The preceding review indicates that self-help materials for insomnia are efficacious in helping individuals to reduce time to fall asleep, decrease the duration and frequency of awakenings, and increase sleep quality. The magnitude of change is not as large as in-person treatment for insomnia but posttreatment improvements are sustained at follow-up assessments. Furthermore, most sleep parameters show additional improvement over time. Self-help therapy for insomnia is also associated with clinically significant changes as reflected in two important areas of sleep functioning. First, many treated participants demonstrate sleep patterns in the normal range (Currie, Clark et al., 2004; Mimeault & Morin, 1999). Second, self-help treatment can help individuals to wean off sleep medication by providing alternative coping strategies (Currie, Clark et al., 2004; Oosterhuis & Klip, 1997). These findings suggest that self-help treatment for insomnia is a potentially cost-effective and easily disseminated method for treating persons with sleep disorders.
Most researchers concede that self-help can never fully replace the benefits of face-to-face therapy. Ideally, all insomnia patients should have unrestricted access to direct mental health care. The preferred approach to treating insomnia remains individual or group interventions conducted by professionals trained in behavioral sleep medicine. Research conducted to date suggests that elderly persons and medication-reliant patients would be better served by in-person treatment of insomnia. With direct treatment, patients can be properly assessed, closely monitored, and appropriately guided in the most effective application of behavioral methods for improving sleep. For patients with limited access to professional sleep services, self-help materials can serve as a less intensive alternative for motivated, self-directed individuals. Self-help books could also provide an important bridge in the treatment continuum. Patients waiting to see a sleep specialist or deciding whether a specialist is necessary could gain valuable insight and coping strategies from a well-written book on insomnia. After CBT for insomnia, an insomnia book can serve as a valuable resource guide to help the patient maintain progress and manage relapses in the absence of professional guidance.
Although self-help approaches for insomnia show promise, there are still important gaps in our knowledge base. More studies that directly compare self-help and face-to-face therapy are needed to properly assess the strengths and weaknesses of both modalities. Furthermore, the benefits of self-help need to be assessed as these materials are intended to be used—without the luxury of an initial professional consultation and ongoing telephone support. The Internet may be the most promising means of delivering a self-guided insomnia program, given the sophistication of the technology and the increasing numbers of people who regularly use the media to access health-related information.
There has been no cost-effective comparison of self-help and direct therapy for insomnia. Self-help for insomnia is generally assumed to be more cost-effective but studies need to be conducted to determine the actual savings in health care costs in relation to therapeutic gains. Finally, dismantling studies are needed to determine how people actually use and benefit from the material in a self-help book. The effective elements of CBT for insomnia are thought to be the behavior change strategies (stimulus control and sleep restriction). However, it is not known how well readers actually follow the recommended steps considered integral to the stimulus control approach.
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