Insomnia Treatment Checklist

Jan 13, 2018 • Mark Morgan

Assessment: Insomnia
Plan:
Sleep hygiene, stimulus and temporal control Lie down to sleep only when feeling sleepy Avoid wakeful activities at bedtime (watching television, talking on the phone, eating) Leave the bed if unable to fall asleep within 20 minutes and return when sleepy Maintain a consistent sleep-wake cycle (e.g., set the alarm for the same time each morning regardless of how much sleep occurs during the night) Avoid daytime naps Exercise regularly (not within 4 hours of bedtime) Avoid large meals and limit fluid intake in the evenings Limit caffeine, tobacco, and alcohol intake Use the bedroom for sleep and sex only Avoid distracting stimuli at bedtime, such as loud noises, bright lights when not being used therapeutically, and extreme temperature variations Ear-plugs can be used if noise is a problem

Sleep restriction Limit time in bed to the number of hours actually spent sleeping (not less than 5 hours), sleep time gradually increases as sleep efficiency improves

Paradoxical intention Advise patient to remain awake to help alleviate the anxiety associated with the pressure to fall asleep

Relaxation training Autogenic training - imagine a calm environment with comforting body perceptions such as warmth and heaviness of the limbs Imagery training - focus on pleasant images Repetitive focus - focus on a word, sound, prayer, phrase, or muscle activity Hypnosis Meditation Yoga Abdominal breathing Progressive muscle relaxation (from the feet up to the facial muscles) Paced respirations: Take a deep breath and hold for five seconds, repeat several times; focus on the sound of the breath

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References:
#1 Harsora P, Kessmann J. Nonpharmacologic management of chronic insomnia. Am Fam Physician. 2009 Jan 15;79(2):125-30.
#2 Schutte-Rodin S, Broch L, Buysse D, Dorsey C, Sateia M. Clinical guideline for the evaluation and management of chronic insomnia in adults. J Clin Sleep Med. 2008 Oct 15;4(5):487-504.
#3 Morgenthaler T, Kramer M, Alessi C, Friedman L, Boehlecke B, Brown T, Coleman J, Kapur V, Lee-Chiong T, Owens J, Pancer J, Swick T; American Academy of Sleep Medicine. Practice parameters for the psychological and behavioral treatment of insomnia: an update. An american academy of sleep medicine report. Sleep. 2006 Nov;29(11):1415-9.
#4 Morin CM, Vallières A, Guay B, Ivers H, Savard J, Mérette C, Bastien C, Baillargeon L. Cognitive behavioral therapy, singly and combined with medication, for persistent insomnia: a randomized controlled trial. JAMA. 2009 May 20;301(19):2005-15.

Insomnia Treatment Checklist

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