Cognitive behavioral treatment for insomnia is equally effective in insomnia patients with objective short and normal sleep duration

BackgroundIt has been suggested that insomnia patients with short sleep duration and insomnia patients with normal sleep duration may respond differently to cognitive behavioral treatment for insomnia (CBT-I). To evaluate this hypothesis, we retrospectively examined a large sample of patients with chronic insomnia regarding their outcome post-treatment and six months after participating in a two-week standardized inpatient CBT-I program.ObjectivesSeventy-two women and 20 men with chronic insomnia received standardized inpatient CBT-I and were examined with three nights of polysomnography (two baseline nights and one post-treatment night directly following the two-week treatment). Follow-up measurements of subjective insomnia symptoms were conducted after six months. The CBT-I outcome was compared between insomnia patients with polysomnographically determined short (< 6 h) and normal (≥ 6 h) sleep duration.ResultsConcerning subjective outcomes, CBT-I was equally effective in insomnia patients with objective short and normal sleep duration. Secondary analyses of polysomnographic data collected at post-treatment revealed that insomnia patients with short sleep duration showed a better treatment response in comparison to those with normal sleep duration.ConclusionsThese results suggest that the distinction in insomnia between objective short and normal sleep duration may be of limited value for treatment decisions regarding CBT-I. However, as the overall picture of the literature on this issue is not conclusive, we conclude that further prospective research is necessary to investigate the clinical validity of phenotyping insomnia patients by objective sleep data.     

认知行为治疗对失眠症患者的治疗作用

目的 探讨认知行为治疗(CBT)对长期服用苯二氮卓艹类药物(BZD)的失眠症患者其睡眠质量、心理健康状况及BZD使用的改善作用,以提高对失眠症的疗效.方法 选择服用BZD治疗3个月以上的失眠症患者64例,随机分为单纯药物治疗组及药物治疗联合认知行为治疗组(联合治疗组),药物组BZD逐步减量,联合治疗组在BZD逐步减量的同时给予CBT治疗,共治疗6～8周.治疗前后采用症状自评量表(SCL-90)、自我和谐量表(SCCS)评价患者心理健康水平,匹兹堡睡眠质量指数(PSQI)评定临床疗效,并比较两组BZD的使用情况.结果 治疗结束后,比较药物治疗组、联合治疗组SCL-90总分[分别为(173.2 ± 41.3)和(147.6±23.6),t=5.696,P<0.01]、抑郁[分别为(2.3±0.6)和(1.9±0.4),t=3.799,P<0.01]、焦虑[分别为(2.2±0.7)和(1.7±0.3),t=4.792,P<0.01]等因子分及SCCS总分[分别为(96.8±11.5)和(87.8±9.3),t=5.067,P<0.01]、不和谐度因子分[分别为(48.7±8.1)和(40.7±6.9),t=4.508,P<0.01],联合治疗组评分显著低于药物治疗组;PSQI睡眠质量[分别为(14.4±2.9)和(9.0±1.8),t=6.902,P<0.01]、催眠药物[分别为(1.9±0.9)和(1.3±0.6),t=6.759,P<0.01]、日间功能等因子分[分别为(2.6±0.6)和(1.8±0.9),t=3.645,P<0.01],联合治疗组得分显著低于药物治疗组.联合治疗组临床显效率为55.2%,优于药物治疗组的17.8%,差异有统计学意义(χ2=18.57,P<0.01);联合治疗组BZD减药量明显大于药物组,差异有统计学意义(χ2＝16.32,P<0.01).结论 CBT可提高失眠症患者的心理健康水平,改善患者的睡眠质量和情绪症状,并可帮助患者减少BZD药物的用量,降低药物依赖的发生.     

伴失眠的抑郁症患者睡眠认知特征及其对睡眠质量的影响

目的 了解伴失眠的抑郁症患者对睡眠的信念与态度,并探讨其对睡眠质量的影响。方法 纳入在首都医科大学附属北京安定医院就诊、符合《精神障碍诊断与统计手册(第4版)》(DSM-IV)诊断标准的伴失眠的抑郁症患者(n=61)和原发性失眠患者(n=62)为研究对象,并招募健康对照组(n=64)。三组被试均接受睡眠功能失调信念和态度量表(DBAS)及匹兹堡睡眠质量指数量表(PSQI)评定,伴失眠的抑郁症患者同时接受汉密尔顿抑郁量表17项版(HAMD-17)评定。采用协方差分析比较三组被试PSQI和DBAS评分。采用多元线性回归分析探讨伴失眠的抑郁症患者PSQI评分的影响因素。结果伴失眠的抑郁症组和原发性失眠组PSQI评分均高于对照组(t=18.932、18.610,P均<0.01),两组DBAS评分均低于对照组(t=-5.561、-5.791,P均<0.01)。以伴失眠的抑郁症患者PSQI评分作为因变量,建立的多元线性回归方程具有统计学意义(F=14.095,R²=0.327,P<0.05),DBAS中对睡眠的预测与控制因子和年龄是患者睡眠质量的影响因素(B...     

The effects of cognitive-behavioral therapy for youth anxiety on sleep problems

The present study examined (a) whether sleep related problems (SRPs) improved following cognitive-behavioral therapy (CBT) for youth with anxiety disorders, (b) whether variables that may link anxiety and SRPs (e.g., pre-sleep arousal, family accommodation, sleep hygiene) changed during treatment, and (c) whether such changes predicted SRPs at posttreatment. Youth were diagnosed with anxiety at pretreatment and received weekly CBT that targeted their principal anxiety diagnosis at one of two specialty clinics (N = 69 completers, Mage = 10.86). Results indicated that parent-reported SRPs improved from pre- to post-treatment and that treatment responders with regard to anxiety yielded greater SRP improvements than nonresponders. Parent report of bedtime resistance and sleep anxiety showed significant improvements. Youth reported lower rates of SRPs compared to their parents and did not demonstrate pre- to post-treatment changes in SRPs. Pre-sleep arousal and family accommodation decreased over treatment but did not predict lower SRPs at posttreatment. Higher accommodation was correlated with greater SRPs. Sleep hygiene evidenced no change and did not mediate links between accommodation and posttreatment SRPs.     

Cognitive mechanisms of sleep outcomes in a randomized clinical trial of internet-based cognitive behavioral therapy for insomnia

ObjectiveThe aim of this study was to investigate in a randomized clinical trial the role of sleep-related cognitive variables in the long-term efficacy of an online, fully automated cognitive behavioral therapy intervention for insomnia (CBT-I) (Sleep Healthy Using the Internet [SHUTi]).MethodThree hundred and three participants (M_age = 43.3 years; SD = 11.6) were randomly assigned to SHUTi or an online patient education condition and assessed at baseline, postintervention (nine weeks after baseline), and six and 12 months after the intervention period. Cognitive variables were self-reported internal and chance sleep locus of control, dysfunctional beliefs and attitudes about sleep (DBAS), sleep specific self-efficacy, and insomnia knowledge. Primary outcomes were self-reported online ratings of insomnia severity (Insomnia Severity Index), and sleep onset latency and wake after sleep onset from online sleep diaries, collected 12 months after the intervention period.ResultsThose who received SHUTi had, at postassessment, higher levels of insomnia knowledge (95% confidence interval [CI] = 0.10–0.16) and internal sleep locus of control (95% CI = 0.04–0.55) as well as lower DBAS (95% CI = 1.52–2.39) and sleep locus of control attributed to chance (95% CI = 0.15–0.71). Insomnia knowledge, chance sleep locus of control, and DBAS mediated the relationship between condition and at least one 12-month postassessment sleep outcome. Within the SHUTi condition, changes in each cognitive variable (with the exception of internal sleep locus of control) predicted improvement in at least one sleep outcome one year later.ConclusionOnline CBT-I may reduce the enormous public health burden of insomnia by changing underlying cognitive variables that lead to long-term changes in sleep outcomes.     

认知行为疗法治疗慢性失眠障碍的研究现状

本文目的是分析失眠的认知行为治疗(CBTI)对慢性失眠障碍的效果,以期为推动CBTI的临床运用提供理论依据,为我国慢性失眠障碍患者选用非药物治疗提供参考.慢性失眠障碍是常见的疾病,CBTI已成为慢性失眠障碍的首选治疗方法.本文主要从CBTI对慢性失眠障碍的生理机制及神经影像学方面研究现状、疗效、不良反应、面临的问题及处...     

认知行为自助疗法和唑吡坦治疗慢性失眠的对照研究

目的 比较电话指导下的认知行为自助疗法(CBTI-SH)和酒石酸唑吡坦对慢性失眠的疗效. 方法 选择自2011年7月至2012年10月中山大学附属三院精神心理科门诊慢性失眠患者60例,按奇偶数法分为研究组和对照组各30例.对照组给予睡眠卫生教育+剂量递减的酒石酸唑吡坦治疗:药物起始剂量为10 mg/d,每周递减1/4剂量,疗程4周;研究组给予睡眠卫生教育+CBTI-SH治疗:疗程4周,内容包括认知重建、睡眠限制、刺激控制、放松训练,将CBTI-SH的内容制成文字材料,由患者自助实施,第1、3周末分别给予15 min的电话指导.在基线时及第2、4、6周末应用匹茨堡睡眠质量指数量表(PSQI)、Epworth嗜睡量表(ESS)对睡眠情况进行评价;要求患者每天记录睡眠日志,评价指标包括入睡潜伏期、入睡后觉醒时间、睡眠时间、卧床时间、睡眠效率;要求患者进行依从性评价,即过去1周内有多少天按照要求执行了CBTI-SH或睡眠卫生教育的6种主要成分. 结果 重复测量的方差分析显示,研究组和对照组PSQI量表、ESS量表评分及入睡潜伏期、睡眠效率、睡眠时间、卧床时间、入睡后觉醒时间在治疗前后不同时间之间的差异均有统计学意义(P＜0.05),且研究组的改善明显优于对照组,效应量分别为1.93、0.04、1.00、0.98、0.11、0.57、0.43.研究组对“不在床上做其他事”和“不在床上担忧”的依从性高于对照组,而对“限制卧床时间”、“不能睡则离开床”的依从性低于对照组,差异均有统计学意义(P＜0.05). 结论 和应用剂量递减的酒石酸唑吡坦治疗策略相比,CBTI-SH治疗慢性失眠及伴随的日间思睡的疗效更优,但部分依从性有待提高.     

Metacognitive beliefs relate specifically to sleep quality in primary insomnia: a pilot study

ObjectiveTo identify whether metacognitive aspects are a specific mental pattern of primary insomnia (PI) or an aspecific correlate of sleep alterations.MethodsSleep quality (Pittsburgh Sleep Quality Index: PSQI), anxiety (Self-rating Anxiety State: SAS), depression (Beck Depression Inventory: BDI) and metacognition (Metacognitions Questionnaire – Insomnia: MCQ-I) were evaluated in 24 PI patients, 13 snorers and 17 healthy controls. Rank-transformed PSQI, BDI, SAS and MCQ-I scores were submitted to one-way analysis of variance with group as a between-factor. PSQI was submitted to three-way analysis of covariance (ANCOVA) with MCQ-I, BDI or SAS as covariate and group as a between-factor. Post-hoc analyses were conducted using pairwise comparisons with Sidak correction.ResultsAs expected, PSQI scores significantly differentiated the three groups, one from another: PI had highest scores followed by snorers and healthy controls. PI subjects had MCQ-I scores significantly higher than those of snorers and healthy controls; no difference between the latter groups was found. The ANCOVA on PSQI with MCQ-I as a covariate abolished the difference in sleep quality between PI and snorers, whereas covarying for BDI or SAS left the differences in sleep quality between the groups unchanged.ConclusionThese preliminary results lead to two main conclusions: (i) metacognitive aspects are more prominent in PI when compared to snorers and healthy controls; (ii) MCQI shows higher sensitivity in defining PI patients, with respect to PSQI. If these findings are confirmed and expanded by further studies, the development of a specific metacognitive model of primary insomnia may be warranted.     

The effect of baclofen on objective and subjective sleep measures in a model of transient insomnia

Study objectivesInsomnia is a common medical complaint. Current pharmacologic treatments have modest efficacy and numerous side effects. Baclofen is a gamma-aminobutyric acid (GABA)b receptor agonist used to treat spasticity in various medical conditions. Several studies noted that baclofen, when used to treat sleep related disorders, resulted in improvement in sleep parameters. Measures of insomnia, however, were not assessed in those studies. To date, baclofen has not been assessed for efficacy in the treatment of insomnia.MethodsWe randomized 20 healthy subjects to baclofen or placebo in a cross over design. All subjects underwent two polysomnograms (PSG) assessing sleep parameters. Baclofen or placebo was given 90 min prior to lights out in random order for each subject. Lights out occurred two hours earlier than the subject's median habitual bedtime.ResultsBaclofen resulted in significantly less objective wake after sleep onset and stage 1 sleep, and significantly increased total sleep time (TST), sleep efficiency, and stage 3/4 sleep. There was no effect on sleep onset latency (SOL). Self-report variables indicated significantly less subjective awakenings from sleep and increased subjective sleep quality. There was no effect on subjective TST or subjective SOL.ConclusionsThis study showed that baclofen was superior to placebo with regard to several objective and subjective measures used to assess sleep quality. These data support the notion that baclofen shows promise as an effective hypnotic drug.     

失眠的认知行为治疗对失眠障碍患者睡眠质量和认知功能的影响

背景 失眠障碍已成为当前社会的一种常见疾病,失眠的认知行为治疗（CBTI）是失眠障碍的非药物治疗方法之一,其对失眠障碍患者睡眠质量和认知功能影响的研究有限。目的 探索CBTI对失眠障碍患者睡眠质量和认知功能的影响,为失眠障碍的非药物治疗提供参考。方法 选取2021年1月-2022年10月在四川省精神卫生中心就诊、符合《精神障碍诊断与统计手册（第5版）》（DSM-5）诊断标准的47例失眠障碍患者为研究对象。患者接受为期6周的CBTI治疗。治疗前,采用汉密尔顿抑郁量表24项（HAMD-24）和汉密尔顿焦虑量表（HAMA）评定患者的抑郁和焦虑症状,在治疗前及治疗6周后采用匹兹堡睡眠质量指数量表（PSQI）和蒙特利尔认知评估量表（MoCA）评定患者的睡眠情况和认知功能。采用Spearman相关分析考查治疗后失眠障碍患者PSQI总评分减分值与MoCA总评分增分值的相关性。结果 治疗6周后,失眠障碍患者PSQI的主观睡眠质量、入睡时间、睡眠时间、睡眠效率、睡眠障碍、日间功能障碍因子评分及PSQI总评分均低于治疗前,差异均有统计学意义（t=5.569~15.290,P均<0.01）,MoCA的视空间与执行功能、命名、注意力、语言能力、抽象思维、记忆力因子评分及总评分均高于治疗前,差异均有统计学意义（t=-11.273~-4.277,P均<0.01）。Spearman相关分析显示,经6周CBTI治疗后,失眠障碍患者PSQI总评分减分值与MoCA总评分增分值呈正相关（r=0.323,P=0.027）。结论 CBTI可能有助于改善失眠障碍患者的睡眠质量和认知功能。CBTI干预后,失眠障碍患者睡眠质量的提高可能与认知功能的改善存在一定的关联。     

慢性失眠症认知行为治疗研究进展

慢性失眠症的治疗方式主要包括药物治疗和认知行为治疗.药物治疗慢性失眠症起效时间短、见效快,但易增加成瘾性,产生不良反应.认知行为疗法（CBT）是应用最广泛的非药物治疗方法,现已用于慢性失眠症的治疗并取得显著的疗效.CBT在治疗慢性失眠症的同时避免了药物治疗的不良反应,并且长期治疗效果优于药物治疗.     

Long-term effectiveness of a short-term cognitive-behavioral group treatment for primary insomnia

The long-term effectiveness of a short-term cognitive-behavioral therapy was evaluated. The structured group treatment consisted of six weekly sessions and included progressive muscle relaxation, cognitive relaxation, modified stimulus control with bedtime restriction, thought stopping and cognitive restructuring. Twenty patients with chronic primary insomnia took part in the study. All patients were referred by physicians for diagnosis and therapy of insomnia. During a waiting period of six weeks prior to treatment, patients did not experience any change of their sleep parameters. After therapy, patients improved their total sleep time and sleep efficiency and reduced their sleep latency and negative sleep-related cognitions. Furthermore, depression scores decreased. Most of the treatment effects were significant at the end of the treatment and remained stable over the long-term follow-up, which was evaluated after a mean of almost three years (35±6.7 months). The subjective estimated total sleep time improved from 298±109 min prior to therapy to 351±54 min at the end of treatment, to 376±75 min at the 3-month follow-up, to 379±58 min at the 12-month follow-up and to 381±92 min. at the long-term follow-up. Received: 27 September 2000 / Accepted: 29 January 2001     

Task switching in older adults with and without insomnia

BackgroundTask-switching deficits are common in older adults and in those with insomnia. Such deficits may be driven by difficulties with sleep continuity and dampened homeostatic sleep drive.ObjectiveTo identify the aspects of task switching affected by insomnia and its treatment, and to determine whether such effects are associated with sleep continuity and homeostatic sleep drive.MethodsPolysomnographic sleep and task switching were tested in healthy older adults aged 60–93 years with insomnia (n = 48) and normal sleeping controls (n = 51). Assessments were repeated in the insomnia group after eight weeks of cognitive behavioral treatment for insomnia. Sleep measures included wake after sleep onset (WASO) and quantitative indices of homeostatic sleep drive (delta power during nonrapid eye movement [NREM] sleep and the ratio of delta power during the first and second NREM periods). A cued task-switching paradigm instructed participants to perform one of two tasks with varying preparatory cue-target intervals, manipulating task alternation, task repetition, and task preparation.ResultsThe effect of preparatory cues on accuracy was diminished in the insomnia group compared with that in controls. Across the two groups, a stronger effect of preparatory cues was associated with a higher delta sleep ratio. Following insomnia treatment, task-repetition accuracy significantly improved. This improvement was associated with improvements in WASO. There were no group or treatment effects on response time or task alternation accuracy.ConclusionsEffects of insomnia diagnosis and treatment apply to conditions that depend on the maintenance of a task set, rather than a domain general effect across task switching. Such effects are associated with homeostatic sleep drive and sleep continuity.     

Beliefs about sleep in disorders characterized by sleep and mood disturbance

OBJECTIVES: Maladaptive sleep beliefs play an important role in primary insomnia, but their role in other disorders with concomitant sleep disruption has rarely been explored. Thus, this study investigated the link between insomnia and sleep beliefs in five groups (N=422): primary insomnia (PI), good sleepers (GS), fibromyalgia (FM), major depressive disorder (MDD), and Community Sleep Clinic patients with comorbid insomnia and mood disturbance (CSC). METHOD: Groups were compared on the Dysfunctional Beliefs and Attitudes about Sleep (DBAS-16) scale. RESULTS: Unlike the GS group, the MDD, FM, and CSC groups had elevated DBAS-16 scores that were similar to, or more pathological than, those of primary insomnia sufferers. Only some of the differences were removed after controlling for depression. CONCLUSION: Like primary insomnia patients, other sleep-disturbed patient groups have problematic sleep beliefs. Depression was not sufficient to account for all elevations in beliefs. The presence of maladaptive sleep beliefs in these patients suggests that belief-targeted treatment might be helpful in alleviating sleep complaints.     

失眠症患者主客观睡眠状况分析

目的：探讨失眠症患者主客观睡眠状况及其临床意义。方法：对71例失眠症患者及27例正常对照者进行睡眠调查及全夜多导睡眠图(PSG)检测。结果：失眠症组主观入睡时间、醒觉次数、睡眠潜伏期的评估值较PSG检测值显著增高；主客观入睡时间的评估显著不一致。结论：失眠症患者对失眠障碍主客观评估不一致，在临床诊断时应引起重视。