NONDRUG TREATMENT TRIALS IN PSYCHOPHYSIOLOGICAL INSOMNIA

Background: Due to a variety of potential problems with long-term hypn otic use, patients and treating physicians often try to avoid drugs in the treatment of psychophysiologic insomnia and to use nondrug treatm ent strategies, but these treatments must bring relief within a limite d amount of time to be acceptable to patients. Method: Thirty patients participated in the study. All had, for a minimum of 6 months, the co mplaint of less than 6 hours total sleep time per night in conjunction with either: (1) spending more than 30 minutes in bed before falling asleep, or (2) awakening during the night within 2 hours of sleep onse t with difficulty returning to sleep. All subjects had the associated complaint of daytime impairment and none had used hypnotics for at lea st 3 months. Patients were randomly assigned to three parallel treatme nt groups: structured sleep hygiene, structured sleep hygiene with lat e afternoon moderate exercise, and structured sleep hygiene with early morning light therapy. Patients responded to questionnaires and fille d out sleep logs. In addition, they underwent clinical evaluation, str uctured interviews, nocturnal monitoring, and actigraphy. The analyzed variables before and at the end of treatment were those derived from sleep logs and actigraphy. Results: All subjects showed a trend toward improvement, independent of the treatment received, but only the ''st ructured sleep hygiene with light treatment'' showed statistically sig nificant improvement at the end of the trial. Conclusions: Patients wi th chronic psychophysiologic insomnia may benefit from a nondrug treat ment approach. Light therapy appears particularly promising.