ABSTRACT
We compared day time functioning in college students with and without insomnia and explored changes in day time functioning after progressive relaxation (PR) treatment for insomnia. Students with insomnia (SWI; n = 57) were compared to a control group of students not complaining of insomnia (SNI; n = 61) on self-reported sleep variables and five questionnaires: Insomnia Impact Scale (IIS), Dysfunctional Beliefs and Attitudes About Sleep Scale (DBAS), Epworth Sleepiness Scale (ESS), Fatigue Severity Scale (FSS), and Penn State Worry Questionnaire (PSWQ). SWI demonstrated significant impairment on all day time functioning and sleep measures compared to SNI. To investigate treatment effects on day time functioning, 28 SWI were randomly assigned to PR. Treated SWI were compared to untreated SWI and SNI at posttreatment. Treated participants improved sleep in comparison to untreated SWI, but failed to show significant improvements in day time functioning. Insomnia treatments focused on improving sleep may not improve day time functioning, or day time gains may emerge more slowly than sleep gains. This study documents the wide range of day time functioning complaints in young adults with insomnia and suggests that the goal of insomnia treatment should be to not only improve sleep but also to improve the subjective experience of day time functioning.
Subject(s)
Circadian Rhythm , Relaxation Therapy , Sleep Initiation and Maintenance Disorders/therapy , Adolescent , Adult , Female , Humans , Male , Muscle Relaxation , Outcome Assessment, Health Care , Sleep Initiation and Maintenance Disorders/psychology , Students/psychology , WakefulnessABSTRACT
This study explores the usefulness of relaxation and gradual medication withdrawal in weaning insomniacs from sleep (hypnotic) medication. We recruited 40 volunteers from the community who had insomnia, half of whom were chronic users of hypnotics while the other half were nonmedicated. Half of all participants (10 medicated and 10 nonmedicated) received progressive relaxation. All medicated participants received a standard gradual drug withdrawal program. Medicated participants reduced sleep medication consumption by nearly 80%. Participants who received relaxation obtained additional benefits in sleep efficiency, rated quality of sleep, and reduced withdrawal symptoms. Medicated and nonmedicated participants attained comparable, improved sleep by posttreatment and follow-up. Hypnotic withdrawal was accompanied by serious worsening of insomnia, but this dissipated by the end of the withdrawal period. The psychological treatment of hypnotic-dependent insomnia has high potential for making an important clinical contribution.
Subject(s)
Hypnotics and Sedatives/adverse effects , Relaxation Therapy , Sleep Initiation and Maintenance Disorders/drug therapy , Substance Withdrawal Syndrome/rehabilitation , Adult , Aged , Aged, 80 and over , Anti-Anxiety Agents/administration & dosage , Anti-Anxiety Agents/adverse effects , Benzodiazepines , Female , Follow-Up Studies , Humans , Hypnotics and Sedatives/administration & dosage , Male , Middle Aged , Personality Inventory , Sleep Initiation and Maintenance Disorders/chemically induced , Substance Withdrawal Syndrome/diagnosis , Treatment OutcomeABSTRACT
A sample of 21 medicated and 20 nonmedicated insomniacs participated in a sleep medication withdrawal program that provided education about sleep medication and a gradual medication withdrawal schedule. Ten medicated participants received stimulus control treatment and the withdrawal program, and 11 medicated participants served as a control group that received only the withdrawal program. Half of the nonmedicated participants received stimulus control, and the remaining nonmedicated participants served as a wait-list control condition. Medicated participants significantly reduced sleep medication use without significant deterioration on sleep, anxiety, or depression measures from baseline to 8-week follow-up. Stimulus control participants, unlike control group participants, showed significant improvement at follow-up for total sleep time, sleep efficiency, and sleep quality. Stimulus control participants also reported less daytime sleepiness than control participants after treatment. Nonmedicated participants exhibited a more positive response to stimulus control than medicated participants.
Subject(s)
Behavior Therapy/methods , Hypnotics and Sedatives/adverse effects , Sleep Initiation and Maintenance Disorders/therapy , Substance Withdrawal Syndrome/therapy , Adult , Aged , Anti-Anxiety Agents/administration & dosage , Anti-Anxiety Agents/adverse effects , Antidepressive Agents/administration & dosage , Antidepressive Agents/adverse effects , Benzodiazepines , Combined Modality Therapy , Female , Follow-Up Studies , Humans , Hypnotics and Sedatives/administration & dosage , Male , Middle Aged , Treatment OutcomeABSTRACT
Fatigue has often been confused with sleepiness and has received little study as an independent symptom of sleep disturbance. To investigate if fatigue is a common and severe symptom in sleep disordered individuals, the Fatigue Severity Scale (FSS) was administered to 206 patients over a 12-month period at a sleep disorder center. Our sample averaged 4.8 on the 7-point FSS, which is in the severe fatigue range. High fatigue was present in a broad range of sleep disorders, but was particularly high among individuals diagnosed with psychophysiological insomnia. A number of variables predicted fatigue (being female, being a smoker, high BMI, low sleep efficiency percent, and high MMPI average clinical scale score), but surprisingly daytime sleepiness (as measured by the multiple sleep latency test) did not. Apparently, daytime sleepiness and perceived fatigue are independent phenomena. We discussed the importance of attributing credence to the complaint of fatigue and suggested some areas for future study including further study of fatigue in insomnia, expanded consideration of sleep variables causing fatigue, and testing objective measures of fatigue.
