Whatever happened to insomnia (and insomnia research)?

Article Abstract:

National surveys conducted to evaluate the number of individuals who suffer from insomnia have revealed that many Americans have complaints about various sleep problems. For example, in 1983, a large random survey found that 33 percent of the Americans interviewed suffered with insomnia, although 50 percent of the self-reported insomniacs denied anxiety or high levels of emotional distress. This is consistent with recent biological, emotional, and social concepts of insomnia. The first Diagnostic and Statistical Manual of Mental Disorders (DSM-1), published in 1952, categorized insomnia as a purely psychological phenomenon. By the late 1970s, research related to various drugs for treating insomnia made it clear that some sleep disorders had an organic basis. By the time the third edition, revised (DSM-III-R) was published in 1987, sleep disorders occupied 17 pages and included over 14 categories divided into organic and nonorganic disorders, including: hypersomnia (excessive daytime sleepiness or sleep attacks), sleep-wake schedule disorder, dream anxiety (nightmare) disorder, and sleepwalking. A review of related studies found only 27 research studies of primary insomnia published during the past two decades which were of empirical value. Primary insomnia is a sleep disorder that is not associated with other mental or medical disorders. Insomnia is unpleasant, frustrating, creates anxiety, and when severe can lead to functional disabilities. It is suggested that research efforts may be inhibited by the perception of both patients and physicians that insomnia is common, usually transient in nature, and trivial in comparison to other disorders. Since insomnia can create serious problems, many more research efforts are required. To date, researchers seem to have been lulled by the tune of take two and go to sleep. (Consumer Summary produced by Reliance Medical Information, Inc.)

Research, Identification and classification, Sleep disorders

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Efficacy of behavioral versus triazolam treatment in persistent sleep-onset insomnia

Article Abstract:

Insomnia is a persistent disorder of starting or maintaining sleep, and is experienced by millions. It is defined as persisting for more than three weeks and not the result of psychiatric or medical causes. For sleep-onset insomnia, or difficulty falling asleep, two treatments have been proven effective: drug therapy with hypnotic sedatives, and behavior therapy (e.g. relaxation training). Drugs may be addicting and lead to other side effects, and most become ineffective after short-term use. With insomnia of several years' duration, alternative treatment may be more appropriate. Relaxation and another behavioral technique, stimulus control (limiting sleep to certain periods of time, regardless of drowsiness at other times), have been shown to be effective in treating sleep-onset insomnia. Behavior therapy was compared to the efficacy of triazolam, a drug frequently prescribed for insomnia. Thirty patients who complained of lying in bed for an average of 81 minutes before falling asleep, and whose complaints had lasted an average of 2.6 years, were assigned to one of two treatment groups: behavioral stimulus control/relaxation training or triazolam therapy. Both treatments decreased sleep onset time. Triazolam began to work immediately but at follow-up (5 weeks later) had become less effective. Behavioral treatment took effect in the second week of treatment with gains maintained at follow-up. Triazolam treatment showed superior immediate treatment effects, while behavioral treatment showed superior treatment effects at follow-up. One treatment strategy implied by the results would be to combine these two interventions concurrently to use the immediate effects provided by the medication until the behavioral skills were learned, at which time medication would be terminated. (Consumer Summary produced by Reliance Medical Information, Inc.)

Psychological aspects, Care and treatment, Evaluation, Drug therapy, Behavior modification, Insomniacs, Triazolam

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Whatever happened to intensive psychotherapy?

Article Abstract:

Intensive psychotherapy has been used less and less frequently as a treatment method in recent years. An essential tool of the psychiatrist since the 1940s, intensive psychotherapy has lost its popularity while biological psychiatry has come into prominence and psychoanalysis has not proven to be effective. Formerly, psychiatric residents received intensive training in psychoanalysis, and in practice some patients were treated in this manner for years. To further investigate the state of psychoanalysis, 163 psychiatric residents were surveyed. The questionnaire concerned the amount of time devoted to the psychoanalytic experience in the residency programs. More than 60 percent of the respondents indicated that patients were seen only once a week and no requirements concerning the number of sessions existed. Fewer than 40 percent of these doctors were required to be involved in performing psychotherapy more than twice a week. In addition, 45 questionnaires were sent to doctors presenting papers at the 1988 meeting of the Society for Psychotherapy Research. Most of these respondents indicated that their patients were seen once a week and the duration of treatment was usually less than six months; treatments lasting six months or longer were reported in only six studies. The implications of this survey are difficult to determine. Although there are proponents of intensive psychotherapy and those who question its overall usefulness, the effect that current trends will have on overall treatment experience and patient outcome are still unknown. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Usage, Training, Psychiatrists, Psychotherapy

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