[Behavior and cognitive treatments for insomnia. An alternative to pharmacotherapy]

Abstract

OBJECTIVE: To familiarize family physicians with cognitive and behavioural treatments for insomnia. DATA SOURCES: MEDLINE was searched from 1983 to 1995 and Psychlit from 1974 to 1995 using the key words "behaviour therapy," "cognitive therapy," "phototherapy," and "insomnia." STUDY SELECTION: We chose randomized trials and meta-analyses on the treatment of insomnia. Information was extracted on time-lag before sleep, frequency and duration of wakeful periods during the night, consumption of hynotics, and subjects' own assessment of their sleep before and after treatment. SYNTHESIS: The most effective interventions were relaxation training, sleep restriction, and stimulus control. Practising good sleeping habits was only somewhat effective and should always be used in conjunction with other interventions. CONCLUSION: Stimulus control for insomnia has been demonstrated to be effective when used by primary care physicians. Other nonpharmacologic treatments should be evaluated in a similar manner.