This finding provides further support for generalized trait vulnerability by demonstrating a sleep disturbance to a wake-promoting pharmacological challenge in specific a priori identified individuals.

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Section: Discussionmentioning

confidence: 99%

Stress-related sleep disturbance and polysomnographic response to caffeine

et al. 2006

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“…111 Perpetuating factors, the largest focus of the 3P model, are behaviors and beliefs that maintain insomnia, 111 such as increasing time in bed to "catch up" on sleep. 110 However, extended time in bed perpetuates insomnia because it leads to increased wakefulness, fragmented sleep, variability in sleep timing, 110 and associations between the sleep environment and wakefulness. Th us, initial attempts to reduce symptoms of insomnia may evolve into perpetuating factors themselves.…”

Section: Perpetuating Factorsmentioning

confidence: 99%

The Pathophysiology of Insomnia

Levenson

Kay

Buysse

2015

Chest

276

147

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Insomnia disorder is characterized by chronic dissatisfaction with sleep quantity or quality that is associated with diffi culty falling asleep, frequent nighttime awakenings with diffi culty returning to sleep, and/or awakening earlier in the morning than desired. Although progress has been made in our understanding of the nature, etiology, and pathophysiology of insomnia, there is still no universally accepted model. Greater understanding of the pathophysiology of insomnia may provide important information regarding how, and under what conditions, the disorder develops and is maintained as well as potential targets for prevention and treatment.The aims of this report are (1) to summarize current knowledge on the pathophysiology of insomnia and (2) to present a model of the pathophysiology of insomnia that considers evidence from various domains of research. Working within several models of insomnia, evidence for the pathophysiology of the disorder is presented across levels of analysis, from genetic to molecular and cellular mechanisms, neural circuitry, physiologic mechanisms, sleep behavior, and self-report. We discuss the role of hyperarousal as an overarching theme that guides our conceptualization of insomnia. Finally, we propose a model of the pathophysiology of insomnia that integrates the various types of evidence presented.

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“…As noted previously, it is possible that these patients develop maladaptive patterns of thinking or behavior that interfere with sleep and perpetuate the sleep problems even after such precipitating factors as nightmares and hypervigilance have decreased (Spielman et al [38], DeViva et al [44]). Patients may get into a pattern of giving themselves long periods of time in bed, thus increasing the likelihood of lying in bed awake.…”

Section: Trauma-focused Cognitive-behavioral Therapy For Posttraumatimentioning

confidence: 99%

“…However, research indicates that although traumafocused therapies improve sleep in some cases, sleep problems often do not remit after otherwise successful treatment of posttraumatic symptoms (Belleville et al [37], Zayfert and DeViva [17]). The simplest explanation for this is based on a well-accepted model of the development and maintenance of insomnia by Spielman and colleagues (Spielman et al [38]). The Spielman model hypothesizes that individuals differ in their level of predisposition toward developing insomnia (e.g., overall arousability).…”

Section: Nonpharmacologic Treatments Of Insomnia and Nightmares In Pomentioning

confidence: 99%

Treatment of sleep disturbances in posttraumatic stress disorder: A review

Schoenfeld

DeViva²,

Manber³

2012

JRRD

217

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Abstract-Sleep disturbances are among the most commonly reported posttraumatic stress disorder (PTSD) symptoms. It is essential to conduct a careful assessment of the presenting sleep disturbance to select the optimal available treatment. Cognitivebehavioral therapies (CBTs) are at least as effective as pharmacologic treatment in the short-term and more enduring in their beneficial effects. Cognitive-behavioral treatment for insomnia and imagery rehearsal therapy have been developed to specifically treat insomnia and nightmares and offer promise for more effective relief of these very distressing symptoms. Pharmacotherapy continues to be an important treatment choice for PTSD sleep disturbances as an adjunct to CBT, when CBT is ineffective or not available, or when the patient declines CBT. Great need exists for more investigation into the effectiveness of specific pharmacologic agents for PTSD sleep disturbances and the dissemination of the findings to prescribers. The studies of prazosin and the findings of its effectiveness for PTSD sleep disturbance are examples of studies of pharmacologic agents needed in this area. Despite the progress made in developing more specific treatments for sleep disturbances in PTSD, insomnia and nightmares may not fully resolve.

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A Behavioral Perspective on Insomnia Treatment

Cited by 966 publications

References 42 publications

Stress-related sleep disturbance and polysomnographic response to caffeine

Stress-related sleep disturbance and polysomnographic response to caffeine

The Pathophysiology of Insomnia

Treatment of sleep disturbances in posttraumatic stress disorder: A review

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