Ahmed Eid Elaghoury MBChB, MScMed, Arab & Egyptian Boards in Psychiatry Abbassia Hospital for Mental Health, Cairo, MOH

Starts spread in 1980s Methods most studied for Insomnias: esp CBT-I Special societies, training programs, and journals Still open and evolving practice: clinical creation of new protocols. Same principles of psychotherapy. Alexandria, April 2014 2 Behavioral Sleep Medicine (BSM)

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Alexandria, April 2014 5 Behavioral Sleep Medicine (BSM)

AASM: Guideline treatment for insomnia Monotherapy or more common as a component of CBT-I Not suitable for pts in need for vigilance during daytime, . Enhances process S (sleep drive) Sleep efficiency (SE) = Total sleep time (TST) / Time in bed (TIB) x 100 Alexandria, April 2014Behavioral Sleep Medicine (BSM) 6

Accepted SE = 85 % ( 80% in elderly) Two weeks: sleep log plus assessment of TST & TIB Wake time: suitable for work days Allowed TIB: not less than 5 HRs No daytime naps Every 2 weeks: TIB 15 / 30 min Middle phase: weekly SE assessment Alexandria, April 2014Behavioral Sleep Medicine (BSM) 7

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AASM: standard treatment for insomnia, esp sleep onset Bed / Bedrooms are CUES for sleep Not suitable for pts prone to disorientation / fall risk Alexandria, April 2014Behavioral Sleep Medicine (BSM) 9

Alexandria, April 2014Behavioral Sleep Medicine (BSM) 10 Bootzin & Perlis, 2011

AASM: standard treatment for insomnia, esp with hyperarousal. Quiescent self inquiry Benson rules Alexandria, April 2014Behavioral Sleep Medicine (BSM) 11

Mediation: Yoga / mindfulness Autogenic training: Progressive muscle relaxation (PMR) Biofeedback Imagery Alexandria, April 2014Behavioral Sleep Medicine (BSM) 12

Alexandria, April 2014Behavioral Sleep Medicine (BSM) 13 Jerrell, 2014. Delta Holistics, URL http://bit.ly/1ex3IeR

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Awareness & acceptance Letting go Alexandria, April 2014Behavioral Sleep Medicine (BSM) 16

AASM: Guideline treatment for insomnia, esp psychophysiological Attack striving for sleep / preoccupation Inhibition / attention model for insomnia Alexandria, April 2014Behavioral Sleep Medicine (BSM) 17

Alexandria, April 2014Behavioral Sleep Medicine (BSM) 18 Espie, 2006

Alexandria, April 2014Behavioral Sleep Medicine (BSM) 19 Espie, 2011

AASM: no recommendation Alexandria, April 2014Behavioral Sleep Medicine (BSM) 20

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Alexandria, April 2014Behavioral Sleep Medicine (BSM) 23 Morin, 1993

1. Behavioral experiments 2. Reduce unhelpful beliefs 3. Reduce misperception 4. Reduce use of safety behaviors 5. CT for dysfunctional beliefs 6. CT for catastrophic beliefs Alexandria, April 2014Behavioral Sleep Medicine (BSM) 24

Behavioral interventions Extinction strategies Parental education Positive routines Scheduled awakenings Delayed bedtime Response cost Alexandria, April 2014Behavioral Sleep Medicine (BSM) 25

BSM is new brach and still evolving. It is NOT synonymous to sleep hygiene CBT-I program is multicomponent: cognitive strategies, stimulus control, relaxation therapy and sleep restriction are common components CBT-I program shows better results than pharmacotherapy Like all psychotherapeutic approaches, BSM methods should be tailored to each pts needs. SOME methods are guideline and standard treatments according AASM, while the specific protocols are still open to modifications. Alexandria, April 2014Behavioral Sleep Medicine (BSM) 26