Adelaide Institute for Sleep Health: A Flinders Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Adelaide, Australia.
School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
J Clin Sleep Med. 2022 Jul 1;18(7):1823-1829. doi: 10.5664/jcsm.10004.
In most standardized approaches to cognitive behavioral therapy for insomnia, it is commonly the case that total wake time is reduced substantially during sleep restriction, but self-reported total sleep time (TST) is minimally affected. By follow-up, however, TST increases by almost 1 hour on average. A secondary analysis was undertaken to assess what percentage of participants meet or appreciably exceed baseline TST after cognitive behavioral therapy for insomnia.
Data were drawn from a randomized controlled trial assessing acute and maintenance therapies for chronic insomnia (n = 80). The present analyses assessed the percentage of participants that 1) reached (≥ 0 minute increase) and 2) appreciably exceeded (≥ 30 minutes increase) baseline TST as assessed via daily sleep diaries at posttreatment and 3, 6, 12, and 24 months following treatment.
By the end of acute treatment, 45% of participants reached or exceeded baseline TST. By 24 months follow-up, this percentage had increased to 86%. Only 17% of participants achieved a 30-minute increase in TST by the end of acute treatment, and this proportion only increased to 58% over time.
These findings suggest that cognitive behavioral therapy for insomnia in its current form does not appreciably increase self-reported TST in a significant proportion of patients with insomnia. Whether participants would benefit from further increases in TST warrants investigation. The further titration of sleep opportunity may be useful to accelerate increases in TST, to extend the effect to a larger subset of patients, and/or to increase the magnitude of the TST gain.
Scott H, Cheung JMY, Muench A, et al. Does total sleep time substantially increase after cognitive behavioral therapy for insomnia? . 2022;18(7):1823-1829.
在大多数针对失眠的认知行为疗法的标准化方法中，睡眠限制通常会大大减少总清醒时间，但自我报告的总睡眠时间（TST）受影响最小。然而，随访时，TST 平均增加近 1 小时。进行了二次分析，以评估认知行为疗法治疗失眠后有多少参与者符合或明显超过基线 TST。
数据来自一项评估慢性失眠急性和维持治疗的随机对照试验（n = 80）。本分析评估了以下百分比的参与者：1）达到（≥ 0 分钟增加）和 2）明显超过（≥ 30 分钟增加）基线 TST，通过治疗后和治疗后 3、6、12 和 24 个月的每日睡眠日记评估。
在急性治疗结束时，45%的参与者达到或超过基线 TST。到 24 个月随访时，这一比例已增加到 86%。只有 17%的参与者在急性治疗结束时达到 TST 增加 30 分钟，这一比例随着时间的推移仅增加到 58%。
这些发现表明，目前形式的失眠认知行为疗法并没有在相当一部分失眠患者中明显增加自我报告的 TST。参与者是否会从进一步增加 TST 中受益，值得进一步研究。进一步增加睡眠机会可能有助于加速 TST 的增加，将效果扩展到更大的患者亚组，以及/或增加 TST 增加的幅度。
Scott H、Cheung JMY、Muench A 等人。失眠认知行为疗法后总睡眠时间会显著增加吗？。2022；18（7）：1823-1829。
