Evidence based and common procedures of psychotherapy for sleep disorders.

1. Ahmed Eid Elaghoury
MBChB, MScMed, Arab & Egyptian Boards in Psychiatry
Abbassia Hospital for Mental Health, Cairo, MOH

2. 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.
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Behavioral Sleep Medicine (BSM)

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Behavioral Sleep Medicine (BSM)

6. 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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7. 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
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9.  AASM: standard treatment for
insomnia, esp sleep onset
 Bed / Bedrooms are CUES for sleep
 Not suitable for pts prone to disorientation
/ fall risk
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Bootzin & Perlis, 2011

11.  AASM: standard treatment for insomnia,
esp with hyperarousal.
 Quiescent self inquiry
 Benson rules
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12. Mediation: Yoga / mindfulness
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Autogenic training:
Progressive muscle relaxation (PMR)
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Biofeedback
Imagery
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Jerrell, 2014. Delta Holistics, URL http://bit.ly/1ex3IeR

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Awareness & acceptance
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Letting go
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17.  AASM: Guideline treatment for
insomnia, esp psychophysiological
 Attack striving for sleep / preoccupation
 “Inhibition / attention” model for insomnia
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Espie, 2006

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Espie, 2011

20. AASM: no recommendation
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Morin, 1993

24. 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
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25. Behavioral interventions
Extinction strategies
Parental education
Positive routines
Scheduled awakenings
Delayed bedtime
Response cost
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26.  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 pt’s needs.
 SOME methods are guideline and standard
treatments according AASM, while the specific
protocols are still open to modifications.
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