A behavioral perspective on insomnia treatment

The major behavioral treatments of insomnia--progressive relaxation, biofeedback, cognitive approaches, stimulus control instructions, chronotherapy, and sleep restriction therapy--are described. The basis of these interventions are conceptualized as issuing from the interdependence of sleep and wakefulness, the temporal organization of sleep-wake processes, cognitive effects on arousal, the role of perpetuating factors in chronic insomnia, and conditioning. A pilot study of the conditioning of rapid sleep onset with the aid of a hypnotic provides a preliminary demonstration of the application of conditioning to the pharmacotherapy of sleep. It is predicted that the commonly accepted view of sleep latency as solely reflecting physiological sleep tendency, will require modification to include the effects of conditioning. The current pattern of hypnotic usage, an issue of widespread concern, is subjected to a behavioral analysis based on a new model of conditioned tolerance. The intermittent administration of placebo within a hypnotic regimen is predicted to be especially beneficial in sustaining hypnotic efficacy.