Terapia non farmacologica dell’insonnia: igiene del sonno e restrizione a confronto
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Pubblicato:
Jun 30, 2020
Parole chiave:
Insonnia, igiene del sonno, restrizione del sonno
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Abstract
Introduzione
L’insonnia è il più comune di tutti i disturbi del sonno interessando nel corso della vita più del 40% della popolazione. La prima scelta terapeutica è di tipo non farmacologico ed è costituita dalla terapia cognitivo-comportamentale (TCC).
Negli anni, è stata studiata l’efficacia della restrizione del sonno e delle regole di igiene del sonno, considerate sia singolarmente sia come parte di un programma più completo.
Obiettivo
Valutare e comparare l’efficacia delle tecniche di restrizione del sonno e igiene del sonno nel trattamento dell’insonnia cronica anche in relazione alla qualità di vita.
Materiali e metodi
L’efficacia terapeutica è stata valutata mediante actigrafia e diario del sonno, la qualità della vita è stata auto-valutata mediante somministrazione del questionario Short Form Health Survey (SF-36).
Risultati
Venti soggetti hanno completato lo studio. Nel gruppo restrizione di sonno, sono state evidenziate differenze statisticamente significative (p<0.05) rispetto a T0, per quanto riguarda il tempo trascorso a letto (TIB) e la veglia infrasonno (WASO), che diminuiscono, e l’efficienza di sonno (SE), che aumenta.
All’SF36, aumenta la percezione di una migliore salute in generale.
Nel gruppo trattamento con igiene del sonno non si evidenziano, dopo trattamento, significative variazioni di TST, TIB, WASO e SE rispetto a T0 mentre all’SF-36 aumentano i punteggi alle sotto scale relative al concetto di salute in generale, al funzionamento fisico, al dolore e alla percezione di salute mentale.
Discussione
Il gruppo restrizione del sonno sembra migliorare maggiormente su parametri oggettivi actigrafici, seppur in presenza di un moderato tasso di drop-out, mentre il gruppo igiene del sonno attraverso alcuni parametri soggettivi relativi alla qualità della vita.
Conclusioni
Lo studio evidenzia come entrambe le tecniche siano efficaci nel miglioramento del sonno in soggetti insonni, benché su aspetti differenti.
Parole chiave
Insonnia, igiene del sonno, restrizione del sonno
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Come citare
Cicolin, A., & Giordano, A. (2020). Terapia non farmacologica dell’insonnia: igiene del sonno e restrizione a confronto. Journal of Biomedical Practitioners, 4(1). https://doi.org/10.13135/2532-7925/4655
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[28] Chung, K. F., Lee, C. T., Yeung, W. F., Chan, M. S., Chung, E. W., & Lin, W. L. (2018). Sleep hygiene ed-ucation as a treatment of insomnia: a systematic review and meta-analysis. Family practice, 35(4), 365–375. https://doi.org/10.1093/fampra/cmx122
[29] Vincent, N., Lewycky, S., & Finnegan, H. (2008). Barriers to engagement in sleep restriction and stimulus control in chronic insomnia. Journal of consulting and clinical psychology, 76(5), 820–828. https://doi.org/10.1037/0022-006X.76.5.820
[30] Hebert, E. A., Vincent, N., Lewycky, S., & Walsh, K. (2010). Attrition and adherence in the online treat-ment of chronic insomnia. Behavioral sleep medicine, 8(3), 141–150. https://doi.org/10.1080/15402002.2010.487457
[31] Perlis, M. L., Sharpe, M., Smith, M. T., Greenblatt, D., & Giles, D. (2001). Behavioral treatment of in-somnia: treatment outcome and the relevance of medical and psychiatric morbidity. Journal of behavioral medicine, 24(3), 281–296. https://doi.org/10.1023/a:1010770807823
[32] Perlis, M., Aloia, M., Millikan, A., Boehmler, J., Smith, M., Greenblatt, D., & Giles, D. (2000). Behavioral treatment of insomnia: a clinical case series study. Journal of behavioral medicine, 23(2), 149–161. https://doi.org/10.1023/a:1005413117932
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[37] Morin C. M. (2004). Cognitive-behavioral approaches to the treatment of insomnia. The Journal of clinical psychiatry, 65 Suppl 16, 33–40
[2] Chesson, A. L., Jr, Anderson, W. M., Littner, M., Davila, D., Hartse, K., Johnson, S., Wise, M., & Rafecas, J. (1999). Practice parameters for the nonpharmacologic treatment of chronic insomnia. An American Academy of Sleep Medicine report. Standards of Practice Committee of the American Academy of Sleep Medicine. Sleep, 22(8), 1128–1133. https://doi.org/10.1093/sleep/22.8.1128
[3] Morin, C. M., Colecchi, C., Stone, J., Sood, R., & Brink, D. (1999). Behavioral and pharmacological ther-apies for late-life insomnia: a randomized controlled trial. JAMA, 281(11), 991–999. https://doi.org/10.1001/jama.281.11.991999
[4] Petit, L., Azad, N., Byszewski, A., Sarazan, F. F., & Power, B. (2003). Non-pharmacological management of primary and secondary insomnia among older people: review of assessment tools and treatments. Age and ageing, 32(1), 19–25. https://doi.org/10.1093/ageing/32.1.19
[5] Morin, C. M. and Espie, C. A. Insomnia – A Clinical Guide to Assessment and Treatment. Springer, New York, 2004
[6] Morgenthaler, T., Kramer, M., Alessi, C., Friedman, L., Boehlecke, B., Brown, T., Coleman, J., Kapur, V., Lee-Chiong, T., Owens, J., Pancer, J., Swick, T., & American Academy of Sleep Medicine (2006). Practice parameters for the psychological and behavioral treatment of insomnia: an update. An american academy of sleep medicine report. Sleep, 29(11), 1415–1419
[7] Morin, C. M., Bootzin, R. R., Buysse, D. J., Edinger, J. D., Espie, C. A., & Lichstein, K. L. (2006). Psy-chological and behavioral treatment of insomnia:update of the recent evidence (1998-2004). Sleep, 29(11), 1398–1414. https://doi.org/10.1093/sleep/29.11.1398
[8] Siebern, A. T., & Manber, R. (2010). Insomnia and its effective non-pharmacologic treatment. The Medical clinics of North America, 94(3), 581–591. https://doi.org/10.1016/j.mcna.2010.02.005
[9] Schutte-Rodin, S., Broch, L., Buysse, D., Dorsey, C., & Sateia, M. (2008). Clinical guideline for the evalu-ation and management of chronic insomnia in adults. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 4(5), 487–504
[10] Wu, R., Bao, J., Zhang, C., Deng, J., & Long, C. (2006). Comparison of sleep condition and sleep-related psychological activity after cognitive-behavior and pharmacological therapy for chronic insomnia. Psycho-therapy and psychosomatics, 75(4), 220–228. https://doi.org/10.1159/000092892
[11] Kay-Stacey, M., & Attarian, H. (2016). Advances in the management of chronic insomnia. BMJ (Clinical re-search ed.), 354, i2123. https://doi.org/10.1136/bmj.i2123
[12] Hassinger AB, Bletnisky N, Dudekula R, et al. Selecting a pharmacotherapy regimen for patients with chron-ic insomnia [published online ahead of print, 2020 Mar 23]. Expert Opin Pharmacother 2020; 1–9: https://doi.org/10.1080/14656566.2020.1743265
[13] Stepanski, E. J., & Wyatt, J. K. (2003). Use of sleep hygiene in the treatment of insomnia. Sleep medicine reviews, 7(3), 215–225. https://doi.org/10.1053/smrv.2001.0246
[14] Spielman A.J., Saskin P., Thorpy M.J. (1987). Treatment of chronic insomnia by restriction of time in bed. Sleep. 10(1):45-56
[15] Nathaniel Kleitman. Sleep and Wakefulness. University of Chicago Press.1987
[16] Hauri P.J. (1991) Sleep Hygiene, Relaxation Therapy, and Cognitive Interventions. In: Hauri P.J. (eds) Case Studies in Insomnia. Critical Issues in Psychiatry (An Educational Series for Residents and Clinicians). Springer, Boston, MA
[17] Sateia MJ, Buysse DJ, Krystal AD, et al. Clinical Practice Guideline for the Pharmacologic Treatment of Chronic Insomnia in Adults: An American Academy of Sleep Medicine Clinical Practice Guideline. J Clin Sleep Med 2017; 13(2):3 07–349; Published 2017 Feb 15. https://doi.org/10.5664/jcsm.6470
[18] Riemann D, Baglioni C, Bassetti C, et al. European guideline for the diagnosis and treatment of insomnia. Journal of sleep research 2017; 26(6): 675–700; https://doi.org/10.1111/jsr.12594
[19] Apolone G., Mosconi P., (1998). The italian SF 36 Health Survey: translation, validation and norming. J Clin Epidemiol. 51:1025
[20] Folstein, M.F., Folstein, S.E., McHugh P.R. (1975) Mini-Mental State: A practical methodfor grading the cognitive state of patients for the clinician Psychiatr Res. 12:189-198
[21] IBM Corp. Released 2017. IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY: IBM Corp
[22] WMA declaration of Helsinki – ethical principles for medical research involving human subjects Adopted by the 18th WMA General Assembly, Helsinki, Finland, June 1964, and amended
[23] Morin, C. M., Culbert, J. P., & Schwartz, S. M. (1994). Nonpharmacological interventions for insomnia: a meta-analysis of treatment efficacy. The American journal of psychiatry, 151(8), 1172–1180. https://doi.org/10.1176/ajp.151.8.1172
[24] Friedman, L., Benson, K., Noda, A., Zarcone, V., Wicks, D. A., O'Connell, K., Brooks, J. O., 3rd, Bliwise, D. L., & Yesavage, J. A. (2000). An actigraphic comparison of sleep restriction and sleep hygiene treat-ments for insomnia in older adults. Journal of geriatric psychiatry and neurology, 13(1), 17–27. https://doi.org/10.1177/089198870001300103
[25] Riemann, D., & Perlis, M. L. (2009). The treatments of chronic insomnia: a review of benzodiazepine re-ceptor agonists and psychological and behavioral therapies. Sleep medicine reviews, 13(3), 205–214. https://doi.org/10.1016/j.smrv.2008.06.001
[26] Miller, C. B., Espie, C. A., Epstein, D. R., Friedman, L., Morin, C. M., Pigeon, W. R., Spielman, A. J., & Kyle, S. D. (2014). The evidence base of sleep restriction therapy for treating insomnia disorder. Sleep medicine reviews, 18(5), 415–424. https://doi.org/10.1016/j.smrv.2014.01.006
[27] Hoch, C. C., Reynolds, C. F., 3rd, Buysse, D. J., Monk, T. H., Nowell, P., Begley, A. E., Hall, F., & Dew, M. A. (2001). Protecting sleep quality in later life: a pilot study of bed restriction and sleep hygiene. The journals of gerontology. Series B, Psychological sciences and social sciences, 56(1), P52–P59. https://doi.org/10.1093/geronb/56.1.p52
[28] Chung, K. F., Lee, C. T., Yeung, W. F., Chan, M. S., Chung, E. W., & Lin, W. L. (2018). Sleep hygiene ed-ucation as a treatment of insomnia: a systematic review and meta-analysis. Family practice, 35(4), 365–375. https://doi.org/10.1093/fampra/cmx122
[29] Vincent, N., Lewycky, S., & Finnegan, H. (2008). Barriers to engagement in sleep restriction and stimulus control in chronic insomnia. Journal of consulting and clinical psychology, 76(5), 820–828. https://doi.org/10.1037/0022-006X.76.5.820
[30] Hebert, E. A., Vincent, N., Lewycky, S., & Walsh, K. (2010). Attrition and adherence in the online treat-ment of chronic insomnia. Behavioral sleep medicine, 8(3), 141–150. https://doi.org/10.1080/15402002.2010.487457
[31] Perlis, M. L., Sharpe, M., Smith, M. T., Greenblatt, D., & Giles, D. (2001). Behavioral treatment of in-somnia: treatment outcome and the relevance of medical and psychiatric morbidity. Journal of behavioral medicine, 24(3), 281–296. https://doi.org/10.1023/a:1010770807823
[32] Perlis, M., Aloia, M., Millikan, A., Boehmler, J., Smith, M., Greenblatt, D., & Giles, D. (2000). Behavioral treatment of insomnia: a clinical case series study. Journal of behavioral medicine, 23(2), 149–161. https://doi.org/10.1023/a:1005413117932
[33] Coradeschi D. Restrizione del sonno e controllo dello stimolo: il cuore dell’intervento comportamentale per l’insonnia. Cognitivismo Clinico (2016) 13, 1, 54-67
[34] Terzano, M. G., Parrino, L., Bonanni, E., Cirignotta, F., Ferrillo, F., Gigli, G. L., Savarese, M., Ferini-Strambi, L., & Members of the Advisory Board (2005). Insomnia in general practice: a consensus report produced by sleep specialists and primary-care physicians in Italy. Clinical drug investigation, 25(12), 745–764. https://doi.org/10.2165/00044011-200525120-00002
[35] Riemann D, Baglioni C, Bassetti C, et al. European guideline for the diagnosis and treatment of insomnia. Journal of sleep research 2017; 26(6): 675–700; https://doi.org/10.1111/jsr.12594
[36] Morin, C. M., Bastien, C., Guay, B., Radouco-Thomas, M., Leblanc, J., & Vallières, A. (2004). Random-ized clinical trial of supervised tapering and cognitive behavior therapy to facilitate benzodiazepine discon-tinuation in older adults with chronic insomnia. The American journal of psychiatry, 161(2), 332–342. https://doi.org/10.1176
[37] Morin C. M. (2004). Cognitive-behavioral approaches to the treatment of insomnia. The Journal of clinical psychiatry, 65 Suppl 16, 33–40