Summary:
Background Insomnia is conceived as the subjective complaint of reduced sleep
quantity and/or quality. Ιn order for the diagnosis to be made, this complaint
must be present quite frequently (at least three times per week) for a
considerable period of time (at least for one month). Psychophysiological
factors such as stress are often presumed to play a major role in the onset and
maintenance of primary insomnia. The treatment should not only focus on
ameliorating sleeplessness, it should also address all those factors that cause
and maintain insomnia, turning it to a chronic condition. Non-pharmacological
treatments, such as stress management techniques can be easily and
inexpensively administered in treatment with good results. The aim of this
study is to identify the effectiveness of stress management techniques as a
treatment in primary insomnia.
Methods This is a two-armed parallel group, randomized controlled trial.
Primary insomniacs were randomly assigned to undergo either an 8-week CD-based
stress management program (n=27) (relaxation breathing, progressive muscle
relaxation and guided imagery twice a day) or a control condition (n=26) both
of the groups took information about insomnia and they participate once in a
week in consultative meetings for the treatment of insomnia). Self-reported
validated measures were used to evaluate insomnia, quality of sleep and
symptoms of depression and anxiety at baseline, at the 4th week and at the end
of 8 weeks. Also, we measured perceived stress and “health locus of control”
(through scale which is appropriate to identify what it is responsible for the
heath problems of an individual) at baseline and at the end of the 8 weeks.
Also, free cortisol, as a biological marker of stress, was measured in saliva
samples taken three times a day at baseline, at the 4th week and at the end of
8 weeks. Finally, we measured the satisfaction with the stress management
program and the compliance with the therapeutic instructions.
Results At the end of 8 weeks of the relaxation program, in the intervention
group, we noticed decrease in insomnia and improvement on sleep quality. Also,
in this group, we found improvements on perceived stress and salivary cortisol,
biological marker of stress. As far as symptoms of depression and anxiety are
concerned, there was significant decrease at the end of the relaxation program.
Finally, there was no change in health locus of control after the practice of
stress management techniques.
Conclusion The training of patients with primary insomnia in relaxation
techniques contributes to decrease in stress and the symptoms of primary
insomnia. Simple techniques such as diaphragmatic breathing, progressive muscle
relaxation and guided imagery which are easily applicable, may be regarded as
effective and low cost non-pharmacological treatment of insomnia.
Keywords:
primary insomnia, stress, anxiety, relaxation, relaxation techniques
