Behavioral Treatments for Insomnia in Primary Care Settings

Joshua Fogel, PhD

Topics in Advanced Practice Nursing eJournal. 2003;3(4)

Summary and Implications for Advanced Practice Nursing

APNs in primary care settings are often called upon to deal with patients with insomnia. Patients may often share more of their sleeping difficulties when a clinician takes the time to inquire. Even after the assessment and diagnosis of insomnia, the APN can take the initiative to begin treatment rather than referring to others. Many patients will not want a referral to a mental health professional because of a perceived stigma associated with this referral, a delay in treatment waiting for another appointment, and perhaps increased cost. By taking the initiative to treat these patients in the primary care setting, APNs can make a big impact on the morbidity of insomnia with resulting patient satisfaction.

In this paper, varying options for behavioral treatment for insomnia were reviewed. A 2-session treatment approach has been explained that can be used in the busy primary care setting. Some patients may need more than 2 treatment sessions, based on their sleep efficiency results. For those who do, additional techniques have been described. APNs have the opportunity to help the large number of primary care patients experiencing insomnia and make an impact on the health of these individuals.

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Cite this: Behavioral Treatments for Insomnia in Primary Care Settings - Medscape - Oct 29, 2003.

Abstract and Introduction
Epidemiology
Assessment
Treatment
Case Vignette
Summary and Implications for Advanced Practice Nursing
References

Table. Brief Behavioral Treatment Plan for Insomnia ^[16]
Session	Intervention
Initial Visit	(1) Screen positive for possible insomnia.
	(2) Assign sleep log and teach how to complete it on daily basis.
	(3) Teach how to calculate a daily sleep efficiency score.^*
First Treatment Session (2 weeks later)	(1) Review of sleep log, including sleep efficiency score, especially to see the amount of time napping.
	(2) Discussion of bedtime habits (eg, television watching, reading, worrying, etc.).
	(3) Brief sleep education consisting of individual differences in sleep needs, the effects of aging on sleep, and the influence of sleep drive and circadian rhythms on sleep.
	(4) Teach stimulus control techniques including: (a) eliminating nonsleep-related activities from bed and bedroom, (b) following a consistent sleep-wake schedule, and (c) avoiding daytime napping.
Second Treatment Session (4 weeks after initial visit)	(1) Review of first treatment session instructions.
	(2) Problem-solving of any potential treatment adherence problems.
	(3) Possible modification of patient's sleep strategy and instructions to encourage future independent trouble-shooting.

^*Sleep efficiency is calculated by taking the ratio of actual time spent asleep to time spent in bed (expressed as a percentage, with higher numbers indicating better sleep efficiency).

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