Arch Intern Med：短期行为疗法

美国研究人员开发一种短期行为疗法治疗失眠。他们发现，当失眠患者难以入眠时，应当缩短在床上辗转反侧的时间，下地走动片刻或与人交谈。

行为治疗

研究人员研究认知行为治疗法已有30年。他们发现，行为疗法治疗失眠与服用助眠药品有同样效果，且副作用较小。

传统行为疗法通常需要患者咨询临床心理师长达6小时至8小时，耗时较长，更不用提每次治疗费用达数百美元。

美国匹兹堡大学医学院研究人员希望开发一种耗时短、程序简的治疗方法。为此，他们招募79名平均年龄72岁的慢性失眠症患者，参与一项对比研究。

研究人员将受试者随机分为两组。一组阅读有关睡眠的印刷材料，另一组接受一项短期行为治疗。

治疗内容包括一次45分钟至60分钟的睡眠咨询，一次30分钟的后续治疗和两通时常20分钟的电话聊天。一名心理健康护士参与其中，严格控制受试者接受每一阶段治疗的时间，为他们制定睡眠时刻表，并与受试者探讨治疗方法背后的生物学原理。

效果明显

研究人员向受试者发放调查问卷，并让他们每天记录自己的睡眠情况。4周后，研究人员发现，三分之二接受行为疗法的受试者反应良好，而仅有四分之一阅读睡眠材料的受试者睡眠质量改善。

研究人员在受试者的手腕或脚踝处配有睡眠监测仪，由此获得实验数据。数据显示，平均每2.4名接受行为疗法的受试者中，一人反应良好，一人克服失眠——这一疗效持续至少6个月。

研究报告由最新一期《内科学文献》（The Archives of Internal Medicine）月刊发表。

路透社1月25日报道，每5名美国人中就有1人失眠。失眠症已经成为美国三大老年病之一，严重影响精神健康并引发一系列精神疾病，例如抑郁或过度紧张。

不要强迫

研究人员总结，这种行为疗法的关键是“反直觉性”。研究带头人丹尼尔·比斯说：“如果你难以入眠，能做的最重要的事就是少花点时间在床上。”

加利福尼亚大学旧金山分校的托马斯·尼兰说：“许多失眠症患者花大量时间躺在床上，担心自己的睡眠或者想东想西。”

他说，有时最好方法是服用助眠处方药物，但这会让患者产生赖药性，白天精神不振。

“如果你还不想睡觉，那么就不要躺在床上辗转反侧，强迫自己入睡。如果你在半夜醒来并且难以再次入睡，那么起身离开床，”尼兰说。

生物谷推荐原文出处：

Arch Intern Med.doi:10.1001/archinternmed.2010.535

Efficacy of Brief Behavioral Treatment for Chronic Insomnia in Older Adults

Daniel J. Buysse, MD; Anne Germain, PhD; Douglas E. Moul, MD, MPH; Peter L. Franzen, PhD; Laurie K. Brar, MSN; Mary E. Fletcher, BS; Amy Begley, MA; Patricia R. Houck, MSH; Sati Mazumdar, PhD; Charles F. Reynolds III, MD; Timothy H. Monk, DSc, PhD

BackgroundChronic insomnia is a common health problem with substantial consequences in older adults. Cognitive behavioral treatments are efficacious but not widely available. The aim of this study was to test the efficacy of brief behavioral treatment for insomnia (BBTI) vs an information control (IC) condition.

MethodsA total of 79 older adults (mean age, 71.7 years; 54 women [70%]) with chronic insomnia and common comorbidities were recruited from the community and 1 primary care clinic. Participants were randomly assigned to either BBTI, consisting of individualized behavioral instructions delivered in 2 intervention sessions and 2 telephone calls, or IC, consisting of printed educational material. Both interventions were delivered by a nurse clinician. The primary outcome was categorically defined treatment response at 4 weeks, based on sleep questionnaires and diaries. Secondary outcomes included self-report symptom and health measures, sleep diaries, actigraphy, and polysomnography.

ResultsCategorically defined response (67% [n = 26] vs 25% [n = 10]; 2 = 13.8) (P < .001) and the proportion of participants without insomnia (55% [n = 21] vs 13% [n = 5]; 2 = 15.5) (P < .001) were significantly higher for BBTI than for IC. The number needed to treat was 2.4 for each outcome. No differential effects were found for subgroups according to hypnotic or antidepressant use, sleep apnea, or recruitment source. The BBTI produced significantly better outcomes in self-reported sleep and health (group x time interaction, F5,73 = 5.99, P < .001), sleep diary (F8,70 = 4.32, P < .001), and actigraphy (F4,74 = 17.72, P < .001), but not polysomnography. Improvements were maintained at 6months.

ConclusionWe found that BBTI is a simple, efficacious, and durable intervention for chronic insomnia in older adults that has potential for dissemination across medical settings.