Insomnia and Anxiety (Series in Anxiety and Related Disorders) by Colleen E. Carney Jack D. Edinger
Author:Colleen E. Carney, Jack D. Edinger
Language: eng
Format: mobi, epub
Published: 0101-01-01T00:00:00+00:00
practices that are generic characteristics among insomnia sufferers. The discussion
begins by demonstrating the use of a sleep diary for identifying the common behav-
ioral treatment targets, namely those common problematic behaviors that serve to
perpetuate insomnia. Subsequently, we provide text that can be used to present
the treatment rationale in therapy and then consider how to combine and deliver
stimulus control and sleep restriction therapy instructions. The chapter concludes
by reviewing strategies for addressing other sleep-interfering habits and sleep envi-
ronments that cause them some sleep disruption. Overall, this chapter is designed
to provide step-by-step instructions for implementing effective behavioral insomnia
treatment strategies as well as a number of useful paper-and-pencil tools for aiding
the clinician in conducting this form of intervention.
Assessing the Sleep Problem Using the Sleep Diary
To demonstrate the value of the sleep diary for insomnia assessment, it is useful to
consider some case examples. Figures 6.1–6.3 provide a sampling of the type of
information that may be gleaned from sleep diary monitoring. Figure 6.1 shows a
common problem among people with insomnia – an erratic sleep schedule. The
diary reveals that the time at which these individuals go to bed over the course of a
week varies by over 5 h. Additionally, the time at which they get out of bed in the
mornings across the week varies over 3 h. When there is an erratic sleep schedule,
it can produce symptoms similar to jetlag (e.g., sleep disruption, fatigue, mood
disturbance). Remember that 1 h of variability is like traveling one time zone, so
5 h of variability is like traveling across 5 time zones. Those who exhibit these
erratic schedules are often motivated by a belief that they should try and obtain the
C.E. Carney and J.D. Edinger, Insomnia and Anxiety, Series in Anxiety and Related Disorders,
79
DOI 10.1007/978-1-4419-1434-7_6, © Springer Science+Business Media, LLC 2010
80
6 Behavioral Strategies for Managing Insomnia
1
2
1
Sun
1/21
None
None
5 min
2:45 AM
2:45 AM
10 min
7:25 AM
7:30 AM
1
3
2
Sat
1/20
None
None
35 min
55 min
11:20 PM
11:20 PM
5:15 AM
5:20 AM
Fri
1
2
2
1/19
None
None
35 min
55min
1:20 AM
12:20AM
5:15 AM
5:20 AM
2
3
3
Thurs
1/18
None
None
65 min
40 min
90 min
11:30 PM
11:30 PM
6:40 AM
7:30 AM
2
4
3
Wed
1/17
None
None
10 min
45 min
90 min
10:30 PM
10:30 PM
8:00 AM
8:05 AM
2
3
2
Tue
1/16
None
None
9:45 PM
45 min
25 min
25 min
10:45 PM
8:30 AM
8:40 AM
1
3
2
Mon
1/15
None
None
20 min.
50 min.
6:05 AM
11:00 PM
11:00 PM
6:30 AM
EXAMPLE
3
2
5 mg.
Monday
3/24/08
Ambien
40 Min.
2 Times
25 Min. 40 Min.
6:30 AM
11:00 PM
11:30 PM
7:15 AM
2:30-3:15 PM
minutes.
1
case
diary
sleep
1 = very poor 4 = good
2 = poor 5 = excellent
3 = fair.
Sample
DAY OF THE WEEK
CALENDAR DATE
1 = not all rested 4 = rested
2 = slightly rested 5 = well rested
3 = somewhat rested
1. Yesterday I napped from __ to __
(note time of all naps).
2. Last night I took___ mg. of ____ or
____of alcohol as a sleep aid
3. Last night I got in my bed at ____
4. Last night I turned off the lights and
attempted to fall asleep at ____
5. After turning off the lights it took me
about ___minutes to fall sleep.
6. I woke from sleep ____ times.
(Do not count your final awakening)
7. My awakenings lasted ____
(List each awakening separately)
8. Today I woke up at _____
NOTE this is your final awakening.
9. Today I got out of bed for the day at
_____.
10. I would rate the quality of last
night's sleep as:
11. How well rested did you feel upon
rising today?
. 6.1
Fig
Assessing the Sleep Problem Using the Sleep Diary
81
2
Sun
3/11
3
2
None
None
9:15 PM
20 min.
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