Treatment Resources for Clinicians

Treatments vary depending upon the type of disorder. Behavior therapy, drug treatments, and several alternative interventions can be helpful for a variety of sleep difficulties. Most people also benefit from basic education about normal sleep (may reduce patient's anxiety about sleep) and sleep hygiene (activities that interfere with sleep).¹

Sleep Disorder Treatments:

Treatment of Insomnia: Short-term insomnia may resolve on its own, and treatment may not be needed. Treatment for insomnia can include a trial of hypnotic medication (followed by supervised withdrawal). ¹More

Additionally, cognitive-behavioral treatment (CBT) or a combination of CBT and hypnotic medication may be beneficial. ¹ CBT for insomnia addresses problematic beliefs about sleep or lack thereof, teaches relaxation skills, and targets stimulus control, which helps the person learn to associate bedtime and the bedroom with being able to sleep. More

If insomnia is secondary to, or caused by another disorder (e.g., depression, medical illness), that disorder should be treated first. If symptoms of insomnia do not improve a referral to sleep specialist may be helpful.¹

Treatment of Hypersomnia: Stimulants, antidepressants, and other medications may be beneficial for treating hypersomnia. It is also important to implement habits to promote sleeping at night and staying awake during the day, such as avoiding activities that delay bed time and avoiding alcohol and caffeine. More

Treatment of Narcolepsy: Stimulant medications may help reduce daytime sleepiness, Anticholinergic (medications that calm muscle spasms) antidepressant agents for cataplexy may help with cataplexy symptoms. Taking scheduled naps in addition to medication is recommended. More

Treatment of Breathing-Related Disorder:For patients with obstructive sleep apnea, treatment may include behavioral interventions, oral/dental appliances, and surgical interventions, depending upon the severity of the disorder. Many patients are treated with nasal continuous positive airway pressure (CPAP). A C-PAP is a machine that blows air into your nose via a nose mask, keeping the airway open and unobstructed. More

Treatment of Circadian Rhythm Disorder: Light therapy (properly timed exposure to bright light to promote a normal sleep-wake cycle and decrease sleep disturbances) and behavioral interventions may be beneficial in the treatment of Circadian Rhythm Disorder.Behavioral interventions include implementing habits to promote normal sleep/wake cycles and gradually shifting the time of sleep. More

Treatment of Sleep Terror Disorder: Before beginning treatment it is recommended that sleep terrors be waited out to see if they resolve. ² If the problem persists, a trial of antidepressants or antianxiety medications may be beneficial, however the effectiveness of these drugs has not been clearly demonstrated. ² Sleep terrors may be impacted by a failure to get enough sleep, therefore getting more sleep might be helpful. Scheduled awakening may also be beneficial for the treatment of sleep terrors. ² Scheduled awakening involves waking the person approximately 30 minutes before the he or she normally awakens, then slowly eliminating the scheduled awakenings as spontaneous awakenings decrease.² More

Treatment of Nightmare Disorder: Behavioral interventions may be beneficial in the treatment of recurrent nightmares.^{3, 4} Treatment may include imagery rehearsal for nightmares (practice of how to respond to the event without actually experiencing it) and sleep hygiene (implementing habits that promote good sleep).

Sleep Walking Disorder: Sleep walking does not necessarily require treatment, and may go away on its own. It is important to implement habits to promote good sleep and treat any underlying medical conditions that may impact sleep problems. Safety measures may be necessary to prevent injury, including locking windows and doors, removing obstacles in the room, adding alarms, or blocking stairways. Medications, such as certain sedatives or antidepressants, may be helpful, particular if the potential risk for injury is great, if other interventions have not been helpful, or if the individual is experiencing excessive daytime sleepiness.Behavioral techniques, such as relaxation and scheduled awakening may also be beneficial for the treatment of sleep walking. Scheduled awakening involves waking the person up approximately 15-20 minutes before the usual time her or she sleep walks and then keeping him or her awake through the time during which the episodes usually occur. More

Additional Treatment Resources:

Problem Sleepiness in Your Patient
Outlines causes, identification, and management of Sleep Disorders.

Treating Sleep Disorders: Principles and Practice of Behavioral Sleep Medicine
K. L. Lichstein & M. L. Perlis

Insomnia: Psychological assessment and management
C.M. Morin

Insomnia: A clinical guide to assessment and treatment
C.M. Morin & C. A. Espie

Principles and Practice of Sleep Medicine (4^th Edition)
M.H. Kryger, T. Roth, & W. C. Dement

Resources

¹McCrae, C. S., Sidney, D. N., Taylor, D. J., & Lichstein, K. L. (in press). Insomnia. In J. Fisher and W. O'Donohue (Eds.), Practice guidelines for evidence based psychotherapy. New York: Kluwer Academic Publications.

²Durand, V. M. (in press). Sleep terrors. In J. Fisher and W. O'Donohue (Eds.), Practice guidelines for evidence based psychotherapy. New York: Kluwer Academic Publications.

³ Krakow, B., Johnston, L., Melendrez, D., Hollifield, M., Warner, T. D., Chavez-Kennedy, D., & Herlan, M. J. (2001).An Open-Label Trial of Evidence-Based Cognitive Behavior Therapy for Nightmares and Insomnia in Crime Victims With PTSD. American Journal of Psychiatry, 158, 2043-2047.

⁴Pagel, J. F. (2000). Nightmares and Disorders of Dreaming. American Family Physician, 61, 7, 2037-2050.

TRICARE policy for reimbursement requires that services must be medically necessary for a diagnosed psychological disorder. The disorder must be one referenced in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and must be of a severity not only to cause the patient distress but also to interfere with the patient's usual activities.