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12.05.2015

Treatments for insomnia psychology, cures for subjective tinnitus - How to DIY

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Primary care physicians tend to choose for pharmacological treatment of insomnia,9although Cognitive Behavioral Therapy for Insomnia (CBT-I) has been recognized as an effective alternative,7,10 causing a durable long-term improvement of the patient’s sleep, well beyond the termination of the treatment. Several models have been proposed to understand the development of chronic insomnia.14,15,16 Despite differences between the models, common aspects are a reciprocal interaction between nervous system arousal, cognitive and emotional activation, environmental aspects, dysfunctional cognitions and maladaptive behavior. As the majority of insomniacs develop an irregular sleep pattern the first concern in CBT-I is to encourage patients to keep regular bedtimes and times of getting up.
With that in mind a web-based system Somnio was developed for the evaluation, diagnosis and treatment of insomnia patients.
From this group 62 patients completed at least 7 of the 8 CBT treatment sessions (20 males, 42 females, age between 18 and 72 years). The treatment plan consisted of 7 sessions with various components of CBT: sleep restriction, stimulus control, cognitive therapy, sleep hygiene and relaxation. The sleep pattern in the apnea group without insomnia as comorbidity was different from the sleep pattern in the insomnia group.
Insomniacs have different types of complaints and generally one of the complaints is predominant. In this paper we showed that the prevalence of insomnia and comorbidities measured via internet is comparable to other studies. The prevalence of insomnia is very high and sleep centers have not been able to offer effective treatment because CBT-I is difficult to offer. It is not surprising that pharmacotherapy is not an effective long-term solution for several of these components and their interaction. This paper reports on our experience with the internet based method and on the effectiveness of online CBT-I for a subgroup of 62 verified insomnia patients.
Interestingly the sleep pattern in the apnea group with comorbid insomnia was more similar to the sleep pattern of the insomnia group (Figure 1). An overview of the answers on this questionnaire form the basis for the cognitive component of the CBT-I. This high prevalence is in agreement with what is found in the literature22,23 and may warrant more emphasis on the assessment of insomnia in apnea diagnosis.


The high percentage of comorbidity of insomnia in apnea patients should be of concern to the sleep centers to also focus on insomnia. In this paper we showed that with modern technology it is possible to offer the treatment cost-effectively. The progress in the pharmacotherapy of insomnia over the last four decades have improved the hypnotic compounds in terms of a reduction of negative effects on the physiological sleep pattern and a reduction of side effects. Cognitive behavioral therapy for insomnia (CBT-I) consists of a combination of several techniques addressing the various aspects of the development of chronic insomnia. A promising alternative for the standard face-to-face delivery of the therapy is the internet.
The 15 questions covered the major symptoms of insomnia, apnea, narcolepsy and limb movement disorders. For each session, the patients had to keep a diary of their sleep wake schedule and their subjective perception of sleep. Encouragement and making the patients understand why a specific assignment was important to do are crucial for the motivation.
Epidemiology of insomnia: prevalence, self-help treatments, consultations, and determinants of help-seeking behaviors.
NIH State-of-the-Science Conference statement on manifestations and management of chronic insomnia in adults. Cognitive Behavioral Therapy for Insomnia Enhances Depression Outcome in Patients with Comorbid Major Depressive Disorder and Insomnia. Insomnia: conceptual issues in the development, persistence, and treatment of sleep disorder in adults.
Frequency of insomnia report in patients with obstructive sleep apnea hypopnea syndrome (OSAHS). Controlled trial of internet-based treatment with telephone support for chronic back pain. As insomnia is one of the most prevalent psychological health problems affecting between 9% and 19% of the adult population, it also has a socioeconomic impact on society in general.


The NIH concludes in their state-of- the-science conference in 20057 that such a combination of techniques can stay effective even after the termination of the treatment.
The rationale of the sleep restriction technique is to increase sleep time by consolidating the fragmented sleep of insomniacs in one solid block and by reducing the time the patient is awake in bed. The advantage of CBT for insomnia over the internet is the fact that that the therapy can be followed at home, so that it is independent of location.
After each week this information was analyzed and a personalized treatment plan was proposed. The three groups were compared on the change in sleep parameters from baseline to the end of the treatment. This is comparable to the values found in some recent studies on online self-administered insomnia treatment.19,20 These effects were found even though the patient group in this study consisted of patients with various insomnia complaints. Practice Parameters for the psychological and behavioral treatment of insomnia: an update. Walsh and Engelhardt1 estimated the direct costs involved in the diagnosis and treatment of insomnia in 1995 in the USA as $14 billion. Indirect costs of insomnia may involve the loss of productivity and the occurrence of accidents. The AASM practice parameters17 support the efficacy of the techniques for the treatment of insomnia. In the first consult each patient was asked to specify their desired sleep pattern by the end of the treatment.
The results in the present study shows effects of the treatment of a heterogeneous patient population comparable to real life situation.



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