Stimulus-control: nonpharmacologic treatment for insomnia.

OBJECTIVES

To evaluate the efficacy and applicability of a behavioural treatment for insomnia that can be administered by family physicians in various clinical settings.

DESIGN

Efficacy of the treatment was evaluated by single-case experimental designs (multiple baseline across subjects). Applicability was assessed through semistructured interviews with physicians.

SETTING

Two private offices, two offices in community health centres, and one office in a family medicine unit.

PARTICIPANTS

Six general practitioners and 24 chronic insomniac patients recruited through media advertisements and from physicians' practices. Of an initial 38 subjects screened, six were excluded for sleep-onset latency less than 30 minutes, five for psychological conditions, one for physical handicaps, and two for other reasons.

INTERVENTIONS: Physicians used stimulus-control treatment during individual therapeutic sessions. Patients using hypnotics were encouraged to taper off their medications after treatment was initiated.

MAIN OUTCOME MEASURES: Time it took patients to get to sleep (sleep-onset latency), amount of hypnotic use, and practitioners' evaluation of the treatment.

RESULTS

Fifteen patients completed the treatment; 80% of them reduced their sleep-onset latency. Six of the seven patients using hypnotics at the beginning of the study reduced or stopped their medications. All therapeutic gains were maintained at 3 and 6 months. Physicians thought stimulus-control treatment could be used in medical practice, but specified that it was most useful for highly motivated patients.

CONCLUSION

Family physicians can use stimulus-control treatment effectively for patients with chronic insomnia. This nonpharmacologic approach could help motivated patients reduce their use of hypnotics.