Home-based central nervous system assessment of a multifactor behavioral intervention for chronic sleep-onset insomnia

The majority of individuals with insomnia treated with single behavioral interventions do not achieve normal sleep. In this study, individuals with chronic sleep-onset insomnia (n=12) were treated with a sequentially administered multifactor behavioral intervention consisting of sleep restriction, modified stimulus control, and relaxation training. They were compared to age- and sex-matched normal sleepers (n=14) prior to and following treatment using home-based polysomnography and power spectral analysis of pre-sleep EEG activity as dependent measures. Individuals with insomnia showed highly significant beneficial changes on EEG measures of insomnia, including a 75% reduction in sleep-onset latency, and did not differ from normal sleepers at posttreatment. Individuals with insomnia exhibited greater pre-sleep CNS arousal than normal sleepers at pretreatment and showed a significant reduction on this measure at posttreatment. Objective improvements in sleep were accompanied by significant improvements in self-report measures of sleep and mood. We conclude that a multifactor behavioral intervention consisting of sleep restriction, modified stimulus control, and relaxation response training is highly effective in moving individuals with chronic sleep-onset insomnia into the range of normal sleepers and may achieve its effect, in part, by reducing pre-sleep CNS arousal.