The new issue of *Canadian Psychology* includes an article: “Chronic
Insomnia: Recent Advances and Innovations in Treatment Developments and
Dissemination.”

The author is Charles M. Morin.

Here’s how the article begins:

[begin excerpt]

Sleep is a vital function, essential to psychological and physical well-
being.

Not surprisingly, sleep disturbances, particularly insomnia, are very
common amongst individuals with psychological or medical problems.

Insomnia is amongst the most prevalent health complaints and the most
common of all sleep disorders in the general population.

Epidemiological estimates indicate that 30% of the adult population
reports insomnia symptoms at least occasionally, while 10% presents an
insomnia disorder (Morin, LeBlanc, Daley, Gregoire, & Merette, 2006;
Ohayon, 2002).

Insomnia is more prevalent amongst women, older adults, shift workers,
amongst individuals with lower socioeconomic status, and those with poor
physical and mental health.

Chronic insomnia produces a significant burden for the individual and
for society, as evidenced by reduced quality of life, increased
absenteeism, and reduced productivity at work and higher health care
costs (Daley et al., 2009; Morin, LeBlanc, et al., 2006; Simon &
VonKorff, 1997).

Persistent insomnia is also associated with increased risks of
depression and chronic use of hypnotics and, amongst older adults with
cognitive impairments, it may hasten placement in a nursing home
facilities (Breslau, Roth, Rosenthal, & Andreski, 1996; Ford & Kamerow, 1989).

[end excerpt]

Here’s another excerpt: “Several psychological and behavioural therapies
have been validated in the treatment of insomnia and the following have
received formal recognition as efficacious or probably efficacious:
sleep restriction, stimulus control therapy, relaxation-based
interventions, sleep hygiene education, and combined cognitive-
behavioural therapy (Morin, Bootzin, Edinger, Espie, & Lichstein, 2006).”

Another excerpt: “There is a general preference amongst investigators
and clinicians for combining multiple interventions, with cognitive-
behavioural therapy (CBT) becoming the standard approach in the field
(Morin, Bootzin, et al., 2006). The most common combination involves a
behavioural (stimulus control, sleep restriction and, sometimes,
relaxation), a cognitive, and an educational (sleep hygiene) component.”

Another excerpt: “Although there has been no complete dismantling of CBT
to isolate the relative efficacy of each component, direct comparisons
of some of those components indicate that sleep restriction, alone or
combined with stimulus control therapy, is more effective than
relaxation alone which, in turn, is more effective than sleep hygiene
education alone. Sleep restriction tend to produce better outcomes than
stimulus control for improving sleep efficiency and sleep continuity,
but it also decreases total sleep time during the initial intervention.
Sleep hygiene education is incorporated to most treatments, but it
should be seen as a minimal intervention as this didactic approach alone
produces little impact on sleep. A recent study has shown that cognitive
therapy alone is effective in the management of insomnia and is
particularly promising to improve daytime variables (Harvey, Sharpley,
Ree, Stinson, & Clark, 2007).”

Another excerpt: “Several studies have contrasted the effects of
behavioural and pharmacological therapies for insomnia. Three studies
compared triazolam to relaxation (McClusky, Milby, Switzer, Williams, &
Wooten, 1991; Milby et al., 1993) or sleep hygiene (Hauri, 1997) and
five other investigations compared CBT to temazepam (Morin, Colecchi,
Stone, Sood, & Brink, 1999), zolpidem (Jacobs, Pace-Schott, Stickgold, &
Otto, 2004; Morin, Vallieres et al., 2009), or zopiclone (Sivertsen et
al., 2006; Vallieres, Morin, & Guay, 2005). Collectively, findings from
these studies indicate that both therapies are effective in the short-
term, with medication producing faster results in the acute phase (first
week) of treatment, whereas both treatments are equally effective in the
short-term interval (4-8 weeks). Long-term effects indicate that
patients treated with CBT maintain their improvements over time, whereas
those treated with medication lose their benefits after discontinuation
of medication.”

Another excerpt: “There is also extensive evidence from epidemiological
studies that insomnia is often comorbid with other psychiatric or
medical disorders, with some data showing that more than 40% of
individuals with insomnia present a comorbid psychiatric disorder (most
frequently major depression) relative to a base rate of about 13%
amongst those without insomnia (Ford & Kamerow, 1989; Pearson, Johnson,
& Nahin, 2006; Roth et al., 2006). Several longitudinal studies have
also documented that chronic and untreated insomnia can increase the
risk of new onset psychiatric disorders. For instance, in a population-
based sample, the risk of developing major depression was nearly four
times higher (3.95) amongst individuals with insomnia complaints
compared to those without insomnia at baseline (Breslau et al., 1996).
Another study found that insomnia (with fatigue) was the most common
residual symptom amongst patients treated for major depression
(Nierenberg et al., 1999) and some have suggested that persistent sleep
disturbances may be a risk factor for future relapse (Perlis, Giles,
Buysse, Tu, & Kupfer, 1997).”

Here’s how the article ends: “For those who already have expertise in
behavioural sleep medicine, they would do well to establish professional
partnerships and offer consulting services to sleep disorders centers
and primary care clinics. Such services are very much needed as shown by
a recent survey which reported that the large majority of sleep
disorders centers in Canada (and probably elsewhere) tend to be
diagnostic centers for more medically based disorders (e.g., sleep
apnea) and by and large do not provide any clinical service for insomnia
despite the demand and need for such services (Ruyak, Bilsbury, & Rajda,
2004).”

Here’s the author contact info: Charles M. Morin, Universite Laval,
Ecole de Psychologie, 2325, rue des Bibliotheques, Pavillon F.A.S.,
Quebec, Canada G1V 0A6
Email: <cmorin@psy.ulaval.ca>

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