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Chapter 6

Behavioral Strategies for Managing Insomnia

Abstract
This chapter is devoted to actual treatment implementation of the core

behavioral strategies. In this and subsequent chapters, we provide “nuts and bolts”

descriptions to aid the reader in understanding and effectively delivering a number

of psychological, evidence-based treatments to those with insomnia and other anxiety-

related forms of sleep difficulties. This chapter focuses exclusively on insomnia and

provides methods for identifying and correcting common sleep-disruptive habits or

practices that are generic characteristics among insomnia sufferers. The discussion

begins by demonstrating the use of a sleep diary for identifying the common behav-

ioral treatment targets, namely those common problematic behaviors that serve to

perpetuate insomnia. Subsequently, we provide text that can be used to present

the treatment rationale in therapy and then consider how to combine and deliver

stimulus control and sleep restriction therapy instructions. The chapter concludes

by reviewing strategies for addressing other sleep-interfering habits and sleep envi-

ronments that cause them some sleep disruption. Overall, this chapter is designed

to provide step-by-step instructions for implementing effective behavioral insomnia

treatment strategies as well as a number of useful paper-and-pencil tools for aiding

the clinician in conducting this form of intervention.

Assessing the Sleep Problem Using the Sleep Diary

To demonstrate the value of the sleep diary for insomnia assessment, it is useful to

consider some case examples. Figures 6.1–6.3 provide a sampling of the type of

information that may be gleaned from sleep diary monitoring. Figure 6.1 shows a

common problem among people with insomnia – an erratic sleep schedule. The

diary reveals that the time at which these individuals go to bed over the course of a

week varies by over 5 h. Additionally, the time at which they get out of bed in the

mornings across the week varies over 3 h. When there is an erratic sleep schedule,

it can produce symptoms similar to jetlag (e.g., sleep disruption, fatigue, mood

disturbance). Remember that 1 h of variability is like traveling one time zone, so

5 h of variability is like traveling across 5 time zones. Those who exhibit these

erratic schedules are often motivated by a belief that they should try and obtain the

C.E. Carney and J.D. Edinger,
Insomnia and Anxiety
, Series in Anxiety and Related Disorders,

79

DOI 10.1007/978-1-4419-1434-7_6, © Springer Science+Business Media, LLC 2010

80

6 Behavioral Strategies for Managing Insomnia

1

2

1

Sun

1/21

None

None

5 min

2:45 AM

2:45 AM

10 min

7:25 AM

7:30 AM

1

3

2

Sat

1/20

None

None

35 min

55 min

11:20 PM

11:20 PM

5:15 AM

5:20 AM

Fri

1

2

2

1/19

None

None

35 min

55min

1:20 AM

12:20AM

5:15 AM

5:20 AM

2

3

3

Thurs

1/18

None

None

65 min

40 min

90 min

11:30 PM

11:30 PM

6:40 AM

7:30 AM

2

4

3

Wed

1/17

None

None

10 min

45 min

90 min

10:30 PM

10:30 PM

8:00 AM

8:05 AM

2

3

2

Tue

1/16

None

None

9:45 PM

45 min

25 min

25 min

10:45 PM

8:30 AM

8:40 AM

1

3

2

Mon

1/15

None

None

20 min.

50 min.

6:05 AM

11:00 PM

11:00 PM

6:30 AM

EXAMPLE

3

2

5 mg.

Monday

3/24/08

Ambien

40 Min.

2 Times

25 Min. 40 Min.

6:30 AM

11:00 PM

11:30 PM

7:15 AM

2:30-3:15 PM