This study explores the usefulness of relaxation and gradual medication withdrawal in weaning insomniacs from sleep (hypnotic) medication.We recruited 40 volunteers from the community who had insomnia, half of whom were chronic users of hypnotics while the other half were nonmedicated. Half of all participants (10 medicated and 10 nonmedicated) received progressive relaxation. All medicated participants received a standard gradual drug withdrawal program. Medicated participants reduced sleep medication consumption by nearly 80%. Participants who received relaxation obtained additional benefits in sleep efficiency, rated quality of sleep, and reduced withdrawal symptoms. Medicated and nonmedicated participants attained comparable, improved sleep by posttreatment and follow-up. Hypnotic withdrawalwas accompanied by serious worsening of insomnia, but this dissipated by the end of the withdrawal period. The psychological treatment of hypnotic-dependent insomnia has high potential for making an important clinical contribution.
Get full access to this article
View all access options for this article.
References
1.
Alperson, J. , & Biglan, A. (1979). Self-administered treatment of sleep onset insomnia and the importance of age. Behavior Therapy, 10, 347-356.
2.
American Sleep Disorders Association . (1990). International classification of sleep disorders: Diagnostic and coding manual. Rochester, MN: Author.
3.
Ashton, H. (1991). Protracted withdrawal syndromes from benzodiazepines. Journal of Substance Abuse Treatment, 8, 19-28.
4.
Beck, A. T. , Steer, R. A., & Garbin, M. G. (1988). Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation. Clinical Psychology Review, 8, 77-100.
5.
Carlson, C. R. , & Hoyle, R. H. (1993). Efficacy of abbreviated progressive muscle relaxation training: A quantitative review of behavioral medicine research. Journal of Consulting and Clinical Psychology, 61, 1059-1067.
6.
Cohen, J. (1987). Statistical power analysis for the behavioral sciences. Hillsdale, NJ: Lawrence Erlbaum.
7.
Johns, M. W. (1991). A new method for measuring daytime sleepiness: The Epworth Sleepiness Scale. Sleep, 14, 540-545.
8.
Kales, A. , Soldatos, C. R., Bixler, E. O., & Kales, J. D. (1983). Rebound insomnia and rebound anxiety: A review. Pharmacology, 26, 121-137.
9.
Kirmil-Gray, K. , Eagleston, J. R., Thoresen, C. E., & Zarcone, V. P. (1985). Brief consultation and stress management treatment for drug-dependent insomnia: Effects on sleep quality, sleep efficacy, and daytime stress. Journal of Behavioral Medicine, 8, 79-99.
10.
Landry, M. J. , Smith D. E., McDuff, D. R., & Baughman, O. L. (1992). Benzodiazepine dependence and withdrawal: Identification and medical management. Journal of the American Board of Family Practice, 5, 167-175.
11.
Lichstein, K. L. (1988). Clinical relaxation strategies. New York: Wiley.
12.
Lichstein, K. L. , & Johnson, R. S. (1993). Relaxation for insomnia and hypnotic medication use in older women. Psychology and Aging, 8, 103-111.
13.
Lichstein, K. L. , & Riedel, B. W. (1994). Behavioral assessment and treatment of insomnia: A review with an emphasis on clinical application. Behavior Therapy, 25, 659-688.
14.
Lick, J. R. , & Heffler, D. (1977). Relaxation training and attention placebo in the treatment of severe insomnia. Journal of Consulting and Clinical Psychology, 45, 153-161.
15.
Mendelson, W. B. (1990). Hypnotics in the treatment of chronic insomnia. In M. J. Thorpy (Ed.), Handbook of sleep disorders (pp. 737-753). New York: Marcel Dekker.
16.
Merz, W. A. , & Ballmer, U. (1983). Symptoms of the barbiturate/benzodiazepine withdrawal syndrome in healthy volunteers: Standardized assessment by a newly developed self-rating scale. Journal of Psychoactive Drugs, 15, 71-84.
17.
Morawetz, D. (1989). Behavioral self-help treatment for insomnia: A controlled evaluation. Behavior Therapy, 20, 365-379.
18.
Morgan, K. (1987). Sleep and aging: A research-based guide to sleep in later life. Baltimore: Johns Hopkins University Press.
19.
Morin, C. M. , & Azrin, N. H. (1988). Behavioral and cognitive treatments of geriatric insomnia. Journal of Consulting and Clinical Psychology, 56, 748-753.
20.
Morin, C. M. , Stone, J., McDonald, K., & Jones, S. (1994). Psychological management of insomnia: A clinical replication series with 100 patients. Behavior Therapy, 25, 291-309.
21.
Murphy, S. M. , & Tyrer, P. (1991). A double-blind comparison of the effects of gradual withdrawal of lorazepam, diazepam, and bromazepam in benzodiazepine dependence. British Journal of Psychiatry, 158, 511-516.
22.
National Institutes of Health, Consensus Development Conference . (1984). Drugs and insomnia: The use of medications to promote sleep. Journal of the American Medical Association251, 2410-2414.
23.
Pecknold, J. C. , McClure, D. J., Fleuri, D., & Chang, H. (1982). Benzodiazepine withdrawal effects. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 6, 517-522.
24.
Petursson, H. , & Lader, M. (1984). Dependence on tranquilizers. New York: Oxford University Press.
Riedel, B. W. , & Lichstein, K. L. (1994). Insomnia. In M. Hersen & R. T. Ammerman (Eds.), Handbook of prescriptive treatments for adults (pp. 369-392). New York: Plenum Press.
27.
Roth, T. , Roehrs, T., & Zorick, F. (1988). Pharmacological treatment of sleep disorders. In R. L. Williams, I. Karacan, & C. A. Moore (Eds.), Sleep disorders: Diagnosis and treatment (pp. 373-395). New York: Wiley.
28.
Spielberger, C. D. , Gorsuch, R. L., Lushene, R., Vagg, P. R., & Jacobs, G. A. (1983). State-Trait Anxiety Inventory (Form Y). Palo Alto, CA: Consulting Psychologists Press.
29.
Tyrer, P. (1988). Dependence as a limiting factor in the clinical use of minor tranquilizers. Pharmacology and Therapeutics, 36, 173-188.
30.
Tyrer, P. , Murphy, S., & Riley, P. (1990). The benzodiazepine withdrawal symptom questionnaire. Journal of Affective Disorders, 19, 53-61.
