Le Bouthillier J, Ivers H, Morin C M
École de psychologie, Université Laval, Quebec City, Québec, Canada.
Centre d'étude des troubles du sommeil, Centre de recherche CERVO, Quebec City, Québec, Canada.
J Sleep Res. 2025 Apr 28:e70043. doi: 10.1111/jsr.70043.
The aim of the study was to compare the efficacy of intensive sleep retraining (ISR) and total sleep deprivation (TSD) against a no-treatment control condition for treating chronic insomnia and examine two potential mechanisms: the resolution of conditioned insomnia and the increase in homeostatic sleep drive produced by sleep deprivation. Thirty-four adults with chronic sleep onset insomnia (with or without sleep maintenance difficulties) were randomised to ISR, TSD, or a control condition. The ISR condition consisted of a 38.5-h period of sleep deprivation, the last 21 h of which included 42 sleep onset trials; the TSD condition consisted of an equivalent 38.5-h sleep deprivation period without any sleep onset trials, and the control condition consisted of one night of habitual sleep in the laboratory. Significant decreases in insomnia severity were observed from pre- to post-treatment in both ISR and TSD, but not in the control condition. A significant reduction in sleep onset latency was observed during the same period for the ISR condition, but not for the TSD or control conditions, with no clinically meaningful change in anxiety or depressive symptoms. Significant decreases in fatigue were also observed for both ISR and TSD conditions during the same period. These results were generally significant at 3 months after treatment. Sleep improvements produced by ISR, and to a lesser extent by TSD, suggest that both the resolution of conditioned insomnia and the increase in homeostatic sleep drive represent important mechanisms responsible for the efficacy of ISR.
本研究的目的是比较强化睡眠再训练（ISR）和完全睡眠剥夺（TSD）与不治疗对照条件在治疗慢性失眠方面的疗效，并研究两种潜在机制：条件性失眠的解决以及睡眠剥夺导致的内稳态睡眠驱动力增加。34名患有慢性入睡性失眠（有或无睡眠维持困难）的成年人被随机分配到ISR组、TSD组或对照组。ISR组包括38.5小时的睡眠剥夺期，其中最后21小时包括42次入睡试验；TSD组包括同等时长的38.5小时睡眠剥夺期，但没有任何入睡试验，对照组则是在实验室进行一晚的习惯睡眠。治疗前到治疗后，ISR组和TSD组的失眠严重程度均显著降低，但对照组没有。同一时期，ISR组的入睡潜伏期显著缩短，但TSD组和对照组没有，且焦虑或抑郁症状没有临床上有意义的变化。同一时期，ISR组和TSD组的疲劳程度也显著降低。这些结果在治疗后3个月时通常具有显著性。ISR产生的睡眠改善，以及在较小程度上TSD产生的睡眠改善，表明条件性失眠的解决和内稳态睡眠驱动力的增加都是ISR疗效的重要机制。
