Tackling sleeplessness: Psychological treatment options for insomnia

Natalie D Dautovich¹, Joseph McNamara², Jacob M Williams³, Natalie J Cross⁴, Christina S McCrae³

¹Department of Psychology, ²Department of Psychiatry, ³Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA; ⁴Department of Veterans Affairs Community Based Outpatient Clinic, Greenville, NC, USA

Abstract: The purpose of the present paper is to review and summarize the research supporting nonpharmacologic treatment options for insomnia. The different treatment approaches are described followed by a review of both original research articles and meta-analyses. Meta-analytic reviews suggest that common nonpharmacologic approaches exert, on average, medium to large effect sizes on SOL, WASO, NWAK, SQR, and SE while smaller effects are seen for TST. Stimulus control therapy, relaxation training, and CBT-I are considered standard treatments for insomnia by the American Academy of Sleep Medicine (AASM). Sleep restriction, multicomponent therapy without cognitive therapy, paradoxical intention, and biofeedback approaches have received some levels of support by the AASM. Sleep hygiene, imagery training, and cognitive therapy did not receive recommendation levels as single (standalone) therapies by the AASM due to lack of empirical evidence. Less common approaches have been introduced (Internet-based interventions, bright light treatment, biofeedback, mindfulness, acupuncture, and intensive sleep retraining) but require further research. Brief and group treatments have been shown to be as efficacious as longer and individually-administered treatments. Considerations are presented for special populations, including older adults, children and teens, individuals from diverse cultural backgrounds, insomnia comorbid with other disorders, and individuals who are taking hypnotics.

Keywords: insomnia, nonpharmacologic, psychological, behavioral, treatments, sleep