Sleep problems are a relatively common healthcare complaint, with 5% to 10% of the general population reporting insomnia causing significant distress or daytime impairment (Ohayon, 2002). Prevalence rates for older adults are higher, estimated between 15% and 35%, though it has been found to be as high as 50% in some studies (Buysse et al., 2011; Ohayon, 2002). Advancing age is a risk factor for insomnia symptoms due to normative age-related changes, as older adults have generally lighter and more fragmented sleep patterns (Buysse et al., 2005). Researchers hypothesize that increased medical problems and medication side effects are the primary reasons for these higher rates of sleep difficulties in older adults (Rybarczyk, Lund, Garroway, & Mack, 2013; Vitiello, 2006). Notably, there are minimal to no differences in prevalence rates of insomnia symptoms between healthy older and younger patients (Ohayon, 2002). One relevant issue regarding late life sleep difficulties is nocturia, or an increase in nocturnal urination. It is believed that with increasing age, the greater likelihood of nocturia is due to co-occurring decreases in anti-diuretic hormone (ADH), gradual loss of bladder capacity, lighter and more fragmented sleep, and potential medication side effects (Jennum, 2002). Although bladder volume remains consistent throughout sleep, it is common for older adults with nocturia to use incorrect post-hoc reasoning, misattributing the urination sensation as the cause for their nighttime awakening (Pressman, Figueroa, Kendrick-Mohamed, Greenspon, & Peterson, 1998). Cognitive behavioral interventions for sleep can help individuals adjust beliefs about nocturia as the reason of their sleep difficulties.
The increased likelihood of medical problems in an older population and subsequent impact on sleep has diagnostic indications as well. The majority of adults over age 60 with insomnia have “comorbid insomnia,” or insomnia that co-occurs with other psychiatric or medical conditions (Lichstein & Rybarczyk, 2010). In the past 15 years, there has been an increasing presence of older adults with comorbid insomnia included in treatment studies in the cognitive behavioral treatment for insomnia (CBT-I) literature.
Assessment of insomnia and sleep difficulty is typically based on clinical interview, however objective measurement tools are available as well. Clinical interviews typically examine history, environmental factors, degree of impairment, and sometimes corroborating information from a bed-partner interview (e.g., Duke Structured Interview for Sleep Disorders; Edinger et al., 2009). One or two-week sleep diaries are often a vital part of assessment, and there are numerous publicly available diaries online (e.g., American Academy of Sleep Medicine diary, 2010). More objective evaluation tools include actigraphy, a motion-sensitive wrist worn device, and polysomnography (PSG), or sleep study. PSG is considered the gold standard for measuring sleep disturbances; the evaluation assesses brain and eye movements, muscle activity, and heart rhythm during sleep (Buysse, Germain, & Moul, 2005).
The most well-established treatment for insomnia is cognitive-behavioral therapy for insomnia (CBT-I), with main treatment components including sleep restriction, stimulus control, cognitive therapy, and sleep hygiene (Morin et al., 2006). This evidence-based treatment is typically effective for 70% to 80% of patients and has good long-term efficacy in reducing insomnia symptoms (Edinger et al., 2001; Morin et al., 2006). CBT-I has short-term outcomes comparable to pharmacotherapy, however CBT-I maintains longer therapeutic benefits after treatment termination (Riemann & Perlis, 2009). There is also good evidence that CBT-I is as effective for older adults compared to their younger counterparts (Irwin, Cole, & Nicassio, 2006; see Rybarczyk et al., 2013 for a review). In response to the high need for more CBT-I trained clinicians to increase dissemination and accessibility of the treatment, a brief behavioral treatment for insomnia has been recently developed and shown to be an effective intervention for chronic insomnia in older adults (Buysse et al., 2011).
Written by Andrea Garroway, MS & Bruce Rybarczyk, PhD
GENERAL
Ancoli-Israel, S., & Cooke, J. R. (2005). Prevalence and comorbidity of insomnia and effect on functioning in elderly populations. Journal of the American Geriatrics Society, 53(S7), S264–S271.
Ancoli-Israel, S., & Cooke, J. R. (2005). Prevalence and comorbidity of insomnia and effect on functioning in elderly populations. Journal of the American Geriatrics Society, 53(S7), S264–S271.
Buysse, D. J., Germain, A. & Moul, D. E. (2005). Diagnosis, epidemiology, and consequences of insomnia. Primary Psychiatry, 12(8), 37-44.
Buysse, D. J., Germain, A. & Moul, D. E. (2005). Diagnosis, epidemiology, and consequences of insomnia. Primary Psychiatry, 12(8), 37-44.
Kocevska, D., Lysen, T. S., Dotinga, A., Koopman-Verhoeff, M. E., Luijk, M. P. C. M., Antypa, N., Biermasz, N. R., Blokstra, A., Brug, J., Burk, W. J., Comijs, H. C., Corpeleijn, E., Dashti, H. S., de Bruin, E. J., de Graaf, R., Derks, I. P. M., Dewald-Kaufmann, J. F., Elders, P. J. M., Gemke, R. J. B. J., Grievink, L., … Tiemeier, H. (2021). Sleep characteristics across the lifespan in 1.1 million people from the Netherlands, United Kingdom and United States: a systematic review and meta-analysis. Nature human behaviour, 5(1), 113–122. https://doi.org/10.1038/s41562-020-00965-x
Kocevska, D., Lysen, T. S., Dotinga, A., Koopman-Verhoeff, M. E., Luijk, M. P. C. M., Antypa, N., Biermasz, N. R., Blokstra, A., Brug, J., Burk, W. J., Comijs, H. C., Corpeleijn, E., Dashti, H. S., de Bruin, E. J., de Graaf, R., Derks, I. P. M., Dewald-Kaufmann, J. F., Elders, P. J. M., Gemke, R. J. B. J., Grievink, L., … Tiemeier, H. (2021). Sleep characteristics across the lifespan in 1.1 million people from the Netherlands, United Kingdom and United States: a systematic review and meta-analysis. Nature human behaviour, 5(1), 113–122. https://doi.org/10.1038/s41562-020-00965-x
Li, J., Vitiello, M. V., & Gooneratne, N. S. (2022). Sleep in Normal Aging. Sleep medicine clinics, 17(2), 161–171. https://doi.org/10.1016/j.jsmc.2022.02.007
Li, J., Vitiello, M. V., & Gooneratne, N. S. (2022). Sleep in Normal Aging. Sleep medicine clinics, 17(2), 161–171. https://doi.org/10.1016/j.jsmc.2022.02.007
Lichstein, K. L., & Rybarczyk, B. (2010). Cognitive-behavior therapy for co-morbid and late-life insomnia. In D. Bussye & M. J. Sateia (Eds.), Insomnia: Diagnosis and treatment. New York, NY: Informa Healthcare, Inc. doi: 10.3109/9781420080803.030
Lichstein, K. L., & Rybarczyk, B. (2010). Cognitive-behavior therapy for co-morbid and late-life insomnia. In D. Bussye & M. J. Sateia (Eds.), Insomnia: Diagnosis and treatment. New York, NY: Informa Healthcare, Inc. doi: 10.3109/9781420080803.030
Mander, B. A., Winer, J. R., & Walker, M. P. (2017). Sleep and Human Aging. Neuron, 94(1), 19–36. https://doi.org/10.1016/j.neuron.2017.02.004
Mander, B. A., Winer, J. R., & Walker, M. P. (2017). Sleep and Human Aging. Neuron, 94(1), 19–36. https://doi.org/10.1016/j.neuron.2017.02.004
Morin, C. M., LeBlanc, M., Daley, M., Gregoire, J. P., & Mérette, C. (2006). Epidemiology of insomnia: prevalence, self-help treatments, consultations, and determinants of help-seeking behaviors. Sleep medicine, 7(2), 123–130. https://doi.org/10.1016/j.sleep.2005.08.008
Morin, C. M., LeBlanc, M., Daley, M., Gregoire, J. P., & Mérette, C. (2006). Epidemiology of insomnia: prevalence, self-help treatments, consultations, and determinants of help-seeking behaviors. Sleep medicine, 7(2), 123–130. https://doi.org/10.1016/j.sleep.2005.08.008
Ohayon, M. M. (2002). Epidemiology of insomnia: What we know and what we still need to learn. Sleep Medicine Reviews, 6, 97–111. https://doi.org/10.1053/smrv.2002.0186
Ohayon, M. M. (2002). Epidemiology of insomnia: What we know and what we still need to learn. Sleep Medicine Reviews, 6, 97–111. https://doi.org/10.1053/smrv.2002.0186
Ohayon, M. M., Carskadon, M. A., Guilleminault, C., & Vitiello, M. V. (2004). Meta-analysis of quantitative sleep parameters from childhood to old age in healthy individuals: developing normative sleep values across the human lifespan. Sleep, 27(7), 1255–1273. https://doi.org/10.1093/sleep/27.7.1255
Ohayon, M. M., Carskadon, M. A., Guilleminault, C., & Vitiello, M. V. (2004). Meta-analysis of quantitative sleep parameters from childhood to old age in healthy individuals: developing normative sleep values across the human lifespan. Sleep, 27(7), 1255–1273. https://doi.org/10.1093/sleep/27.7.1255
Ravyts, S. G., & Dzierzewski, J. M. (2022). Sleep and Healthy Aging: A Systematic Review and Path Forward. Clinical gerontologist, 1–13. Advance online publication. https://doi.org/10.1080/07317115.2022.2064789
Ravyts, S. G., & Dzierzewski, J. M. (2022). Sleep and Healthy Aging: A Systematic Review and Path Forward. Clinical gerontologist, 1–13. Advance online publication. https://doi.org/10.1080/07317115.2022.2064789
Rybarczyk, Lund, Garroway, & Mack (2013). Cognitive behavioral therapy for insomnia in older adults: Background, evidence, and overview of treatment protocol. Clinical Gerontologist, 36, 70-93. doi: 10.1080/07317115.2012.731478
Rybarczyk, Lund, Garroway, & Mack (2013). Cognitive behavioral therapy for insomnia in older adults: Background, evidence, and overview of treatment protocol. Clinical Gerontologist, 36, 70-93. doi: 10.1080/07317115.2012.731478
Rybarczyk, Lund, Garroway, & Mack (2013). Cognitive behavioral therapy for insomnia in older adults: Background, evidence, and overview of treatment protocol. Clinical Gerontologist, 36, 70-93. doi: 10.1080/07317115.2012.731478
Rybarczyk, Lund, Garroway, & Mack (2013). Cognitive behavioral therapy for insomnia in older adults: Background, evidence, and overview of treatment protocol. Clinical Gerontologist, 36, 70-93. doi: 10.1080/07317115.2012.731478
Vaughan, C. P., & Bliwise, D. L. (2018). Sleep and Nocturia in Older Adults. Sleep medicine clinics, 13(1), 107–116. https://doi.org/10.1016/j.jsmc.2017.09.010
Vaughan, C. P., & Bliwise, D. L. (2018). Sleep and Nocturia in Older Adults. Sleep medicine clinics, 13(1), 107–116. https://doi.org/10.1016/j.jsmc.2017.09.010
Bastien, C. H., Vallières, A., & Morin, C. M. (2001). Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Medicine, 2(4), 297-307.
Bastien, C. H., Vallières, A., & Morin, C. M. (2001). Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Medicine, 2(4), 297-307.
Boyle, J. T., Rosenfield, B., Di Tomasso, R. A., Moye, J., Bamonti, P. M., Grandner, M., Vargas, I., & Perlis, M. (2023). Sleep Continuity, Sleep Related Daytime Dysfunction, and Problem Endorsement: Do These Vary Concordantly by Age?. Behavioral sleep medicine, 21(4), 436–447. https://doi.org/10.1080/15402002.2022.2124994
Boyle, J. T., Rosenfield, B., Di Tomasso, R. A., Moye, J., Bamonti, P. M., Grandner, M., Vargas, I., & Perlis, M. (2023). Sleep Continuity, Sleep Related Daytime Dysfunction, and Problem Endorsement: Do These Vary Concordantly by Age?. Behavioral sleep medicine, 21(4), 436–447. https://doi.org/10.1080/15402002.2022.2124994
Brouwer, W. B., van Exel, N. J., & Stolk, E. A. (2005). Acceptability of less than perfect health states. Social science & medicine (1982), 60(2), 237–246. https://doi.org/10.1016/j.socscimed.2004.04.032
Brouwer, W. B., van Exel, N. J., & Stolk, E. A. (2005). Acceptability of less than perfect health states. Social science & medicine (1982), 60(2), 237–246. https://doi.org/10.1016/j.socscimed.2004.04.032
Buysse, D. J., Reynolds, C. F., 3rd, Monk, T. H., Berman, S. R., & Kupfer, D. J. (1989). The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry research, 28(2), 193–213. https://doi.org/10.1016/0165-1781(89)90047-4
Buysse, D. J., Reynolds, C. F., 3rd, Monk, T. H., Berman, S. R., & Kupfer, D. J. (1989). The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry research, 28(2), 193–213. https://doi.org/10.1016/0165-1781(89)90047-4
Carney, C. E., Buysse, D. J., Ancoli-Israel, S., Edinger, J. D., Krystal, A. D., Lichstein, K. L., & Morin, C. M. (2012). The consensus sleep diary: standardizing prospective sleep self-monitoring. Sleep, 35(2), 287–302. https://doi.org/10.5665/sleep.1642
Carney, C. E., Buysse, D. J., Ancoli-Israel, S., Edinger, J. D., Krystal, A. D., Lichstein, K. L., & Morin, C. M. (2012). The consensus sleep diary: standardizing prospective sleep self-monitoring. Sleep, 35(2), 287–302. https://doi.org/10.5665/sleep.1642
Chung, F., Yegneswaran, B., Liao, P., Chung, S. A., Vairavanathan, S., Islam, S., . . . Shapiro, C. M. (2008). STOP questionnaire: A tool to screen patients for obstructive sleep apnea. Anesthesiology, 108, 812–821.
Chung, F., Yegneswaran, B., Liao, P., Chung, S. A., Vairavanathan, S., Islam, S., . . . Shapiro, C. M. (2008). STOP questionnaire: A tool to screen patients for obstructive sleep apnea. Anesthesiology, 108, 812–821.
Edinger, J. D., Wyatt, J. K., Olsen, M. K., Stechuchak, K. M., Carney, C. E., Chiang, A., … Knauss, F. (2009) Reliability and validity of insomnia diagnoses derived from the Duke Structured Interview for Sleep Disorders. Sleep, 32(A265).
Edinger, J. D., Wyatt, J. K., Olsen, M. K., Stechuchak, K. M., Carney, C. E., Chiang, A., … Knauss, F. (2009) Reliability and validity of insomnia diagnoses derived from the Duke Structured Interview for Sleep Disorders. Sleep, 32(A265).
Grandner, M. A., & Malhotra, A. (2015). Sleep as a vital sign: why medical practitioners need to routinely ask their patients about sleep. Sleep health, 1(1), 11–12. https://doi.org/10.1016/j.sleh.2014.12.011
Grandner, M. A., & Malhotra, A. (2015). Sleep as a vital sign: why medical practitioners need to routinely ask their patients about sleep. Sleep health, 1(1), 11–12. https://doi.org/10.1016/j.sleh.2014.12.011
Kapur, V. K., Auckley, D. H., Chowdhuri, S., Kuhlmann, D. C., Mehra, R., Ramar, K., & Harrod, C. G. (2017). Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline. Journal of clinical sleep medicine: JCSM : official publication of the American Academy of Sleep Medicine, 13(3), 479–504. https://doi.org/10.5664/jcsm.6506
Kapur, V. K., Auckley, D. H., Chowdhuri, S., Kuhlmann, D. C., Mehra, R., Ramar, K., & Harrod, C. G. (2017). Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline. Journal of clinical sleep medicine: JCSM : official publication of the American Academy of Sleep Medicine, 13(3), 479–504. https://doi.org/10.5664/jcsm.6506
Klingman, K. J., Jungquist, C. R., & Perlis, M. L. (2017). Introducing the sleep disorders symptom checklist-25: A primary care friendly and comprehensive screener for sleep disorders. Sleep Medicine Research, 8(1), 17-25.
Klingman, K. J., Jungquist, C. R., & Perlis, M. L. (2017). Introducing the sleep disorders symptom checklist-25: A primary care friendly and comprehensive screener for sleep disorders. Sleep Medicine Research, 8(1), 17-25.
Morin, C. M. (1993). Insomnia: Psychological assessment and management. Guilford press.
Morin, C. M. (1993). Insomnia: Psychological assessment and management. Guilford press.
Pandi-Perumal, S. R., Spence, D. W., & BaHammam, A. S. (2014). Polysomnography: an overview. Primary Care Sleep Medicine: A Practical Guide, 29-42.
Pandi-Perumal, S. R., Spence, D. W., & BaHammam, A. S. (2014). Polysomnography: an overview. Primary Care Sleep Medicine: A Practical Guide, 29-42.
Smith, M. T., McCrae, C. S., Cheung, J., Martin, J. L., Harrod, C. G., Heald, J. L., & Carden, K. A. (2018). Use of Actigraphy for the Evaluation of Sleep Disorders and Circadian Rhythm Sleep-Wake Disorders: An American Academy of Sleep Medicine Clinical Practice Guideline. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 14(7), 1231–1237. https://doi.org/10.5664/jcsm.7230
Smith, M. T., McCrae, C. S., Cheung, J., Martin, J. L., Harrod, C. G., Heald, J. L., & Carden, K. A. (2018). Use of Actigraphy for the Evaluation of Sleep Disorders and Circadian Rhythm Sleep-Wake Disorders: An American Academy of Sleep Medicine Clinical Practice Guideline. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 14(7), 1231–1237. https://doi.org/10.5664/jcsm.7230
MEASURES and TOOLS
- STOP Questionnaire—screening tool for patients with obstructive sleep apnea
- Epworth Sleepiness Scale (ESS)—measures excessive daytime sleepiness
- Pittsburg Sleep Quality Index—measures quality and patterns of sleep in older adults
- American Association of Sleep Medicine sleep diary
- Consensus Sleep Diary
- Insomnia Severity Index
- Sleep Disorders Symptoms Checklist
TREATMENT OF SLEEP ISSUES IN LATER LIFE
Buysse, D. J., Germain, A., Moul, D. E., Franzen, P. L., Brar, L. K., Fletcher, M.E., . . . Monk, T.H. (2011). Efficacy of brief behavioral treatment for chronic insomnia in older adults. Archives of Internal Medicine, 171, 887–895. doi: 10.1001/archinternmed.2010.535
Buysse, D. J., Germain, A., Moul, D. E., Franzen, P. L., Brar, L. K., Fletcher, M.E., . . . Monk, T.H. (2011). Efficacy of brief behavioral treatment for chronic insomnia in older adults. Archives of Internal Medicine, 171, 887–895. doi: 10.1001/archinternmed.2010.535
Edinger, J. D., Wohlgemuth, W. K., Radtke, R. A., Marsh, G. R., & Quillian, R. E. (2001). Cognitive behavioral therapy for treatment of chronic primary insomnia. JAMA: The Journal of the American Medical Association, 285(14), 1856-1864. doi: 10.1001/jama.285.14.1856
Edinger, J. D., Wohlgemuth, W. K., Radtke, R. A., Marsh, G. R., & Quillian, R. E. (2001). Cognitive behavioral therapy for treatment of chronic primary insomnia. JAMA: The Journal of the American Medical Association, 285(14), 1856-1864. doi: 10.1001/jama.285.14.1856
Harvey, A. G., Sharpley, A. L., Ree, M. J., Stinson, K., & Clark, D. M. (2007). An open trial of cognitive therapy for chronic insomnia. Behaviour research and therapy, 45(10), 2491–2501. https://doi.org/10.1016/j.brat.2007.04.007
Harvey, A. G., Sharpley, A. L., Ree, M. J., Stinson, K., & Clark, D. M. (2007). An open trial of cognitive therapy for chronic insomnia. Behaviour research and therapy, 45(10), 2491–2501. https://doi.org/10.1016/j.brat.2007.04.007
Hinrichsen, G. A., & Leipzig, R. M. (2022). Implementation and Effectiveness of Cognitive Behavioral Therapy for Insomnia in Geriatric Primary Care. Clinical gerontologist, 1–8. Advance online publication. https://doi.org/10.1080/07317115.2022.2104675
Hinrichsen, G. A., & Leipzig, R. M. (2022). Implementation and Effectiveness of Cognitive Behavioral Therapy for Insomnia in Geriatric Primary Care. Clinical gerontologist, 1–8. Advance online publication. https://doi.org/10.1080/07317115.2022.2104675
Hughes, J. M., & Martin, J. L. (2022). CBT-I for older adults. In Adapting Cognitive Behavioral Therapy for Insomnia (pp. 347-366). Academic Press.
Hughes, J. M., & Martin, J. L. (2022). CBT-I for older adults. In Adapting Cognitive Behavioral Therapy for Insomnia (pp. 347-366). Academic Press.
Irwin, M. R., Cole, J. C., & Nicassio, P. M. (2006). Comparative meta-analysis of behavioral interventions for insomnia and their efficacy in middle-aged adults and in older adults 55+ years of age. Health Psychology, 25, 3–14. doi: 10.1037/0278-6133.25.1.3
Irwin, M. R., Cole, J. C., & Nicassio, P. M. (2006). Comparative meta-analysis of behavioral interventions for insomnia and their efficacy in middle-aged adults and in older adults 55+ years of age. Health Psychology, 25, 3–14. doi: 10.1037/0278-6133.25.1.3
Johann, A. F., & Hertenstein, E. (2022). Acceptance and Commitment Therapy (ACT) for Insomnia: Theoretical Issues and Principles and Interventional Strategies and Instruments. Cognitive‐Behavioural Therapy For Insomnia (CBT‐I) Across The Life Span: Guidelines and Clinical Protocols for Health Professionals, 200-206.
Johann, A. F., & Hertenstein, E. (2022). Acceptance and Commitment Therapy (ACT) for Insomnia: Theoretical Issues and Principles and Interventional Strategies and Instruments. Cognitive‐Behavioural Therapy For Insomnia (CBT‐I) Across The Life Span: Guidelines and Clinical Protocols for Health Professionals, 200-206.
Lichstein, K. L., & Rybarczyk, B. (2010). Cognitive-behavior therapy for co-morbid and late-life insomnia. In D. Bussye & M. J. Sateia (Eds.), Insomnia: Diagnosis and treatment. New York, NY: Informa Healthcare, Inc. doi: 10.3109/9781420080803.030
Lichstein, K. L., & Rybarczyk, B. (2010). Cognitive-behavior therapy for co-morbid and late-life insomnia. In D. Bussye & M. J. Sateia (Eds.), Insomnia: Diagnosis and treatment. New York, NY: Informa Healthcare, Inc. doi: 10.3109/9781420080803.030
Morin, C. M., & Espie, C. A. (2003). Insomnia: A clinical guide to assessment and treatment. New York: Kluwer Academic/Plenum Publishers.
Morin, C. M., & Espie, C. A. (2003). Insomnia: A clinical guide to assessment and treatment. New York: Kluwer Academic/Plenum Publishers.
Muench, A., Vargas, I., Grandner, M. A., Ellis, J. G., Posner, D., Bastien, C. H., Drummond, S. P., & Perlis, M. L. (2022). We know CBT-I works, now what?. Faculty reviews, 11, 4. https://doi.org/10.12703/r/11-4
Muench, A., Vargas, I., Grandner, M. A., Ellis, J. G., Posner, D., Bastien, C. H., Drummond, S. P., & Perlis, M. L. (2022). We know CBT-I works, now what?. Faculty reviews, 11, 4. https://doi.org/10.12703/r/11-4
Ong, J. C., & Smith, C. E. (2017). Using Mindfulness for the Treatment of Insomnia. Current sleep medicine reports, 3(2), 57–65. https://doi.org/10.1007/s40675-017-0068-1
Ong, J. C., & Smith, C. E. (2017). Using Mindfulness for the Treatment of Insomnia. Current sleep medicine reports, 3(2), 57–65. https://doi.org/10.1007/s40675-017-0068-1
Perlis, M. L., Jungquist, C., Smith, M. T., & Posner, D. (2005). Cognitive behavioral treatment of insomnia: A session-by-session guide (Vol. 1). Springer Science & Business Media.
Perlis, M. L., Jungquist, C., Smith, M. T., & Posner, D. (2005). Cognitive behavioral treatment of insomnia: A session-by-session guide (Vol. 1). Springer Science & Business Media.
Qaseem, A., Kansagara, D., Forciea, M. A., Cooke, M., Denberg, T. D., & Clinical Guidelines Committee of the American College of Physicians (2016). Management of Chronic Insomnia Disorder in Adults: A Clinical Practice Guideline From the American College of Physicians. Annals of internal medicine, 165(2), 125–133. https://doi.org/10.7326/M15-2175
Qaseem, A., Kansagara, D., Forciea, M. A., Cooke, M., Denberg, T. D., & Clinical Guidelines Committee of the American College of Physicians (2016). Management of Chronic Insomnia Disorder in Adults: A Clinical Practice Guideline From the American College of Physicians. Annals of internal medicine, 165(2), 125–133. https://doi.org/10.7326/M15-2175
Riemann, D., & Perlis, M. L. (2009). The treatments of chronic insomnia: A review of benzodiazepine receptor agonists and psychological and behavioral therapies. Sleep Medicine Reviews, 13, 205–214. doi: 10.1016/j.smrv.2008.06.001
Riemann, D., & Perlis, M. L. (2009). The treatments of chronic insomnia: A review of benzodiazepine receptor agonists and psychological and behavioral therapies. Sleep Medicine Reviews, 13, 205–214. doi: 10.1016/j.smrv.2008.06.001