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ORIGINAL ARTICLE
J Korean Sleep Res Soc. 2010;7(2):49-56.         doi: https://doi.org/10.13078/jksrs.10009
The Effects of Sleep Restriction-Emphasized Cognitive Behavioral Therapy for Insomnia on Sleep with Chronic Insomniacs: A Preliminary Study
Su Jung Choi, and Keum Soon Kim
1Brain-Nerve Center, Samsung Medical Center, Seoul, Korea
2College of Nursing, Seoul National University, Seoul, Korea
Corresponding Author: Su Jung Choi ,Tel: +82-2-3410-2851, Fax: +82-2-3410-2759, Email: sujungchoi@hanmail.net
Received: 24 August 2010;  Accepted: 12 December 2010.
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ABSTRACT
Objectives: Cognitive-behavioral therapy for insomnia (CBT-I) is recommended as the 1st choice of treat-ment for chronic insomnia patients. Among CBT-I program, sleep restriction (SR) has known as the most effective and relatively well-tolerated treatment tool, but in practice, it is not easy to apply to all insomnia patients due to a lack of properly trained therapist. This study is designed to investigate the clinical utility of SR-emphasized CBT-I (SRCBT-I) conducted by a trained nurse.
Methods: Thirteen chronic insomniacs were enrolled for SRCBT-I (four biweekly-individual session) and eight (6 women; mean age 51.1 yr) of them completed the whole sessions. Control insomniacs (n=9; 7 women; age 56.8 yr) were treated with standard CBT-I. Eleven of them underwent night polysomnography before CBT-I. Main outcomes of treatment ev-aluation were sleep onset latency (SOL), wake time after sleep onset (WASO), total sleep time (TST), time in bed, and sleep efficiency (SE), which were determined based on patients’ sleep diary before and after CBT-I.
Results: All patients with standard or SRCBT-I reported the improvement in SOL (60.2 → 10.6 min), WASO (155.0 → 20.7 min), TST (242.2 → 32.6 min), SE (51.0 → 92.0%) and sleep medication (1.0 → 0.25 tablet). Compared to control insomniacs with standard CBT-I, patients with SRCBT-I showed a lesser WASO (Z=-2.792, p=0.005) and a higher SE (Z=-2.694, p=0.006) after CBT-I.
Conclusions: Our preliminary study demonstrated that SRCBT-I is more effective than standard CBT-I especially for sleep maintenance in chronic insomnia patients.
Keywords: Cognitive behavior therapy | Chronic insomnia | Sleep restriction
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