One alternative perspective, which has the potential to address issues of access and tolerability, is to look more closely at the intervention itself. 22, 23 Furthermore, where attempts have been made to identify specific issues that can affect tolerability and ultimately early termination of CBT-I, such as patient expectations, patient depression levels, levels of therapeutic alliance, and partner involvement, 24 – 26 these findings have yet to be integrated into standard care. 18 – 21 Despite the introduction and widespread dissemination of these innovative modalities, early indications suggest there may be a tradeoff in terms of reduced efficacy compared to individual face-to-face contact. 16, 17 To improve access and treatment completion, there has been a recent upsurge in studies exploring alternative treatment delivery modalities such as group therapy, telehealth, and computerized CBT-I (cCBT-I). 13 – 15 Despite the overwhelming evidence for CBT-I, two main issues hamper its widespread uptake-a lack of qualified providers and high levels of non-adherence and attrition. 11, 12 In fact CBT-I is considered the first-line treatment for both “pure” chronic insomnia and chronic insomnia comorbid with other diseases, disorders, or disabilities. Standard Cognitive Behavioral Therapy for Insomnia (CBT-I), a 6- to 8-w intervention targeting sleep-incompatible thoughts, beliefs, and behaviors, has been consistently demonstrated as efficacious, effective, and durable. 9 In essence, chronic insomnia is a highly prevalent, costly (the direct costs of chronic insomnia alone are estimated to be in the region of $13.9 billion annually), 10 and largely unrelenting condition. 7, 8 Importantly, chronic insomnia is also a persistent disorder with one study demonstrating the majority (74%) of individuals reporting insomnia at baseline still report having insomnia 1 y later and almost half (46%) report having insomnia at three consecutive annual assessment points. 1 – 6 At symptom level, between 30–48% of the population report having chronic insomnia and at syndrome level the prevalence, albeit significantly lower at between 6–15%, still represents a major challenge at both individual and societal levels. All rights reserved.Chronic insomnia is a significant public health concern and has been linked to the development and/or worsening of a number of physical and psychiatric conditions. Published by Oxford University Press on behalf of the Sleep Research Society. Incident chronic insomnia only occurs in about 2 in 100 individuals.Īcute insomnia aging incidence insomnia natural history. This said, most incident cases resolve within a few days to weeks. The incidence rate of acute insomnia (3 or more nights a week for between 2 and 12 weeks) is remarkably high. 19.3% (n = 65) of the acute insomnia sample continued to experience persistent poor sleep, but did not meet criteria for chronic insomnia. Of those that developed acute insomnia, 72.4% (n = 244) went on to recover good sleep. The incidence rate of chronic insomnia was 1.8% (n = 23). The 1-year incidence rate of acute insomnia was 27.0% (n = 337). The online measures consisted primarily of daily sleep diaries, as well as weekly/bi-weekly and monthly measures of sleep, stress, and psychological and physical health. Subjects were recruited nationwide and completed online assessments for 1 year. Good sleeper subjects (n = 1,248 67% female) that were at least 35 years old participated in this prospective study on the natural history of insomnia. daily diaries) and this allowed for a more precise detection of acute insomnia and the follow-on states (the transitions to either recovery or chronic insomnia). Unlike prior studies, a dense-sampling approach was used here (i.e. The primary aim of the present study was to estimate the incidence per annum of acute insomnia and to what extent those that develop acute insomnia recover good sleep or develop chronic insomnia.
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