AASM Insomnia

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Table 8B. Common Elements of Behavioral Therapies for Insomnia Element Rationale Establish regular wake-up time, regardless of sleep duration of prior night Reduce time in bed to match actual sleep time Do not go to bed unless sleepy Do not stay in bed for long times if awake Avoid caffeine and alcohol Get exercise and exposure to light* Helps to establish strong circadian rhythm for sleep; increases sleep drive for subsequent nights Increases sleep drive; prevents frustration and negative associations with bed Increases sleep drive; prevents "trying too hard" to go to sleep Prevents frustration and negative associations with bed Caffeine and alcohol can disrupt sleep, particularly for those with insomnia Exercise and light can help sleep and mood *Morning and evening bright light exposures have phase-shifting effects that may alter sleep-wake schedules. For most insomnia patients, a regular hour of arising and immediate exposure to bright light will reinforce a normal schedule. Late evening/nighttime exposure to bright light may contribute to a delay in sleep onset. • General comments about psychological and behavioral therapies: ◉ Effective application of these treatments typically requires referral to a provider with training in CBT-I. ◉ Although sleep hygiene education is a reasonable intervention for primary care providers to provide, there is insufficient evidence to support its effectiveness as a stand-alone treatment for chronic insomnia. Sleep hygiene education may be useful in prevention of chronic insomnia when provided to patients with acute insomnia symptoms. Adapted from: Schutte-Rodin S, Broch L, Buysse D, Dorsey C, Sateia M. Clinical Guideline for the Evaluation and Management of Chronic Insomnia in Adults. J Clin Sleep Med. 2008;4(5):487-504. Standards of Practice Committee of the American Academy of Sleep Medicine. Practice parameters for the evaluation of chronic insomnia. Sleep. 2000;23(2):237-241. Standards of Practice Committee of the American Academy of Sleep Medicine. Practice parameters for the nonpharmacologic treatment of chronic insomnia. Sleep. 1999;22(8):1128-1133. Abbreviations: BzRA, Benzodiazepine Receptor Agonistic Modulators; CBT-I, cognitive-behavioral treatment - insomnia; Tx, treatment Disclaimer This Guideline attempts to define principles of practice that should produce high-quality patient care. It focuses on the needs of primary care practice, but also is applicable to providers at all levels. This Guideline should not be considered exclusive of other methods of care reasonably directed at obtaining the same results. The ultimate judgment concerning the propriety of any course of conduct must be made by the clinician aſter consideration of each individual patient situation. Neither IGC, the medical associations, nor the authors endorse any product or service associated with the distributor of this clinical reference tool. 5740 Executive Drive Suite 220 Baltimore, MD 21228 TEL: 410-869-3332 • FAX: 410-744-2150 For additional copies: orders@GuidelineCentral.com Copyright © 2010 All rights reserved

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