Researchers from the Sleep Disorders Center at the Mayo Clinic College in Rochester, MN replicated and extended an earlier study (by Hurwitz et al, 1991) looking at the effectiveness of one or two sessions of hypnosis in substantially improving “parasomnias” (sleep disorders such as sleepwalking, sleep-eating, nightmares, night terrors, bedwetting, sleep sex, teeth grinding, sleep talking, restless legs syndrome, and so on) up to five years later.
The study sample consisted of thirty-six patients (19 male, 17 female), ages ranging from 6 to 71, with an average age of 32.7 years. Four were children aged 6 to 16. All had chronic, self-sustaining parasomnias. All underwent 1 or 2 hypnotherapy sessions and were then followed with a questionnaire for 5 years.
Researchers from the University of Wisconsin-Madison conducted a pilot randomized controlled trial to assess the initial efficacy of a patient-controlled cognitive-behavioral (CB) intervention for the pain, fatigue, and sleep disturbance symptom cluster that often accompanies advanced cancer treatment.
Eighty-six patients with advanced lung, prostate, colorectal, or gynecologic cancers, receiving treatment at a comprehensive cancer center, were stratified by recruitment clinics (chemotherapy and radiation therapy) and randomized to the intervention or control groups.
Forty-three patients were assigned to receive training in and use of up to 12 relaxation, guided imagery or distraction exercises, delivered via an MP3 player for two weeks during cancer treatment.
Forty-three patients were assigned to a waitlist control condition for the same two week period. Outcomes included symptom cluster severity and overall symptom interference with daily life, measured at baseline (Time 1) and two weeks later (Time 2).
Investigators from the University of Michigan School of Nursing in Ann Arbor examined the effects of using our Healthful Sleep guided imagery on post-cardiac surgery sleep disturbances (problems with sleep quality, time taken to fall asleep and total sleep time) and systemic inflammatory response, as measured by stress hormones and inflammatory markers, including cortisol and C-reactive proteins. These post-surgical difficulties are exacerbated when a patient is put on a bypass machine, and are predictors of post-op morbidity and mortality.
Of the 52 patients who provided informed consent, 27 were randomly assigned to the guided imagery group and 25 to usual care only during the ICU and step-down phases of post-op recovery. Of these, 5 in each group were lost to follow-up.
Researchers from the National Center for Posttraumatic Stress Disorder at the VA Boston Healthcare System and Boston University Medical Center performed a meta-analysis to evaluate the efficacy of imagery rehearsal therapy (IRT) as a treatment for nightmares, general sleep disturbance, and symptoms of post-traumatic stress.
Bibliographic databases and cited references were searched to identify clinical trials of imagery rehearsal in individuals with post-trauma nightmares.
Thirteen studies met inclusion criteria and reported sleep and post-traumatic stress outcomes in sufficient detail to calculate effect sizes.
Researchers from the Karolinska Institute in Stockholm, Sweden, examined whether cognitive behavioral therapy could be offered in a self-help book format, with or without minimal phone support from a therapist, to remediate insomnia.
The study used a volunteer sample of 133 media-recruited adults with a history of insomnia. The mean history of sleep difficulties in this sample was 11.8 years. Ninety-two percent had co-morbid problems (e.g. allergy, pain, and depression).
The intervention consisted of six weeks of bibliotherapeutic self-help using established cognitive behavioral methods, including sleep restriction, stimulus control, and cognitive restructuring.
Investigators from Bright Path Yoga in Plano, Texas discuss the benefits of yoga and meditation for fibromyalgia, a chronic syndrome characterized by widespread pain, sleep disturbance, stiffness, fatigue, headache, and mood disturbance. The author outlines a strategy for using yoga and meditation as a therapy for fibromyalgia sufferers.
A preliminary 8-week study with eleven participants found significant improvement in the overall health status of the participants and in symptoms of stiffness, anxiety, and depression. Significant improvements were also seen in the reported number of days "felt good" and number of days "missed work" because of fibromyalgia.
Researchers from Bright Path Yoga in Plano, Texas looked at the efficacy of an 8-week strategy of using yoga and meditation to help manage fibromyalgia symptoms, which typically consist of widespread pain, sleep disturbance, stiffness, fatigue, headache, and mood disorders.
The small pilot study looked at the impact of this program on 11 participants.
Results revealed significant improvement in the overall health status of the participants and in symptoms of stiffness, anxiety, and depression. Significant improvements were also seen in the reported number of days "felt good" and number of days "missed work" because of fibromyalgia.
Researchers from the Michael E. DeBakey Veterans Affairs Medical Center in Houston conducted an open trial of a group psychological treatment for Veterans with posttraumatic stress and chronic posttraumatic nightmares called "Imagery Rescripting and Exposure Therapy" (IRET).
IRET is a variant of a successful imagery rescripting treatment for civilian trauma-related nightmares that was modified to address the needs of the Veteran population [Ed. Note: This technique is sometimes referred to as Imagery Rehearsal Therapy and/or Nightmare Reprocessing].
Researchers from the Michael E. DeBakey Veterans Affairs Medical Center in Houston evaluated a group treatment called "Imagery Rescripting and Exposure Therapy" (IRET) for Veterans with posttraumatic stress disorder (PTSD) and chronic posttraumatic nightmares. (There is a good summary of imagery rescripting tx here.)
IRET is a variant of a successful imagery rescripting treatment for civilian trauma-related nightmares that was modified to address the needs of the Veteran population.
Researchers from the School of Psychology at the University of Ottawa in Canada investigated whether imagery rehearsal therapy (IRT - a simple protocol based on lucid dreaming, using a a sequence similar to EMDR) could be used with children experiencing frequent nightmares.
Eleven boys and 9 girls, ages 9 - 11, with moderate to severe primary nightmares (1 or more per week for 6 months) and without posttraumatic stress disorder, were randomly divided into an imagery rehearsal treatment group (n = 9) or a waiting-list (n = 11) group.
Researchers from the San Diego V.A. system examined the efficacy of Imagery Rehearsal Therapy or IRT (a kind of nightmare reprocessing therapy that trains people to use a variety of “lucid dreaming” to change or control the content of the nightmare) on reducing nightmares in veterans seeking outpatient treatment for chronic, trauma-related nightmares.
Of those offered IRT, veterans who completed a full course of treatment for PTSD in the past year were more likely to initiate treatment. However, completion of IRT was not related to previous treatment, demographic variables, or nightmare severity as reported at the first treatment session.
Treatment completers reported significant reductions in nightmare frequency and intensity, severity of insomnia, and subjective daytime PTSD symptoms. Insomnia and PTSD symptoms, on average, were below clinical cutoffs following treatment, and 23% of patients showed a complete treatment response (defined as one or no nightmares per week).
Researchers from the University of Wisconsin School of Nursing in Madison evaluated the feasibility and potential efficacy of a patient-controlled cognitive-behavioral intervention for pain, fatigue, and sleep disturbance, during treatment for advanced cancer.
This one group pre- and post-test design consisted of 30 adults with advanced (recurrent or metastatic) colorectal, lung, prostate, or gynecologic cancer receiving chemotherapy or radiotherapy.
Participants completed baseline measures (demographics and symptom inventory) and received education and training to use an MP3 player loaded with 12 cognitive-behavioral strategies (e.g., relaxation exercises, guided imagery, nature sound recordings, etc).
Researchers from the Departments of Sociology and Criminal Justice at Old Dominion University at Norfolk, Virginia, examined the impact of a structured meditation program intervention on female detainees, comparing an experimental group and a control group for medical symptoms, emotions, and behaviors before and after the intervention.
A 2 1/2-hour meditation session was held once a week for 7 weeks. Study participants completed a medical symptoms checklist before the program began and after it ended.
Researchers from Vrije Universiteit Amsterdam in The Netherlands explored whether self-help could offer an inexpensive and more accessible alternative to face-to-face treatment, comparing non-pharmacological therapies only.
Ten studies with a total of 1000 subjects were included. The self-help style of intervention was found to improve sleep efficiency (d=0.42; p<0.05), sleep onset latency (d=0.29; p<0.05), waking after sleep onset (d=0.44; p<0.05) and sleep quality (d=0.33; p<0.05) but not total sleep time (d=0.02; p>0.05).
Researchers R. Bruce Lydiard, Ph.D., M.D., and Mark Hammer MD from the Ralph H. Johnson VA Medical Center in Charleston SC , are embarking on some important research that targets sleep disturbance in posttraumatic stress. Their premise is that the first-line treatments for posttraumatic stress disorder - medication (selective serotonin reuptake inhibitors) and cognitive behavior therapy – do not adequately treat nightmares and insomnia. Nor do they feel that there is sufficient awareness in the mental health community of the critical role sleep disturbance plays in PTSD.
Researchers from Vrije Universiteit in Amsterdam, The Netherlands, examined whether a self-help intervention might offer an inexpensive and more accessible alternative to face-to-face therapy for the non-pharmacologic treatment of insomnia.
They conducted a meta-analysis of randomized controlled studies examining the effects of self-help interventions for insomnia, identified through extensive searches of bibliographical databases. They examined the effects of self-help on different sleep outcomes, in comparison with both wait list controls and face-to-face treatments.
Researchers from Cardiff and Vale NHS Trust in Wales, UK, explored the impact of various interventions when they are delivered within 3 months of the traumatic event.
The study identified 25 randomized, controlled trials of multiple-session psychological treatments aimed at preventing or reducing traumatic stress symptoms in individuals within 3 months of exposure to a traumatic event. The studies examined a range of interventions.
What Helps Older Adults Sleep Better? Melatonin, Valerian, Tai Chi, Acupressure, Yoga ...
A review from the University of Pennsylvania finds several promising holistic therapies improve sleep disorders in older adults .
Research from the University of Pennsylvania School of Medicine’s Center for Sleep and Respiratory Neurobiology reviewed the growing body of well-designed clinical trials testing efficacy of complementary and alternative medicines (CAM) for sleep disorders in older adults. They point to three promising areas:
- Melatonin is an effective agent for circadian phase sleep disorders; less clearly so for primary or secondary insomnia;
- Valerian shows benefit in some but not all clinical trials;
- Chi, acupuncture, acupressure, yoga, and meditation improve sleep parameters in a limited number of early trials
The author recommends that more research be done in all these areas.