수면제한을 강화한 인지행동치료가 만성 불면증 환자의 수면에 미치는 효과: 예비연구
The Effects of Sleep Restriction-Emphasized Cognitive Behavioral Therapy for Insomnia on Sleep with Chronic Insomniacs: A Preliminary Study
1
조회
0
다운로드
2
인용
0
참고문헌
키워드
초록
Objectives: Cognitive-behavioral therapy for insomnia (CBT-I) is recommended as the 1st choice of treat-ment for chronic insomnia patients. Among CBT-I program, sleep restriction (SR) has known as the most effective and relatively well-tolerated treatment tool, but in practice, it is not easy to apply to all insomnia patients due to a lack of properly trained therapist. This study is designed to investigate the clinical utility of SR-emphasized CBT-I (SRCBT-I) conducted by a trained nurse. Methods: Thirteen chronic insomniacs were enrolled for SRCBT-I (four biweekly-individual session) and eight (6 women; mean age 51.1 yr) of them completed the whole sessions. Control insomniacs (n=9; 7 women; age 56.8 yr) were treated with standard CBT-I. Eleven of them underwent night polysomnography before CBT-I. Main outcomes of treatment ev-aluation were sleep onset latency (SOL), wake time after sleep onset (WASO), total sleep time (TST), time in bed, and sleep efficiency (SE), which were determined based on patients’ sleep diary before and after CBT-I. Results: All patients with standard or SRCBT-I reported the improvement in SOL (60.2 → 10.6 min), WASO (155.0 → 20.7 min), TST (242.2 → 32.6 min), SE (51.0 → 92.0%) and sleep medication (1.0 → 0.25 tablet). Compared to control insomniacs with standard CBT-I, patients with SRCBT-I showed a lesser WASO (Z=-2.792, p=0.005) and a higher SE (Z=-2.694, p=0.006) after CBT-I. Conclusions: Our preliminary study demonstrated that SRCBT-I is more effective than standard CBT-I especially for sleep maintenance in chronic insomnia patients.
Abstract
Objectives: Cognitive-behavioral therapy for insomnia (CBT-I) is recommended as the 1st choice of treat-ment for chronic insomnia patients. Among CBT-I program, sleep restriction (SR) has known as the most effective and relatively well-tolerated treatment tool, but in practice, it is not easy to apply to all insomnia patients due to a lack of properly trained therapist. This study is designed to investigate the clinical utility of SR-emphasized CBT-I (SRCBT-I) conducted by a trained nurse. Methods: Thirteen chronic insomniacs were enrolled for SRCBT-I (four biweekly-individual session) and eight (6 women; mean age 51.1 yr) of them completed the whole sessions. Control insomniacs (n=9; 7 women; age 56.8 yr) were treated with standard CBT-I. Eleven of them underwent night polysomnography before CBT-I. Main outcomes of treatment ev-aluation were sleep onset latency (SOL), wake time after sleep onset (WASO), total sleep time (TST), time in bed, and sleep efficiency (SE), which were determined based on patients’ sleep diary before and after CBT-I. Results: All patients with standard or SRCBT-I reported the improvement in SOL (60.2 → 10.6 min), WASO (155.0 → 20.7 min), TST (242.2 → 32.6 min), SE (51.0 → 92.0%) and sleep medication (1.0 → 0.25 tablet). Compared to control insomniacs with standard CBT-I, patients with SRCBT-I showed a lesser WASO (Z=-2.792, p=0.005) and a higher SE (Z=-2.694, p=0.006) after CBT-I. Conclusions: Our preliminary study demonstrated that SRCBT-I is more effective than standard CBT-I especially for sleep maintenance in chronic insomnia patients.
참고문헌 (28)
- Morin CM, "Psychological and behavioral treatment of insomnia:update of the recent evidence (1998-2004)", Sleep, 29, pp.1398~1414 (2006)
- 조용원, "Epidemiology of Insomnia in Korean Adults: Prevalence and Associated Factors", Journal of Clinical Neurology, 5(1), pp.20~23 (2009), 대한신경과학회
- Ohayon MM, "Epidemiology of insomnia: what we know and what we still need to learn", Sleep Med Rev, 6, pp.97~111 (2002)
- Basta M, "Chronic Insomnia and stress system", Sleep Med Clin, 2, pp.279~291 (2007)
- Grandner MA, "Mortality associated with short sleep duration: The evidence, the possible mechanisms, and the future", Sleep Med Rev, 14, pp.191~203 (2010)
- Morlock RJ, "Patient characteristics and patterns of drug use for sleep complaints in the United States: analysis of National Ambulatory Medical Survey data, 1997-2002", Clin Ther, 28, pp.1044~1053 (2006)
- Espie CA, "The clinical effectiveness of cognitive behaviour therapy for chronic insomnia: implementation and ev-aluation of a sleep clinic in general medical practice", Behav Res Ther, 39, pp.45~60 (2001)
- Stepanski EJ, "Hypnotics should not be considered for the initial treatment of chronic insomnia. Con", J Clin Sleep Med, 1, pp.125~128 (2005)
- Jacobs GD, "Cognitive behavior therapy and pharmacotherapy for insomnia: a randomized controlled trial and direct comparison", Arch Intern Med, 164, pp.1888~1896 (2004)
- Hamblin JE, "Insomnia: an ignored health problem", Prim Care, 34, pp.659~674 (2007)
- Espie CA, "Randomized clinical effectiveness trial of nurse-administered small-group cognitive behavior therapy for persistent insomnia in general practice", Sleep, 30, pp.574~584 (2007)
- Harvey L, "Insomniacs’ reported use of CBT components and relationship to long-term clinical outcome", Behav Res Ther, 40, pp.75~83 (2002)
- Vincent N, "Treatment preference and patient satisfaction in chronic insomnia", Sleep, 24, pp.411~417 (2001)
- Spielman AJ, "Treatment of chronic insomnia by rest-riction of time in bed", Sleep, 10, pp.45~56 (1987)
- Youngstedt SD, "Long sleep and mortality: rationale for sleep restriction", Sleep Med Rev, 8, pp.159~174 (2004)
- Vincent N, "Barriers to engagement in sleep restriction and stimulus control in chronic insomnia", J Consult Clin Psychol, 76, pp.820~828 (2008)
- Perlis ML, "Cognitive Behavioral Treatment of Insomnia; A Session-by-Session Guide" (2005), Springer
- Edinger JD, "Dose-response effects of cognitive-behavioral insomnia therapy: a randomized clinical trial", Sleep, 30, pp.203~212 (2007)
- Choi SJ, "Effects of the abbreviated cognitive behavioral therapy for chronic insomniacs", J Kor Critical Care Nursing, 1, pp.19~31 (2008)
- Cho YW, "Sleepiness Scale and Sleep hygiene", J Kor Sleep Research Soc, 1, pp.12~31 (2004)
- Morin CM, "Are changes in beliefs and attitudes about sleep related to sleep improvements in the treatment of insomnia?", Behav Res Ther, 40, pp.741~752 (2002)
- Kryger MH, "Principles and practices of sleep medicine" (2005), ELSEVIER SAUNDERS
- Vanable PA, "Sleep latency and duration estimates among sleep disorder patients: variability as a function of sleep disorder diagnosis, sleep history, and psy-chological characteristics", Sleep, 23, pp.71~79 (2000)
- Globus GG, "Sleep duration and feeling state", Int Psychiatry Clin, 7, pp.78~84 (1970)
- Friedman L, "An actigraphic comparison of sleep restriction and sleep hygiene treatments for insomnia in older ad-ults", J Geriatr Psychiatry Neurol, 13, pp.17~27 (2000)
- Carskadon MA, "Cumulative effects of sleep restriction on daytime sleepiness", Psychophysiology, 18, pp.107~113 (1981)
- Perlis ML, "The effects of modafinil and cognitive behavior therapy on sleep continuity in patients with primary insomnia", Sleep, 27, pp.715~725 (2004)
- Perlis ML, "Placebo effects in primary insomnia", Sleep Med Rev, 9, pp.381~389 (2005)