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Sleep Hygiene 105 It is essential to inform people, at the first appearance of symptoms of the potential sleep problems that poor sleep hygiene can cause, and help identify and stop them. TREATMENT Like all extrinsic sleep disorders, the mainstay of treatment needs to be modification or complete removal of the external factors causing the insomnia. Sleep hygiene must be taught and reinforced in patients suffering with this disorder (20). It may be overwhelming for patients to follow every single sleep hygiene regulation at once. This may lead to noncompliance. It is best to isolate two or three key factors individualized to the patient and ask the patient to concentrate on those (13). Other cognitive-behavioral treatment modalities may be helpful in select cases. These include relaxation therapy, biofeedback, sleep-restriction consolidation, and stimulus control therapy (13). Usually, however, sleep hygiene education is simpler, easier to follow, and as effective as the more elaborate and difficult to follow cognitive-behavioral therapy. In fact, of all the nonpharmacological/behavioral treatments, sleep hygiene education is one of the most effective methods and one of the easiest to follow (6). REFERENCES 1. American Sleep Disorders Association. (1997) International classification of sleep disorders: diagnostic and coding manual. American Sleep Disorders Association, Rochester, MN. 2. Manni, R., Ratti, M. T., Marchone, E., et al. (1997) Poor sleep in adolescents: a study of 869 17year-old Italian secondary school students. J. Sleep Res. 6(1), 44–49. 3. Schnelle, J. F., Cruise, P. A., Alessi, C. A., Ludlow, K., al-Smarrai, N. R., and Ouslander, J. G. (1998) Sleep hygiene in physically dependent nursing home residents: behavioral and environmental intervention implications. Sleep 21(5), 515–523. 4. Schnelle, J. F., Alessi, C., A., al-Samarrai, N. R., Fricker, R. D. Jr., and Ouslander, J. G. (1999) The nursing home at night: effects of an intervention on noise, light, and sleep. J. Am. Geriatr. Soc. 47(4), 430–438. 5. Martinez-Manzano, C. and Levario-Carrillo, M. (1997) [The efficacy of sleep hygiene measures in the treatment of insomnia]. Gac. Med. Mex. 133(1), 3–6. 6. Friedman, L., Benson, K., Noda, A., et al., (2000) An actigraphic comparison of sleep restriction and sleep hygiene treatments for insomnia in older adults. J. Geriatr. Psychiatry Neurol. 13(1), 17–27. 7. Kageyama, T., Kabuto, M., Netta, H., et al., (1997) A population study on risk factors for insomnia among adult Japanese women: a possible effect of road traffic volume. Sleep 20(11), 963–971. 8. Onen, S. H., Onen, F., Bailley, D., and Parquet, P. (1994) [Prevention and treatment of sleep disorders through regulation] of sleeping habits]. Presse Med. 23(10), 485–489. 9. Ulfberg, J., Carter, N., Talback, M., and Edling, C. (2000) Adverse health effects among women living with heavy snorers. Health Care Women Int. 21(2), 81–90. 10. Ibata, Y., Okamura, H., Tanaka, M., et al. (1999) Functional morphology of the suprachiasmatic nucleus. Front. Neuroendocrinol. 20(3), 241–268. 11. Bonnet, M. H. and Arand, D. L. (1996) The consequences of a week of insomnia. Sleep 19(6), 453–461. 12. Bonnet, M. H. and Arand, D. L. (1998) The consequences of a week of insomnia. II: Patients with insomnia. Sleep 21(4), 359–368.
106 Attarian 13. Hauri, P. J. (1998) <strong>Insomnia</strong>. Clin. Chest Med. 19(1), 157–168. 14. Domino, G., Blair, G., and Bridges, A. (1998) Subjective assessment of sleep by Sleep Questionnaire. Percept. Mot. Skills 59(1), 163–170. 15. Buysse, D. J., Reynolds, C. F., 3rd, Monk, T. H., Berman, S. R., and Kupfer, D. J. (1989) The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 28(2), 193–213. 16. Blake, D. D. and Gomez, M. H. (1998) A scale for assessing sleep hygiene: preliminary data. Psychol. Rep. 83(3 Pt 2), 1175–1178. 17. Chesson, A., Jr., Hartse, K., Anderson, W. M., et al. (2000) Practice parameters for the evaluation of chronic insomnia. An American Academy of Sleep Medicine report. Standards of Practice Committee of the American Academy of Sleep Medicine. Sleep 23(2), 237–241. 18. Laube, I., Seeger, R., Russi, E. W., and Bloch, K. E. (1998) Accidents related to sleepiness: review of medical causes and prevention with special reference to Switzerland. Schweiz. Med. Wochenschr. 128(40), 1487–1499. 19. Philip, P., Taillard, J., Guilleminault, C., Quera Salva, M. A., Boulac, B., and Ohayon, M. (1999) Long distance driving and self-induced sleep deprivation among automobile drivers. Sleep 22(4), 475–480. 20. Lacks, P. and Rotert, M. (1986) Knowledge and practice of sleep hygiene techniques in insomniacs and good sleepers. Behav. Res. Ther. 24(3), 365–368.
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Clinical Handbook of Insomnia Edite
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C URRENT CLINICAL NEUROLOGY Daniel
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© 2004 Humana Press Inc. 999 River
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Series Editor’s Introduction The
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x Foreword nervous system hypersomn
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Contents Series Editor’s Introduc
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Contributors HRAYR P. ATTARIAN, MD
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2 Attarian et al.
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4 Attarian et al. until the 1970s t
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6 Attarian et al. Table 2 Diagnosti
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8 Attarian et al. Duration of Illne
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10 Attarian et al. REFERENCES 1. Ma
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12 Attarian Another study in Austri
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14 Attarian even less well studied.
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16 Attarian communities. A structur
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18 Attarian 5. Sutton, D. A., Moldo
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20 Attarian 53. Kageyama, T., Kabut
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22 Attarian
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24 Bonnet and Arand Table 1 Reporte
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26 Bonnet and Arand On the day spen
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28 Bonnet and Arand SUMMARY These m
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30 Bonnet and Arand chronic caffein
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32 Bonnet and Arand response that a
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34 Bonnet and Arand The Development
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36 Bonnet and Arand ACKNOWLEDGMENT
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38 Bonnet and Arand 45. Bonnet, M.
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40 Attarian Table 1 Types of Insomn
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42 Attarian 15 to 40 seconds. PLMs
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44 Fig. 1. Example of a 1-week slee
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46 Fig. 3. One-week printout of an
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48 Attarian Fig. 4. Algorithm. (Use
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50 Attarian 27. Polo-Kantola, P., E
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52 Garcia
Page 71 and 72: 54 Garcia association is known as s
Page 73 and 74: 56 Fig. 1. A sleep log used in chil
Page 75 and 76: 58 Garcia the reality that the tend
Page 77 and 78: 60 Fig. 2. Actigraph recording in a
Page 79 and 80: 62 Garcia neurodevelopmental disabi
Page 81 and 82: 64 Garcia 35. Czeisler, C., kronaue
Page 83 and 84: 66 Garcia
Page 85 and 86: 68 Attarian showed similar degrees
Page 87 and 88: 70 Attarian agitation and hence the
Page 89 and 90: 72 Attarian Affective disorder is s
Page 91 and 92: 74 Attarian and Drug Administration
Page 93 and 94: 76 Fig. 2. Sleep log after treatmen
Page 95 and 96: 78 Attarian 18. Bonnet, M. H. and A
Page 97 and 98: 80 Attarian 65. Perlis, M., Aloia,
Page 99 and 100: 82 Attarian was confirmed by resear
Page 101 and 102: 84 Attarian times worrying about th
Page 103 and 104: 86 Attarian insomnia or for other s
Page 105 and 106: 88 Attarian
Page 107 and 108: 90 Duntley tion systems found that
Page 109 and 110: 92 Duntley Case 1 A 36-year-old fem
Page 111 and 112: 94 Fig. 2. The objective amount of
Page 113 and 114: 96 Duntley PROGNOSIS AND COMPLICATI
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Page 117 and 118: 100 Attarian EPIDEMIOLOGY There are
Page 119 and 120: 102 Attarian CLINICAL MANIFESTATION
Page 121: 104 Attarian DIAGNOSTIC WORKUP The
Page 125 and 126: 108 Plotkin
Page 127 and 128: 110 Plotkin quality of sleep. Ultim
Page 129 and 130: 112 Plotkin of the therapeutic effi
Page 131 and 132: 114 Plotkin months or years. The ef
Page 133 and 134: 116 Plotkin associated somatic disc
Page 135 and 136: 118 Plotkin Table 1 Causes of Secon
Page 137 and 138: 120 Plotkin Table 1 (continued) Lew
Page 139 and 140: 122 Plotkin REFERENCES 1. Foley, D.
Page 141 and 142: 124 Plotkin 48. Marchetti, F., Rome
Page 143 and 144: 126 Plotkin
Page 145 and 146: 128 Karaz Table 1 DSM-IV Diagnoses
Page 147 and 148: 130 Karaz poor. Focusing only on th
Page 149 and 150: 132 Karaz He felt hopeless that his
Page 151 and 152: 134 Karaz Table 4 Diagnostic Criter
Page 153 and 154: 136 Karaz complained of feeling anx
Page 155 and 156: 138 Karaz other physicians avoided
Page 157 and 158: 140 Karaz 17. Attarian, H. P. (2000
Page 159 and 160: 142 Duntley disorders has been conf
Page 161 and 162: 144 Duntley itance. A recent study
Page 163 and 164: 146 Duntley The patient’s primary
Page 165 and 166: 148 Duntley return to sleep. He tos
Page 167 and 168: 150 Duntley Treatment of RLS should
Page 169 and 170: 152 Duntley 34. Cartwright, R. (197
Page 171 and 172: 154 Perlis et al.
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156 Perlis et al. Fig. 1. A schemat
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158 Perlis et al. ditioned arousal
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160 Perlis et al. subjected to empi
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162 Perlis et al. effect), (3) may
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164 Perlis et al. Cognitive Therapy
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166 Perlis et al. Table 2 Cognitive
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168 Perlis et al. Perhaps more impo
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170 Perlis et al. 28. Carskadon, M.
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172 Perlis et al.
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174 Attarian Secondary Insomnias Re
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176 Attarian 50 years of age who sl
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178 Attarian Antidepressants Becaus
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180 Attarian The use of benzodiazep
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182 Attarian to placebo. Zaleplon a
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184 Attarian 3. Wyatt, R. J., Engel
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186 Attarian residual sedation foll
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188 Index Clonidine, 183 CNS arousa
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190 Index Proton pump inhibitors, 1
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Current Clinical Neurology CLINICAL
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