Intensive Sleep Re-Training: From Bench to Bedside
2. Cognitive/Behavior Therapy for Insomnia (CBT-I)
- Do not have a pre-determined bed time, go to bed only when sleepy;
- Get out of bed if not asleep within 15 min;
- Repeat #1 and #2 until a rapid sleep onset occurs;
- Maintain the same wake-up time regardless of sleep length; and
- Do not nap during the day.
3. Challenges to the Implementation of Behavior Therapies
4. Intensive Sleep Re-Training (ISR)
5. Translation of ISR to the Home Environment
6. Future Research to Improve the Effectiveness of Intensive Sleep Re-Training
6.1. Distributed Versus Massed Trials
6.2. Robust Recovery Sleep
6.3. The Experience of Sleep Deprivation
6.4. Feedback of Time Taken to Fall Asleep
6.5. Effectiveness of ISR on Different Insomnia Phenotypes
7. Potential Improvements of the Behavioral Response Measure of Sleep Onset
8. Development of THIM Wearable Device for Sleep
9. Other Future Research Projects
- Will the use of a tactile stimulus and finger movement response with the Thim device be as accurate or more accurate an indicator of EEG sleep onset and PSG determined sleep/wake state than a hand movement response to an external auditory stimulus? How will this accuracy compare to the passive movement indicator of the sleep/wake state in actigraphy? Will the answers to these questions be the same in those with chronic insomnia sufferers as in good sleepers?
- Can a Thim type device effectively administer ISR and obtain effective treatment outcomes?
- If ISR is administered in only one long session (e.g., across one entire night or night and following day), how many sleeping trials are required to reach maximal or near maximal improvement? The earlier versions of ISR in the laboratory spaced the sleep attempt trials apart by 30 min. This was not a choice based on treatment effectiveness but only on administrative convenience when running two or more patients simultaneously in the laboratory protocol. If trials do not have to delay until each half-hour time point, subsequent trials can be run as soon as the participant has awoken from the previous trial, thus increasing the frequency of trials across the night. In this way, a participant may be able to complete up to 40 quick sleep onsets within 8 h and have the rest of the following day available for other activities, keeping in mind the sleepiness inducing effect of the virtual total sleep deprivation and avoiding potentially dangerous situations (e.g., driving while excessively sleepy). A study varying the number of sleep onset trials could determine in general the number of trials necessary to reach near maximal treatment effectiveness. It may be considerably less than 40 trials.
- Should the break between sleep onset trials in ISR simulate the normal process of going to bed each night? The conditioning model of chronic insomnia would suggest that many of the cues or elements of deciding to go to bed and the process of doing so may have developed as conditioned stimuli eliciting an arousal (fight or flight) insomnia response. These processes should be reversed by replicating them each time preceding a rapid sleep onset. However, this would require getting out of bed after being awoken by the ISR program and going back to the normal location when deciding to go to bed (e.g., TV room or computer room) and resuming those pre-bed activities for a few minutes before returning to the bedroom and initiating another sleep onset trial. Although this procedure may provide somewhat more effective re-association of all the possible conditioned stimuli from being triggers for arousal to becoming triggers for sleepiness, it may be arduous for some individuals, especially in the colder winter months, and likely to receive poor adherence. It would also slow down the rate of sleep onset trials. Another option would be to initiate another sleep onset trial immediately after being awoken on the previous trial. This would be much easier and probably have good adherence. It would also allow many more sleep onset trials in a given period of re-training. Although each trial may be individually less effective than when following the longer procedure, it may be compensated by more trials administered in a given time. Research is needed to determine which of these two methods overall is a more effective insomnia treatment.
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Lack, L.; Scott, H.; Micic, G.; Lovato, N. Intensive Sleep Re-Training: From Bench to Bedside. Brain Sci. 2017, 7, 33. https://doi.org/10.3390/brainsci7040033
Lack L, Scott H, Micic G, Lovato N. Intensive Sleep Re-Training: From Bench to Bedside. Brain Sciences. 2017; 7(4):33. https://doi.org/10.3390/brainsci7040033Chicago/Turabian Style
Lack, Leon, Hannah Scott, Gorica Micic, and Nicole Lovato. 2017. "Intensive Sleep Re-Training: From Bench to Bedside" Brain Sciences 7, no. 4: 33. https://doi.org/10.3390/brainsci7040033