Index Abdominal breathing, 70; see also Breathing; Relaxation therapy Activation, sleep drive/responsivity, 6-9 Age level; see also Elderly circadian rhythms and, 68-69 delayed sleep phase syndrome and, 194 pharmacotherapy and, 118, 120 vicious circle model and, 167 Alcohol delayed sleep phase syndrome and, 200, 201 pharmacotherapy and, 116 sleep hygiene rules and, 68 treatment selection strategy and, 140 Antidepressants; see also Depression; Pharmacology pharmacotherapy protocols and, 123-124 sleep behavior management and, 181 Anxiety barriers to sleep and, 4 209, 2U insomnia and, 156 pharmacotherapy and, 119, 122-U3 predisposing factor, 11 psychotherapy (short-term), 103, 1U sleep restriction therapy. 61 treatment selection strategy and, 137, 138, 140, 146-147 Arousal barriers to sleep and, 3 Arousal (cont.) functional chronic insomnia, 104, 106 psychotherapy (short-term), 112 stimulus control instructions and, 19 Associative control of sleep, 4-6 Asthma, 233 Autogenic training, 70; see also Relaxation therapy Bed cue, stimulus control instructions, 19 Bedtime regularization, sleep hygiene rules, 68-69 Behavior therapy pharmacotherapy combined with, 117 stimulus control (group setting), 32-34 stimulus control instructions and, 21 Benzodiazepine sedative-hypnotics, 115; see also Pharmacology; Pharmacotherapy Biofeedback, 70; see also Relaxation therapy Body temperature rhythms sleep hygiene rules, 68 wake-maintenance zone and, 9, 10 Breathing; see also Relaxation therapy abdominal breathing, 70 good night's sleep model, 142 Bright light therapy body temperature rhythms and, 10 delayed sleep phase syndrome and, 196, 199-200 early morning awakening insomnia and, 207, 210-211, 214; see also Early morning awakening insomnia effectiveness discussed, 215-218 249
250 Caffeine phannacotherapy and, 116 psychotherapy and, 88 sleep hygiene rules and, 68 Chronic illness, 223-236; see also Organic sleep pathology cardiogenic nocturnal dyspnea case study, 229-232 hypnogenic dystonia case study, 228-229 method of treatment, 224-228 overview of, 223-224 treatment application~ 232-234 Chronic insomnia: see Functional chronic insomnia Chronicity, phannacotherapy, 119 Chronic obstructive pulmonary disease (COPD) sleep disturbance and, 224 treatment method and, 225 Chronic pain chronic illness and, 233-234 treatment strategy and, 136-137 Circadian rhythm bright light therapy and, 210-211 delayed sleep phase syndrome, 194, 198 209-210 good night's sleep model, 144 sleep hygiene rules, 67-68 sleep-wake schedule disorders, 191 vicious circle model, 155 wake-maintenance zone and, 10 Classical conditioning, associative control of sleep, 4-6 Oock, sleep hygiene rules, 67 Oonazepam, organic sleep pathology, 123; see also Pharmacotherapy Coffee, sleep hygiene rules, 68; see also Caffeine Cognitive relaxation, sleep behavior management, 179-180 Cognitive restructuring good night's sleep model, 142-143 sleep behavior management and, 178 Cognitive therapy combined therapy, 71-74 psychotherapy (short-term), 103 Combined therapies pharmacotherapy/behavior therapy, 117 INDEX Combined therapies (cont.) sleep hygiene/relaxation therapy/ cognitive strategies case history (successful), 74-79 case history (unsuccessful), 79-82 cognitive component, 71-74 relaxation therapy component, 70-71 sleep hygiene component, 65-70 Compliance: see Patient compliance Conditioned insomnia, psychotherapy, 90 Conditioning, associative control of sleep, 4-6 Control needs, treatment selection strategy, 138, 145-146 Coping, functional chronic insomnia, 104 Core temperature: see Body temperature rhythms Countertransference, psychotherapy, 95 Daily sleep log: see Sleep log Deep breathing exercises: see Breathing Delayed sleep phase syndrome, 193-205 background of, 193-196 case study (successful), 200-202 case study (unsuccessful), 202-204 method of treatment, 197-200 overview of, 193 Depression barriers to sleep and, 3 delayed sleep phase syndrome, 193, 195, 201 212 insomnia and, 30, 156 pharmacotherapy and, 115, 123-124 predisposing factor, 11 psychotherapy and, 89 stimulus control instructions and, 23-24, 25 treatment selection strategy and, 138 Disease-related insomnia: see Chronic illness; Organic sleep pathology Dreaming, early morning insomnia, 209; see also Night terror Drug abuse, delayed sleep phase syndrome, 200, 201; see also Alcohol; Substance abuse Drug treatment: see Pharmacology Dysthymia sleep behavior management and, 181
INDEX Dysthymia (cont.) stimulus control instructions and, 25 Early morning insomnia, 207-220 bright light and the sleep-wake cycle, 210-211 case history in, 212-215 differential diagnosis of, 208-210 effectiveness discussed, 215-218 overview of, 207-208 symptoms of, 208 treatment summarized, 218-219 Education (of patient) sleep behavior management, 175; see also Sleep behavior management treatment selection strategy, 139-140 Ego-supportive psychotherapy, described, 93-94 Elderly, 237-247; see also Age level case example (successful), 240-242 case example (unsuccessful), 243-245 circadian rhythms and, 68-69 method of treatment, 238-249 overview of sleep in, 237-238 sleep drive and, 8 sleep restriction therapy and, 51, 54 stimulus control (group setting), 43-44 Electromyography, relaxation therapy, 71 Emotional arousal: see Arousal Exercise delayed sleep phase syndrome, 195-1% good night's sleep model, 142 sleep hygiene rules, 67-68 Family counseling, described, 97 Family therapy, psychotherapy (shortterm), 103 Flurazepam, sleep behavior management, 183-186 Forbidden zone: see Wake-maintenance zone Functional chronic insomnia; see also Insomnia pharmacotherapy and, 115, 116 psychotherapy (short-term), 104 Gestalt therapy, described, 95-% Good night's sleep model; see also 1leatment selection strategy attributes of, 134-135 described, 141-145 Group psychotherapy, described, 97 Group stimulus control, 29-47; see also Stimulus control (group setting) Hand temperature, relaxation therapy, 71 Hunger, sleep hygiene rules, 69 Hypnotics: see Pharmacology; Pharmacotherapy Iatrogenic insomnia, 223 Insomnia; see also Functional chronic insomnia; Sleep barriers to sleep and, 2-4 chronic illness and, 223-236; see also Chronic illness elderly and, 237-238 functional chronic insomnia, 104 overview of, 1-2 predisposing, precipitating, and perpetuating factors in, 11-13 sources of, 30, 156 treatment revolution for, vii treatment variety for, viii Life-style treatment selection strategy and, 138 Light therapy: see Bright light therapy 251 Marriage counseling, described, 97 Meals, sleep hygiene rules, 69 Medical problems, treatment selection strategy, 136-137; see also Organic sleep pathology Meditation relaxation therapy and, 70; see also Relaxation therapy sleep behavior management and, 179-180 Napping, sleep hygiene rules, 69 Neurosis, functional chronic insomnia, 104 Nicotine sleep hygiene rules, 68 treatment selection strategy, 140 Night terror 209 vicious circle model and, 164 Nonrestorative sleep syndrome, pharmacotherapy, 115 Older adults: see Elderly
252 Organic sleep pathology, 30; see also Chronic illness assessment and, 31 chronic illness and, 228 pharmacotherapy protocols for, U2-U3 psychotherapy and, 89 psychotherapy (short-term) and, 105 sleep restriction therapy contraindicated, 51-52 treatment selection strategy and, 137 Outcomes chronic illness and, 228-232 combined therapy (sleep hygiene/ relaxation therapy/cognitive strategies), 74-82 delayed sleep phase syndrome, 200-204 2U-218 elderly and, 240-245 pharmacotherapy, U4-126 psychotherapy, 94, 100 psychotherapy (short-term), 106-111 sleep restriction therapy, 60-62 stimulus control (group setting), 41-42 treatment selection strategy, 145-149 vicious circle model, 161-170 Pain chronic illness and, 233-234 treatment strategy and, 136-137 Patient compliance, sleep restriction therapy, 52, 53 Pharmacology, 85-86 associative control of sleep and, 5-6 chronic illness and, 225-228, 232-233, 233-234 early morning insomnia, 2U sleep behavior management and, 181, 183-186 sleep drive and, 8 sleep hygiene rules and, 69-70 stimulus control (group setting), 44 treatment selection strategy, 137, 140 withdrawal of hypnotics, stimulus control instructions, 20-21, 24 Pharmacotherapy, 115-U9 behavior treatment combined with, 117 case histories in, 124-126 contraindications for, 127 delayed sleep phase syndrome, 1%, 200 discontinuation of medication, U6-127 INDEX Pharmacotherapy (cont.) indications for, 115-117 medication choice, 117-120 dosages, UO duration of effect, 118-119 metabolism type, 120 onset of effect, 119-UO method of treatment, 120-124 antidepressant use, 123-U4 general rules, 120-U2 protocol examples for specific diagnoses, U2-123 overview of, 115 side effects, U7 sleep behavior management and, 178 vicious circle model, 159-160 Polysomnography delayed sleep phase syndrome, 197, 198, 201-202, 203 213 organic sleep pathology and, 31 pharmacotherapy and, 116 psychotherapy (short-term) and, 105 Problem diary, good night's sleep model, 143 Progressive muscle relaxation; see also Relaxation therapy Psychoanalysis, described, 92-93 Psychoanalytic psychotherapy, described, 93 Psychopathology barriers to sleep, 3-4 delayed sleep phase syndrome, 195 208 elderly, 239 Gestalt therapy, % insomnia, 30 psychotherapy, 90, 94-95 psychotherapy (short-term), 105, 1U stimulus control instructions, 25-26 treatment selection strategy, 137 Psychotherapy (general), 85-86, 87-101 case history, 98-100 classical psychoanalysis, 92-93 differential diagnosis, 88-89 ego-supportive psychotherapy, 93-94 Gestalt therapy, 95-% group psychotherapy, 97 indications for, 90
INDEX Psychotherapy (general) (cont.) marriage and family counseling, 97 outcomes, 94 overview of, 87-88 psychoanalytic psychotherapy, 93 referral considerations, 90-92 sleep behavior management, 182 time-limited, dynamic psychotherapy, 94-95; see also Psychotherapy (shortterm) vicious circle model, 159, 160, 170-171 Psychotherapy (short-term), 103-114 case example (successful), 106-109 case example (unsuccessful), 109-111 discussion of, 111-113 functional chronic insomnia and, 104-105 method of, 105-106 overview of, 103-104 Rapid-eye-movement (REM) sleep, psychotherapy, 89 Relaxation therapy combined therapy, 70-71 good night's sleep model, 142 sleep behavior management and, 179-180 vicious circle model, 160, 171 Resistance, psychoanalysis, 92 Responsivity, activation/sleep drive, 6-9 Restless legs syndrome: see Organic sleep pathology Ritual, good night's sleep model, 141-142 Schizophrenia, insomnia, 30 Secondary gains, treatment selection strategy, 138 Self-reports; see also Daily sleep log delayed sleep phase syndrome, 198-199 pharmacotherapy and, 119 sleep behavior management, 177 treatment selection strategy and, 135-136 Short-term insomnia, pharmacotherapy protocols for, 122 Short-term psychotherapy: see Psychotherapy (short-term) Sleep associative control of, 4-6 barriers to, 2-4 253 Sleep (cant.) perception of, 10-11 timing of, 9-10 Sleep apnea, 229-232 Sleep behavior management, 175-189 case study (successful), 180-183 case study (unsuccessful), 183-188 implementation of, 177-180 overview of, 175 patient selection and management in, 176 treatment scheme, 176-177 Sleep deprivation therapy: see Sleep restriction therapy Sleep diary: see Sleep log Sleep disturbance threshold, 7-9 Sleep drive, activation/responsivity, 6-9 Sleep history questionnaire, 30 Sleep hygiene combined therapy, 65-70 sleep behavior management and, 177-178 Sleep hygiene rules listing of, 66-70 stimulus control (group setting), 34, 35 Sleep log cognitive strategies and, 71 delayed sleep phase syndrome, 198-199 good night's sleep model, 143, 148 sample of, 72, 73 sleep behavior management, 177, 182 sleep restriction therapy and, 51 stimulus control (group setting), 31, 37 stimulus control instructions, 20 treatment selection strategy, 140 vicious circle model and, 168 Sleep restriction therapy, 49-63 assessment in, 50-51 case examples, 53-60 early morning insomnia, 214 method of, 51-53 outcomes, 60-62 overview of, 49 psychotherapy (short-term), 103 sleep drive and, 6-7 treatment selection strategy, 140 Sleep-wake schedule disorders delayed sleep phase syndrome, 193-205; see also Delayed sleep phase syndrome
254 Sleep-wake schedule disorders (cont.) 207-220; see also Early morning awakening insomnia overview of, 191 Snacks, sleep hygiene rules, 69 Socioeconomic class, stimulus control (group setting), 44 Stimulants, sleep drive and, 8; see also Caffeine; Pharmacology Stimulus control (group setting), 29-47 method of study, 30-34 assessment, 30-32 behavior therapy elements, 32-34 older adults, 43-44 overview of, 29-30 predictors of outcomes, 41-42 sleep maintenance clients, 42-43 treatment sessions in, 34-41 Stimulus control (individual), 19-28 case history (successful), 23-25 case history (unsuccessful), 25-27 good night's sleep model, 141 intake method for study, 20-21 listing of, 21-23 overview of, 19-20 psychotherapy (short-term), 103 Stress perpetuating factor, 12-13 treatment selection strategy and, 136 vicious circle model, 160 Substance abuse delayed sleep phase syndrome, 200, 201 pharmacotherapy contraindication, 127 INDEX Thought stopping, good night's sleep model, 143 Time in bed, curtailment of, sleep hygiene rules, 66 Time-limited, dynamic psychotherapy, described, 94-95; see also Psychotherapy (short-term) Tobacco: see Nicotine 'Iiansference, 92-93, 95 'freatment selection strategy, 133-153 assessment in, 135-139 case study (successful), 145-147 case study (unsuccessful), 147-149 overview of, 133-135 treatment program, 139-145 education, 139-140 good night's sleep model, 141-145 learning factors, 140 mcyclic antidepressants, pharmacotherapy protocols, 123-124; see also Depression; Pharmacology 'frying to sleep, sleep hygiene rules, 67 'fryptophan, sleep hygiene rules, 69 Vicious circle model, 155-174 background of, 156-157 case example (successful), 161-167 case example (unsuccessful), 167-170 discussed, 170-172 method of treatment, 157-161 overview of, 155-156 Wake-maintenance zone, timing of sleep, 9-10