STIMULUS-CONTROL - NONPHARMACOLOGIC TREATMENT FOR INSOMNIA

OBJECTIVES To evaluate the efficacy and applicability of a behavioural treatment for insomnia that can be administered by family physicians in various clinical settings. DESIGN Efficacy of the treatment was eva luated by single-case experimental designs (multiple baseline across s ubjects). Applicability was assessed through semistructured interviews with physicians. SETTING Two private offices, two offices in communit y health centres, and one office in a family medicine unit. PARTICIPAN TS Six general practitioners and 24 chronic insomniac patients recruit ed through media advertisements and from physicians' practices. Of an initial 38 subjects screened, six were excluded for sleep-onset latenc y less than 30 minutes, five for psychological conditions, one for phy sical handicaps, and two for other reasons. INTERVENTIONS Physicians u sed stimulus-control treatment during individual therapeutic sessions. Patients using hypnotics were encouraged to taper off their medicatio ns after treatment was initiated. MAIN OUTCOME MEASURES Time it took p atients to get to sleep (sleep-onset latency), amount of hypnotic use, and practitioners' evaluation of the treatment. RESULTS Fifteen patie nts completed the treatment; 80% of them reduced their sleep-onset lat ency. Six of the seven patients using hypnotics at the beginning of th e study reduced or stopped their medications. All therapeutic gains we re maintained at 3 and 6 months. Physicians thought stimulus-control t reatment could be used in medical practice, hut specified that it was most useful for highly motivated patients. CONCLUSION Family physician s can use stimulus-control treatment effectively for patients with chr onic insomnia. This nonpharmacologic approach could help motivated pat ients reduce their use of hypnotics.