Behavioral treatments for sleep disorders Ahmed Eid Elaghoury MBChB, MScMed, Arab & Egyptian Boards in Psychiatry Abbassia Hospital for Mental Health, Cairo, MOH
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Ahmed Eid Elaghoury MBChB, MScMed, Arab & Egyptian Boards
in Psychiatry Abbassia Hospital for Mental Health, Cairo, MOH
Starts spread in 1980s Methods most studied for Insomnias: esp
CBT-I Special societies, training programs, and journals Still open
and evolving practice: clinical creation of new protocols. Same
principles of psychotherapy. Alexandria, April 2014 2 Behavioral
Sleep Medicine (BSM)
Alexandria, April 2014Behavioral Sleep Medicine (BSM) 3
Alexandria, April 2014Behavioral Sleep Medicine (BSM) 4
Alexandria, April 2014 5 Behavioral Sleep Medicine (BSM)
AASM: Guideline treatment for insomnia Monotherapy or more
common as a component of CBT-I Not suitable for pts in need for
vigilance during daytime, . Enhances process S (sleep drive) Sleep
efficiency (SE) = Total sleep time (TST) / Time in bed (TIB) x 100
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Accepted SE = 85 % ( 80% in elderly) Two weeks: sleep log plus
assessment of TST & TIB Wake time: suitable for work days
Allowed TIB: not less than 5 HRs No daytime naps Every 2 weeks: TIB
15 / 30 min Middle phase: weekly SE assessment Alexandria, April
2014Behavioral Sleep Medicine (BSM) 7
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AASM: standard treatment for insomnia, esp sleep onset Bed /
Bedrooms are CUES for sleep Not suitable for pts prone to
disorientation / fall risk Alexandria, April 2014Behavioral Sleep
Medicine (BSM) 9
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Bootzin & Perlis, 2011
AASM: standard treatment for insomnia, esp with hyperarousal.
Quiescent self inquiry Benson rules Alexandria, April
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Mediation: Yoga / mindfulness Autogenic training: Progressive
muscle relaxation (PMR) Biofeedback Imagery Alexandria, April
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Jerrell, 2014. Delta Holistics, URL http://bit.ly/1ex3IeR
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Awareness & acceptance Letting go Alexandria, April
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AASM: Guideline treatment for insomnia, esp psychophysiological
Attack striving for sleep / preoccupation Inhibition / attention
model for insomnia Alexandria, April 2014Behavioral Sleep Medicine
(BSM) 17
Alexandria, April 2014Behavioral Sleep Medicine (BSM) 18 Espie,
2006
Alexandria, April 2014Behavioral Sleep Medicine (BSM) 19 Espie,
2011
AASM: no recommendation Alexandria, April 2014Behavioral Sleep
Medicine (BSM) 20
Alexandria, April 2014Behavioral Sleep Medicine (BSM) 21
Alexandria, April 2014Behavioral Sleep Medicine (BSM) 22
Alexandria, April 2014Behavioral Sleep Medicine (BSM) 23 Morin,
1993
1. Behavioral experiments 2. Reduce unhelpful beliefs 3. Reduce
misperception 4. Reduce use of safety behaviors 5. CT for
dysfunctional beliefs 6. CT for catastrophic beliefs Alexandria,
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BSM is new brach and still evolving. It is NOT synonymous to
sleep hygiene CBT-I program is multicomponent: cognitive
strategies, stimulus control, relaxation therapy and sleep
restriction are common components CBT-I program shows better
results than pharmacotherapy Like all psychotherapeutic approaches,
BSM methods should be tailored to each pts needs. SOME methods are
guideline and standard treatments according AASM, while the
specific protocols are still open to modifications. Alexandria,
April 2014Behavioral Sleep Medicine (BSM) 26