Insomnia - Treatment - Practical skills for applying CBT-I

Cognitive behaviour therapy for insomnia (CBT-I) is a multi-component treatment including behavioural, cognitive and educational strategies. CBT-I targets those behavioural and cognitive factors which are known to maintain the disorder of insomnia, such as maladaptive behaviours, dysregulation of the sleep drive, false beliefs about sleep and sleep-related anxiety. Within the most commonly used CBT-I strategies, sleep restriction and stimulus control behavioural interventions have been recognized as the most effective, even when administered alone. Nevertheless, because both these strategies initially provoke sleep deprivation, future research should adequately address the associated side effects. CBT-I cognitive strategies have received less systematic evaluation compared to behavioural components. However, as recent theories on insomnia identi ed cognitive hyperarousal as the most speci c pathophysiological factor of the disorder, new cognitive approaches have been recently proposed and tested. Furthermore, the emotional component of insomnia so far is not targeted directly by the standard CBT-I protocol. The addition of interventional strategies which deal directly with the emotional charge associated with the experience of insomnia could, however, be linked with an improved treatment outcome. Finally, new cognitive–behavioural approaches dealing more explicitly with daytime symptoms of insomnia have received rst empirical support.