Insomnia A Clinical Guide to Assessment and Treatment
Along with increasing recognition of the consequences and costs of ins- nia, there is growing evidence documenting the effectiveness of cogniti- behavior therapy for insomnia. Yet, there is still a major gap between available evidence and current clinical
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Insomnia A Clinical Guide to Assessment and Treatment
Charles M. Morin Université Laval Quebec, Canada
and
Colin A. Espie University of Glasgow Glasgow, Scotland
KLUWER ACADEMIC PUBLISHERS NEW YORK, BOSTON, DORDRECHT, LONDON, MOSCOW
CD-ROM available only in print edition eBook ISBN: 0-306-47896-X Print ISBN: 0-306-47750-5
©2004 Springer Science + Business Media, Inc. Print ©2003 Kluwer Academic/Plenum Publishers New York All rights reserved No part of this eBook may be reproduced or transmitted in any form or by any means, electronic, mechanical, recording, or otherwise, without written consent from the Publisher Created in the United States of America Visit Springer's eBookstore at: and the Springer Global Website Online at:
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To our children, Geneviève and Sébastien (CM) and Craig, Carolyn, and Robbie (CE), for their love and inspiration, and to Rena whose courage in adversity is an example to follow (CE)
Preface
Along with increasing recognition of the consequences and costs of insomnia, there is growing evidence documenting the effectiveness of cognitivebehavior therapy for insomnia. Yet, there is still a major gap between available evidence and current clinical practice. Much of this gap is due to economics, limited treatment access, and ineffective dissemination of knowledge. There is a definite need for practical materials to facilitate access to and implementation of interventions for insomnia. As scientistspractitioners, we are constantly reminded of this need by frequent requests from clinicians around the world for questionnaires and handouts to assist them in treating insomnia patients. It was during a recent international sleep meeting, more specifically on a train journey between Dresden and Prague, that we drafted an outline of a handbook that would help fill this gap. This clinical handbook describes an evidence-based treatment program for insomnia. Its content is based on materials that have been clinically tested and validated with patients in various settings and with different subtypes of insomnia. The manual is divided into eight chapters. Chapter 1 presents an introduction to sleep and provides answers to frequently asked questions about the nature of sleep, its determinants, and about the consequences of sleep loss and insomnia. Chapters 2 and 3 outline the main clinical features of insomnia and differential diagnostic issues and describe a practical approach to the assessment of insomnia complaint. Chapters 4–6 provide a step-by-step description of the treatment program, including sleep hygiene guidelines, relaxation therapy, behavioral and sleep scheduling strategies, and cognitive interventions. Chapter 7 covers the essentials of sleep medications, their indications, risks and benefits, as well as clinical guidelines to discontinue their usage among prolonged vii
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Preface
users. Chapter 8 concludes with practical strategies for effective treatment implementation and addresses clinical issues arising when w
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