Selecting a Treatment Strategy

  • Michael M. Stevenson
  • Marsha K. Weinstein
Part of the Critical Issues in Psychiatry book series (CIPS)


Patients complaining of insomnia are a fairly heterogeneous group, with multiple factors causing and maintaining their sleeplessness. We find it helpful in selecting an optimal treatment strategy to understand insomnia from the patient’s perspective. Understanding how insomnia has been conceptualized, what coping strategies have been selected, and the role it has come to play in the patient’s life provides useful information as to how insomnia can best be treated. The patient’s own selection of a coping strategy is often determined by how the insomnia is perceived and evaluated. This is partly a function of the patient’s belief system about his or her ability to sleep and to function without sleep.


Coping Strategy Sleep Disorder Sleep Problem Stimulus Control Total Sleep Time 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Recommended Readings

  1. Kryger, M. H., Roth, T., Dement, W. C. (1989). Principles and practice of sleep medicine. Philadelphia: W. B. Saunders, pp. 431–493. The insomnia section, written by several authors, covers the etiology and treatment of transient insomnias, primary insomnia, and insomnias associated with circadian rhythm disorders, psychiatric disturbances, medical disorders, and other sleep disorders.Google Scholar
  2. Mendelson, W. B. (1987). Chronic insomnia. In W. B. Mendelson, Human sleep, research and clinical care. New York: Plenum Press, pp. 323–342. This chapter focuses on research into the experiences and subjective perceptions of sleep in insomniacs as well as a review of treatment approaches that have been found to be effective.Google Scholar
  3. Ulene, A., Stevenson, M. M. (1987). How to fall asleep and stay asleep. New York: Random House Audiobooks. This is a self-help audiobook for patients with insomnia. It contains interviews with insomniacs who have overcome their sleeping problems and techniques patients can use to prevent and relieve insomnia.Google Scholar


  1. American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders (3rd ed., rev.). Washington, DC: American Psychiatric Association.Google Scholar
  2. American Sleep Disorders Association Diagnostic Classification Steering Committee (Thorpy, M. J., Chairman). (1990) The international classification of sleep disorders, diagnostic and coding manual. Lawrence, Kansas: Allen Press.Google Scholar
  3. Bootzin, R. R., Nicassio, P. M. (1978). Behavioral treatments for insomnia. In M. Hersen, R. M. Eisler, P. M. Miller (Eds.), Progress in behavior modification (Vol. 6). New York: Academic Press, pp. 1–45.Google Scholar
  4. Carskadon, M. A., Dement, W. C., Mittler, M. M., Guilleminault, C., Zarcone, V. R, Spiegel, R. (1976). Self reports versus sleep laboratory findings in 122 drug free subjects with complaints of chronic insomnia. American Journal of Psychiatry, 133, 1382–1383.PubMedGoogle Scholar
  5. Curatolo, P. W, Robertson, D. (1983). The health consequences of caffeine. Annals of Internal Medicine, 98, 641–653.PubMedCrossRefGoogle Scholar
  6. Czeisler, C. A., Richardson, G. S., Coleman, R. M., Zimmerman, J. C., Moore-Ede, M. C., Dement, W. C., Weitzman, E. D. (1981). Chronotherapy: Resetting the circadian clocks of patients with delayed sleep phase insomnia. Sleep, 4, 1–21.PubMedGoogle Scholar
  7. Dinges, D. F. (1989). The influence of the human circadian time keeping system on sleep. In M. H. Kryger, T. Roth, W. C. Dement (Eds.), Principles and practice of sleep medicine. Philadelphia: W. B. Saunders, pp. 153–162.Google Scholar
  8. Hoddes, E., Zarcone, V. P., Smythe, H., Phillips, R., Dement, W. C. (1973). Quantification of sleepiness: A new approach. Psychophysiology, 10, 431–436.PubMedCrossRefGoogle Scholar
  9. Horne, J. (1988). Why we sleep: The functions of sleep in humans and other mammals. Oxford: Oxford University Press.Google Scholar
  10. Horne, J. A., Porter, J. M. (1976). Time of day effects with standardized exercise upon subsequent sleep. Electroencephalography and Clinical Neurophysiology, 40, 178–184.PubMedCrossRefGoogle Scholar
  11. Jacobson, E. (1974). Progressive relaxation. Chicago: University of Chicago Press.Google Scholar
  12. Mahoney, M. J. (1974). Cognition and behavior modification. Cambridge, MA: Ballinger.Google Scholar
  13. McMullen, R. E. (1986). Handbook of cognitive therapy techniques. New York: W. W. Norton.Google Scholar
  14. Nicholson, A. N. (1989). Hypnotics: Clinical pharmacology and therapeutics. In M. H. Kryger, T. Roth, W. C. Dement (Eds.), Principles and practice of sleep medicine. Philadelphia: W. B. Saunders, pp. 219–227.Google Scholar
  15. Reynolds, C. E, Kupfer, D. J., Taska, L. S., Hoch, C. C., Sewitch, D. E., Spiker, D. G. (1985). The sleep of health seniors: A revisit. Sleep, 8, 20–29.PubMedGoogle Scholar
  16. Smith, J. C. (1985). Relaxation dynamics: Nine world approaches to self-relaxation. Champaign, IL: Research Press.Google Scholar
  17. Soldatos, C. R., Kales, J. D., Scharf, M. B., Bixler, E. O., Kales, A. (1980). Cigarette smoking associated with sleep difficulty. Science, 207, 551–552.PubMedCrossRefGoogle Scholar
  18. Spielman, A. J., Saskin, P, Thorpy, M. J. (1987). Treatment of chronic insomnia by restriction of time in bed. Sleep, 10, 45–56.PubMedGoogle Scholar
  19. Zarcone, V. P. (1989). Sleep hygiene. In M. H. Kryger, T. Roth, W. C. Dement, (Eds.), Principles and practice of sleep medicine. Philadelphia: W. B. Saunders, pp. 490–493.Google Scholar

Copyright information

© Springer Science+Business Media New York 1991

Authors and Affiliations

  • Michael M. Stevenson
    • 1
  • Marsha K. Weinstein
    • 1
  1. 1.North Valley Sleep Disorders CenterMission HillsUSA

Personalised recommendations