Table 3.

Summary of interventions.

Intervention	Treatment Type*	Description
STRONG RECOMMENDATION FOR USE
Cognitive behavioral therapy for insomnia (CBT-I)	Multicomponent	CBT-I combines one or more of the cognitive therapy strategies with education about sleep regulation plus stimulus control instructions and sleep restriction therapy. CBT-I also often includes sleep hygiene education, relaxation training and other counter-arousal methods. Treatment progresses using information typically gathered with sleep diaries completed by the patient throughout the course of treatment (typically 4–8 sessions).
CONDITIONAL RECOMMENDATIONS FOR USE
Brief therapies for insomnia (BTIs)	Multicomponent	BTIs include abbreviated versions of CBT-I (typically 1–4 sessions) emphasizing the behavioral components. BTIs typically consist of education about sleep regulation, factors that influence sleep, and behaviors that promote or interfere with sleep, along with a tailored behavioral prescription based on stimulus control and sleep restriction therapy and on information typically derived from a pretreatment sleep diary. Some therapies include brief relaxation or cognitive therapy elements.
Stimulus control	Single-component	A set of instructions designed to (1) extinguish the association between the bed/bedroom and wakefulness to restore the association of bed/bedroom with sleep; and (2) establish a consistent wake-time. Stimulus control instructions are: (a) go to bed only when sleepy; (b) get out of bed when unable to sleep; (c) use the bed/bedroom for sleep and sex only (no reading, watching TV, etc. in bed); (d) wake up the same time every morning; (e) refrain from daytime napping.
Sleep restriction therapy	Single-component	A method designed to enhance sleep drive and consolidate sleep by limiting time in bed equal to the patient’s sleep duration, typically estimated from daily diaries. Time in bed is initially limited to the average sleep duration, and subsequently increased or decreased based on sleep efficiency thresholds, until sufficient sleep duration and overall sleep satisfaction is achieved.
Relaxation therapy	Single-component	Structured exercises designed to reduce somatic tension (eg, abdominal breathing, progressive muscle relaxation; autogenic training) and cognitive arousal (eg, guided imagery training; meditation) that may perpetuate sleep problems.
CONDITIONAL RECOMMENDATION AGAINST USE
Sleep hygiene	Single-component	A set of general recommendations about lifestyle (eg, diet, exercise, substance use) and environmental factors (eg, light, noise, temperature) that may promote or interfere with sleep. Sleep hygiene may include some education about what constitutes “normal” sleep and changes in sleep patterns with aging.
NO RECOMMENDATIONS
Cognitive therapy	Single-component	A set of strategies including structured psychoeducation, Socratic questioning, use of thought records, and behavioral experiments designed to identify and modify unhelpful beliefs about sleep that may support sleep-disruptive habits and/or raise performance anxiety about sleeping.
Biofeedback	Single-component	A variant of relaxation training that employs a device capable of monitoring and providing ongoing feedback on some aspect of the patient’s physiology. This technique has most commonly employed continuous monitoring of frontalis electromyography (EMG) activity to assess the overall level of muscle tension. Typically, the biofeedback device produces an ongoing auditory tone to train the patient to relax by learning how to alter the auditory feedback tone in the desired direction (eg, reduced muscle tone).
Paradoxical intention	Single-component	Patients are instructed to remain awake as long as possible after getting into bed. The patient is instructed to purposefully engage in the feared activity (staying awake) in order to reduce performance anxiety and conscious intent to sleep that confound associated goal-directed behavior (falling asleep). This method alleviates both the patient’s excessive focus on sleep and anxiety over not sleeping; as a result, sleep becomes less difficult to initiate.
Intensive sleep retraining	Single-component	This newly described treatment is designed to markedly enhance homeostatic sleep drive in order to reduce both sleep onset difficulties and sleep misperception. Following a night wherein the patient limits time in bed to no more than 5 hours, the treatment includes a 24-hour laboratory protocol in which the patient is given an opportunity to fall asleep every 30 minutes in sleep-conducive conditions. If sleep occurs the patient is awakened after three minutes and remains awake until the subsequent 30-minute trial. For each sleep opportunity, the patient is given feedback as to whether or not sleep occurred.
Mindfulness therapies	Multicomponent or single-component	Mindfulness approaches are used as a form of meditation, emphasizing nonjudgmental state of heightened or complete awareness of one’s thoughts, emotions, or experiences on a moment-to-moment basis. Mindfulness therapies are typically administered in a group format. Structured exercises teach momentary awareness, self-acceptance, and muted reactivity. Home practice of mindfulness exercises is required. When applied to people with insomnia, standard mindfulness is often combined with other insomnia therapies such as stimulus control, sleep restriction therapy, and sleep hygiene (described above).

^*Multicomponent = this treatment is a combination of approaches, single-component = this treatment is delivered in isolation.