Elsevier

Sleep Medicine

Volume 14, Supplement 1, December 2013, Page e173
Sleep Medicine

Stress management techniques in primary insomnia: a randomized controlled trial

https://doi.org/10.1016/j.sleep.2013.11.405Get rights and content

Introduction

Background Insomnia is conceived as the subjective complaint of reduced sleep quantity and/or quality. Én order for the diagnosis to be made, this complaint must be present quite frequently (at least three times per week) for a considerable period of time (at least for one month). Psychophysiological factors such as stress are often presumed to play a major role in the onset and maintenance of primary insomnia. The treatment should not only focus on ameliorating sleeplessness, it should also address all those factors that cause and maintain insomnia, turning it to a chronic condition. Non-pharmacological treatments, such as stress management techniques can be easily and inexpensively administered in treatment with good results. The aim of this study is to identify the effectiveness of stress management techniques as a treatment in primary insomnia.

Materials and methods

This is a two-armed parallel group, randomized controlled trial. Primary insomniacs were randomly assigned to undergo either an 8-week CD-based stress management program (n = 27) (relaxation breathing, progressive muscle relaxation and guided imagery twice a day) or a control condition (n = 26) both of the groups took information about insomnia and they participate once in a week in consultative meetings for the treatment of insomnia). Self-reported validated measures were used to evaluate insomnia, quality of sleep and symptoms of depression and anxiety at baseline, at the 4th week and at the end of 8 weeks. Also, we measured perceived stress and ”health locus of control” (through scale which is appropriate to identify what it is responsible for the heath problems of an individual) at baseline and at the end of the 8 weeks. Also, free cortisol, as a biological marker of stress, was measured in saliva samples taken three times a day at baseline, at the 4th week and at the end of 8 weeks. Finally, we measured the satisfaction with the stress management program and the compliance with the therapeutic instructions.

Results

At the end of 8 weeks of the relaxation program, in the intervention group, we noticed decrease in insomnia and improvement on sleep quality. Also, in this group, we found improvements on perceived stress and salivary cortisol, biological marker of stress. As far as symptoms of depression and anxiety are concerned, there was significant decrease at the end of the relaxation program. Finally, there was no change in health locus of control after the practice of stress management techniques.

Conclusion

The training of patients with primary insomnia in relaxation techniques contributes to decrease in stress and the symptoms of primary insomnia. Simple techniques such as diaphragmatic breathing, progressive muscle relaxation and guided imagery which are easily applicable, may be regarded as effective and low cost non-pharmacological treatment of insomnia.

Acknowledgements

I would like to thank Dimitrios Dikeos, Associate Professor of Psychiatry at Eginition Hospital for his help to fullfill this study.

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