Non-Pharmacological Treatment of Insomnia
Published
Feb 6, 2017
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Abstract
Insomnia is the most frequent sleep disorder and is often associated with psychiatric
disorders. This diagnosis is made when the predominant complaint is difficulty
initiating or maintaining sleep, or non-restorative sleep, for at least 3 months. The
objective of this article is to describe the different models of insomnia and the
non-pharmacologic therapeutic approaches. The most common therapy modalities
include behavioral approaches, stimulus control, sleep restriction, sleep hygiene and progressive muscle relaxation. Since insomnia is a chronic condition, long-term and safe
treatments are recommended.
Keywords
sleep, insomnia, sleep initiation and maintenance disorders, cognitive-behavior therapysueño, insomnio, trastornos del inicio y mantenimiento del sueño, terapia cognitiva.
References
1. Ohayon M. Epidemiology of insomnia:
what we know and what we still need to
learn. Sleep Med Rev. 2002;6:97-111.
2. American Psychiatric Association. Diagnostic
and statistical manual of mental
disorders. 5th ed. Arlington, VA: APA;
2013. p. 361-422.
3. Sadock B, Sadock V. Kaplan & Sadock’s
comprehensive textbook of psychiatry.9th ed. Philadelphia, PA: Lippincott Williams
& Wilkins; 2009. p. 2150-77.
4. Sateia MJ. International classification
of sleep disorders. 3rd ed.
Highlights and Modifications. CHEST.
2014;146(5):1387-94.
5. American Sleep Disorder Association.
International classification of sleep disorders.
2nd ed.: Diagnostic coding manual.
Westchesler, IL; 2005.
6. Lichstein Kl, Durrence HH, Taylor DJ,
et al. Quantitative criteria for insomnia.
Behav Res Ter. 2003;41:427-45.
7. Espie CA. Insomnia: conceptual issues
in the development, persistence, and
treatment of sleep disorder in adults.
Annu Rev Psychol. 2002;53:215-43.
8. Petit L, Azad N, Byszewski A, Sarazan
F, Power B. Non pharmacological management
of primary and secondary insomnia
among older people: review of
assessment tools and treatments. Age
Ageing. 2003;32:19-25.
9. Volltrath. M, Wicky W, Angst J. The Zurich
study: VIII Insomnia; Association
with depression, anxiety, somatic syndromes,
and course of insomnia. Eur Arch
Psychiatry Neurol Sci. 1989;239:113-
232.
10. Silber MH. Chronic insomnia. N Eng J
Med. 2005;353:803-10.
11. Viniegra Domínguez MA, et al. Abordaje
integrativo del insomnio en atención primaria:
medidas no farmacológicas y fitoterapia
frente al tratamiento convencional.
Aten Primaria. 2015;47(6):351-8. http://
dx.doi.org/10.1016/j.aprim.2014.07.009
12. Buysse D. Insomnia. JAMA. 2013;
309(7):706-16.
13. Mitchell M et al. Comparative effectiveness
of cognitive behavioral therapy
for insomnia: a systematic review.
BMC Family Practice. 2012;13:40. doi:
10.1186/1471-2296-13-4.
14. Roth T, Drake C. Evolution of insomnia:
current status and future directions. Sleep
Med. 2004;5(1):23-30.
15. Leger D, Guilleminault C, Dreyfus JP et
al. Prevalence of insomnia in a survey
of 12778 adults in France. J Sleep Res.
2000;9:35-42.
16. Sateina MJ. Evaluation of chronic insomnia.
Sleep. 2000;23:243-63.
17. Ford ES, Wheaton AG, Cunningham
TJ, Giles WH, Chapman DP, Croft JB.
Trends in outpatient visits for insomnia,
sleep apnea, and prescriptions for
sleep medications among US adults:
findings from the National Ambulatory
Medical Care Survey 1999-2010. Sleep.
2014;37(8):1283.
18. Glovinski P, CM Yang, Dubrovsky
B, Spielman A. Nonpharmacologic
strategies in the management of
insomnia:rationale and implementation.
Sleep Med Clin. 2008;3:189-204.
19. Thase ME. Correlates and consequences
of chronic insomnia. Gen Hos Psychiatry.
2005;27:100-12.
20. Sateia MJ Nowell PD. Insomnia. Lancet.
2004;364:1959-73CM.
21. Glovinski P, CM Yang, Dubrovsky B,
Spielman A. Nonpharmacologic strategies
in the management of insomnia: rationale
and implementtation. Sleep Med
Clin. 2008;3:189-204.
22. Yang CM, Spielman A, Glovinski P.
Nonpharmacologic strategies in the management of insomnia. Psychiatr Clin N
Am. 2006;29:895-919.
23. Mauss I, Troy A, LeBourgeois M. Poorer
sleep quality is associated with lower
emotion-regulation ability in a laboratory
paradigm. Cogn Emot. 2013;27(3):567-
76.
24. Stepanski E, Glinn M, Zorick F, et al.
Heart rate changes in chronic insomnia.
Stress Med. 1994;10:261-6.
25. Bonnet MH, Arand DL. Heart rate variability
in insomniacs and matched normal
sleepers. Psychosom Med. 1998;60:610-
15.
26. ML Perlis, DE Guilles, WB Mendelson
et al. Psychophysiological insomnia: The
behavioural model and a neurocognitive
perspective. J Sleep Res. 1997;6:179-88.
27. Johns MW. Relationship between sleep
habits, adrenocortical activity and personality.
Psychosom Med. 1071;33:499-
508.
28. Vgontzas AN, Tsigos C, Bixler EO, Lin
HM et al. Chronic insomnia is associated
with nyctohemeral activation of the
hypothalamic. Pituitary-adrenal axis:
Clinical implications. J Clin Endocrinol
Metab. 2001;86:3787-94.
29. Bastien CH, Morin CM, Ouellet MC,
Blais FC, Bouchard S. Cognitive-behavioral
therapy of insomnia: comparison
of individual therapy, group therapy, and
telephone cosultations. J. Consulting
Clin Psychol. 2004;72(4):653-9.
30. Rybarczyk B, Lopez M, Benson R, et al.
Efficacy of two behavioral treatment programs
for comorbid geriatric insomnia.
Psychol Aging. 2002;17:288-98.
31. Hiller RM, Johnston A, Dohnt H, Lovato
N, Gradisar M. Assessing cognitive processes
related to insomnia: A review and
measurement guide for Harvey’s cognitive
model for the maintenance of insomnia.
Sleep Med Rev. 2015;23:46-53.
32. Harvey L, Inglis SJ, Espie CA. Insomniacs’
reported use of CBT components
and relationship to long-term clinical
outcome. Behav Res Ther. 2002;40:75-
83.
33. Nofzinger EA, Buysse DJ, Germain
A, Price JC, Miedwald JM, Kupfer DJ.
Functional imaging evidence for hyperarousal
in insomnia. Am J Psychiatry.
2004;161(11):2126-31.
34. Harvey AG, Bélanger L, Talbot L, Eidelman
P, Beaulieu-Bonneau S, Fortier-
Brochu É, et al. Comparative efficacy of
behavior therapy, cognitive therapy, and
cognitive behavior therapy for chronic
insomnia: a randomized controlled trial. J
Consult Clin Psych. 2014;82 (4):670-83.
35. Perlis M, Aloia M, Millikan A et al. Behavioral
treatment of insomnia: A clinical
case series study. J Behav Med.
2000;23:149-61.
36. Sutton E. Insomnia. Med Clin N Am.
2014;98:565-81.
37. Sutton E. Psychiatric disorders and sleep
issues. Med Clin N Am. 2014;98(5):1123-
43.
38. Hood HK, Rogojanski J, Taryn M. Cognitive-
behavioral therapy for chronic
insomnia. Curr Treat Options Neurol.
2014;16:321.
39. Miller CB, Espie CA, Epstein DR, et al.
The evidence base of sleep restriction
therapy for treating insomnia disorder.
Sleep Med Rev. 2014;18(5):415-24.
40. Means MK, Lichstein KL, Epperson MT,
et al. Relaxation therapy for insomnia:nighttime and day time effects. Behav
Res Ther. 2000;38:665-78.
41. Ong JC, Shapiro SL, Manber R. Mindfulness
meditation and cognitive behavioral
therapy for insomnia a naturalistic
12-month follow-up. Explore. 2009;5:30-
6.
42. Smith MT, Perlis ML, Park A, et al. Comparative
meta-analysis of pharmacotherapy
and behavior therapy for persistent
insomnia. Am J Psychiatry. 2002;159:5-
11.
43. Gancedo-García A, Gutiérrez-Antezana
AF, González-García P, Salinas-Herrero
S, Prieto Merino D, Suárez-Gil P.
Efectividad de una intervención educativa
breve en pacientes con insomnio
en atención primaria. Aten Primaria.
2014;46(10):549-57.
44. Chennaoui M, Arnal JP, Sauvet F, Léger
D. Sleep and exercise: A reciprocal issue?
Sleep Med Rev. 2015;20:59-72.
45. Morin CM. Insomnia: Psychological assessment
and management. New York:
Guillford Press; 1993.
46. Baillargeon L, Landreville P, Verreault
R, et al. Discontinuation of benzodiazepines
among older insomniac adults treated
through cognitive-behavioral therapy
combined with gradual tapering: A randomized
trial. CMAJ. 2003;169:1015-20.
47. Edinger JD, Wohlgemuth WK, Radtke
RA, Marsh GR. Dose response effects
of behavioral insomnia therapy. Sleep.
2000;23:310.
48. Roth T, Rohers T, Pies R. Insomnia:
Patophysiology and implications for
treatment. Sleep Med Rev. 2007;10:541-
53.
49. Edinger JD, Sampson WS. A primary
care “friendly” cognitive behavioral insomnia
therapy. Sleep. 2003;26:177-82.
50. Taylor DJ, Zimmerman MR, Gardner
CE, Williams JM, Grieser EA, Tatum JI,
et al. A pilot randomized controlled trial
of the effects of cognitive-behavioral therapy
for insomnia on sleep and daytime
functioning in college students. Behav
Ther. 2014;45:376-89.
what we know and what we still need to
learn. Sleep Med Rev. 2002;6:97-111.
2. American Psychiatric Association. Diagnostic
and statistical manual of mental
disorders. 5th ed. Arlington, VA: APA;
2013. p. 361-422.
3. Sadock B, Sadock V. Kaplan & Sadock’s
comprehensive textbook of psychiatry.9th ed. Philadelphia, PA: Lippincott Williams
& Wilkins; 2009. p. 2150-77.
4. Sateia MJ. International classification
of sleep disorders. 3rd ed.
Highlights and Modifications. CHEST.
2014;146(5):1387-94.
5. American Sleep Disorder Association.
International classification of sleep disorders.
2nd ed.: Diagnostic coding manual.
Westchesler, IL; 2005.
6. Lichstein Kl, Durrence HH, Taylor DJ,
et al. Quantitative criteria for insomnia.
Behav Res Ter. 2003;41:427-45.
7. Espie CA. Insomnia: conceptual issues
in the development, persistence, and
treatment of sleep disorder in adults.
Annu Rev Psychol. 2002;53:215-43.
8. Petit L, Azad N, Byszewski A, Sarazan
F, Power B. Non pharmacological management
of primary and secondary insomnia
among older people: review of
assessment tools and treatments. Age
Ageing. 2003;32:19-25.
9. Volltrath. M, Wicky W, Angst J. The Zurich
study: VIII Insomnia; Association
with depression, anxiety, somatic syndromes,
and course of insomnia. Eur Arch
Psychiatry Neurol Sci. 1989;239:113-
232.
10. Silber MH. Chronic insomnia. N Eng J
Med. 2005;353:803-10.
11. Viniegra Domínguez MA, et al. Abordaje
integrativo del insomnio en atención primaria:
medidas no farmacológicas y fitoterapia
frente al tratamiento convencional.
Aten Primaria. 2015;47(6):351-8. http://
dx.doi.org/10.1016/j.aprim.2014.07.009
12. Buysse D. Insomnia. JAMA. 2013;
309(7):706-16.
13. Mitchell M et al. Comparative effectiveness
of cognitive behavioral therapy
for insomnia: a systematic review.
BMC Family Practice. 2012;13:40. doi:
10.1186/1471-2296-13-4.
14. Roth T, Drake C. Evolution of insomnia:
current status and future directions. Sleep
Med. 2004;5(1):23-30.
15. Leger D, Guilleminault C, Dreyfus JP et
al. Prevalence of insomnia in a survey
of 12778 adults in France. J Sleep Res.
2000;9:35-42.
16. Sateina MJ. Evaluation of chronic insomnia.
Sleep. 2000;23:243-63.
17. Ford ES, Wheaton AG, Cunningham
TJ, Giles WH, Chapman DP, Croft JB.
Trends in outpatient visits for insomnia,
sleep apnea, and prescriptions for
sleep medications among US adults:
findings from the National Ambulatory
Medical Care Survey 1999-2010. Sleep.
2014;37(8):1283.
18. Glovinski P, CM Yang, Dubrovsky
B, Spielman A. Nonpharmacologic
strategies in the management of
insomnia:rationale and implementation.
Sleep Med Clin. 2008;3:189-204.
19. Thase ME. Correlates and consequences
of chronic insomnia. Gen Hos Psychiatry.
2005;27:100-12.
20. Sateia MJ Nowell PD. Insomnia. Lancet.
2004;364:1959-73CM.
21. Glovinski P, CM Yang, Dubrovsky B,
Spielman A. Nonpharmacologic strategies
in the management of insomnia: rationale
and implementtation. Sleep Med
Clin. 2008;3:189-204.
22. Yang CM, Spielman A, Glovinski P.
Nonpharmacologic strategies in the management of insomnia. Psychiatr Clin N
Am. 2006;29:895-919.
23. Mauss I, Troy A, LeBourgeois M. Poorer
sleep quality is associated with lower
emotion-regulation ability in a laboratory
paradigm. Cogn Emot. 2013;27(3):567-
76.
24. Stepanski E, Glinn M, Zorick F, et al.
Heart rate changes in chronic insomnia.
Stress Med. 1994;10:261-6.
25. Bonnet MH, Arand DL. Heart rate variability
in insomniacs and matched normal
sleepers. Psychosom Med. 1998;60:610-
15.
26. ML Perlis, DE Guilles, WB Mendelson
et al. Psychophysiological insomnia: The
behavioural model and a neurocognitive
perspective. J Sleep Res. 1997;6:179-88.
27. Johns MW. Relationship between sleep
habits, adrenocortical activity and personality.
Psychosom Med. 1071;33:499-
508.
28. Vgontzas AN, Tsigos C, Bixler EO, Lin
HM et al. Chronic insomnia is associated
with nyctohemeral activation of the
hypothalamic. Pituitary-adrenal axis:
Clinical implications. J Clin Endocrinol
Metab. 2001;86:3787-94.
29. Bastien CH, Morin CM, Ouellet MC,
Blais FC, Bouchard S. Cognitive-behavioral
therapy of insomnia: comparison
of individual therapy, group therapy, and
telephone cosultations. J. Consulting
Clin Psychol. 2004;72(4):653-9.
30. Rybarczyk B, Lopez M, Benson R, et al.
Efficacy of two behavioral treatment programs
for comorbid geriatric insomnia.
Psychol Aging. 2002;17:288-98.
31. Hiller RM, Johnston A, Dohnt H, Lovato
N, Gradisar M. Assessing cognitive processes
related to insomnia: A review and
measurement guide for Harvey’s cognitive
model for the maintenance of insomnia.
Sleep Med Rev. 2015;23:46-53.
32. Harvey L, Inglis SJ, Espie CA. Insomniacs’
reported use of CBT components
and relationship to long-term clinical
outcome. Behav Res Ther. 2002;40:75-
83.
33. Nofzinger EA, Buysse DJ, Germain
A, Price JC, Miedwald JM, Kupfer DJ.
Functional imaging evidence for hyperarousal
in insomnia. Am J Psychiatry.
2004;161(11):2126-31.
34. Harvey AG, Bélanger L, Talbot L, Eidelman
P, Beaulieu-Bonneau S, Fortier-
Brochu É, et al. Comparative efficacy of
behavior therapy, cognitive therapy, and
cognitive behavior therapy for chronic
insomnia: a randomized controlled trial. J
Consult Clin Psych. 2014;82 (4):670-83.
35. Perlis M, Aloia M, Millikan A et al. Behavioral
treatment of insomnia: A clinical
case series study. J Behav Med.
2000;23:149-61.
36. Sutton E. Insomnia. Med Clin N Am.
2014;98:565-81.
37. Sutton E. Psychiatric disorders and sleep
issues. Med Clin N Am. 2014;98(5):1123-
43.
38. Hood HK, Rogojanski J, Taryn M. Cognitive-
behavioral therapy for chronic
insomnia. Curr Treat Options Neurol.
2014;16:321.
39. Miller CB, Espie CA, Epstein DR, et al.
The evidence base of sleep restriction
therapy for treating insomnia disorder.
Sleep Med Rev. 2014;18(5):415-24.
40. Means MK, Lichstein KL, Epperson MT,
et al. Relaxation therapy for insomnia:nighttime and day time effects. Behav
Res Ther. 2000;38:665-78.
41. Ong JC, Shapiro SL, Manber R. Mindfulness
meditation and cognitive behavioral
therapy for insomnia a naturalistic
12-month follow-up. Explore. 2009;5:30-
6.
42. Smith MT, Perlis ML, Park A, et al. Comparative
meta-analysis of pharmacotherapy
and behavior therapy for persistent
insomnia. Am J Psychiatry. 2002;159:5-
11.
43. Gancedo-García A, Gutiérrez-Antezana
AF, González-García P, Salinas-Herrero
S, Prieto Merino D, Suárez-Gil P.
Efectividad de una intervención educativa
breve en pacientes con insomnio
en atención primaria. Aten Primaria.
2014;46(10):549-57.
44. Chennaoui M, Arnal JP, Sauvet F, Léger
D. Sleep and exercise: A reciprocal issue?
Sleep Med Rev. 2015;20:59-72.
45. Morin CM. Insomnia: Psychological assessment
and management. New York:
Guillford Press; 1993.
46. Baillargeon L, Landreville P, Verreault
R, et al. Discontinuation of benzodiazepines
among older insomniac adults treated
through cognitive-behavioral therapy
combined with gradual tapering: A randomized
trial. CMAJ. 2003;169:1015-20.
47. Edinger JD, Wohlgemuth WK, Radtke
RA, Marsh GR. Dose response effects
of behavioral insomnia therapy. Sleep.
2000;23:310.
48. Roth T, Rohers T, Pies R. Insomnia:
Patophysiology and implications for
treatment. Sleep Med Rev. 2007;10:541-
53.
49. Edinger JD, Sampson WS. A primary
care “friendly” cognitive behavioral insomnia
therapy. Sleep. 2003;26:177-82.
50. Taylor DJ, Zimmerman MR, Gardner
CE, Williams JM, Grieser EA, Tatum JI,
et al. A pilot randomized controlled trial
of the effects of cognitive-behavioral therapy
for insomnia on sleep and daytime
functioning in college students. Behav
Ther. 2014;45:376-89.
How to Cite
Oviedo Lugo, G. F., Verhelst Forero, P. R., & Jordan Mondragon, V. (2017). Non-Pharmacological Treatment of Insomnia. Universitas Medica, 57(3), 348–366. https://doi.org/10.11144/Javeriana.umed57-3.mnfi
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