Inpatient CBT For Insomnia

[watto]

Just thought I'd post to see if anyone had any ideas for me regarding my first exposure to using CBT for insomnia in some psychiatric inpatients I'm working with. I'm writing a paper on the topic and thought I'd employ some of the practices that appear to be well-validated in the research. Right now, we're working on sleep diaries, doing stimulus-control, and I've downloaded some progressive relaxation files to the patients' iPods for their own use.

We push benzos / trazodone / seroquel so often for sleep, I felt it might be interesting to try something else (something with better long-term efficacy, anyway). Anyone else use these techniques or other modalities for patients with subjective complaints of poor sleep onset / maintenance / quality? Your suggestions are eagerly anticipated...

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[TheWowEffect]

Just thought I'd post to see if anyone had any ideas for me regarding my first exposure to using CBT for insomnia in some psychiatric inpatients I'm working with. I'm writing a paper on the topic and thought I'd employ some of the practices that appear to be well-validated in the research. Right now, we're working on sleep diaries, doing stimulus-control, and I've downloaded some progressive relaxation files to the patients' iPods for their own use.

We push benzos / trazodone / seroquel so often for sleep, I felt it might be interesting to try something else (something with better long-term efficacy, anyway). Anyone else use these techniques or other modalities for patients with subjective complaints of poor sleep onset / maintenance / quality? Your suggestions are eagerly anticipated...

CBT has been proven to be a very effective maintainance treatment for Insomnia in multiple well-designed studies. AASM offers a certificate course in Behavioral Sleep Medicine.

I am quoting NIH statement on Insomnia below to emphasize the importance of CBT.

NIH State-of-the-Science Conference Statement on
Manifestations and Management of Chronic Insomnia in Adults


Behavioral and cognitive-behavioral therapies (CBTs) have demonstrated efficacy in moderate to high-quality RCTs. Behavioral methods, which include relaxation training, stimulus control, and sleep restriction, were developed and first tested in the 1970s. More recently, cognitive therapy methods have been added to behavioral methods. Cognitive therapy methods include cognitive restructuring, in which anxiety-producing beliefs and erroneous beliefs about sleep and sleep loss are specifically targeted. When these cognitive methods have been added to the behavioral methods to compose a CBT package, it has been found to be as effective as prescription medications are for short-term treatment of chronic insomnia. Moreover, there are indications that the beneficial effects of CBT, in contrast to those produced by medications, may last well beyond the termination of active treatment. There is no evidence that such treatment produces adverse effects, but thus far, there has been little, if any, study of this possibility.

It is likely that most CBT is currently delivered by mental health practitioners or physicians with formal sleep medicine training. However, CBT refers to a number of varied nonpharmacologic treatments for insomnia, and a standardized “best practice” model has yet to be formulated and validated. Thus, future research should explore the optimum number and duration of sessions to yield positive results, particularly as delivered in busy primary care practices where the need and impact may be greatest.