Cognitive Therapy for Insomnia. In: Sateia MJ, Buysse DJ, editors. Insomnia. Informa Healthcare; 2010. pp. 299-309. [DOI: 10.3109/9781420080803.027]

Pre-sleep imagery under the microscope: a comparison of patients with insomnia and good sleepers

During the pre-sleep period and in the natural home environment patients with insomnia (N=20) and good sleepers (N=20) were asked to record when an image came to mind by pressing a handheld counter. They then provided an oral description of the image and indicated whether the image was 'pleasant', 'unpleasant', or 'neutral' (responses captured via a voice-activated tape recorder). Subjective and objective (actigraphy) estimates of sleep-onset latency (SOL) were recorded. On both the handheld counter and the audiotape recording, participants with insomnia reported fewer images than the good sleepers. The insomnia group had a higher percentage of unpleasant images compared to good sleepers. For the insomnia group, but not the good sleeper group, there was a positive correlation between unpleasant images and subjective SOL. The insomnia group experienced more images regarding 'intimate relationships' and 'sleep' and fewer regarding 'random/non-connected topics' compared to the good sleeper group. The results are discussed with reference to proposals made by Borkovec, Ray and Stöber (Cognitive Ther. Res., 22, (1998) 561) in the context of generalised anxiety disorder (GAD).

Trouble in Bed: The Role of Pre-Sleep Worry and Intrusions in the Maintenance of Insomnia

Insomnia chronically affects 1 in 9 individuals. It causes sufferers severe distress as well as social, interpersonal, and occupational impairment. One of the most replicated findings in the insomnia literature is that people who suffer from insomnia attribute their sleep disturbance to unwanted and excessive intrusive thoughts and worries whilst trying to get to sleep. This article aims to provide an overview of published studies relating to unwanted worry and intrusions in insomnia and to establish the extent to which unwanted worry and intrusions, and the management of them, contribute to the maintenance of insomnia. It is argued that a key mechanism underpinning excessive negatively toned cognitive activity is the strategy by which the unwanted thoughts are managed. Preliminary research is presented in support of this proposal and the clinical implications of it are discussed. It is concluded that investigations of the mechanisms underpinning excessive and unwanted pre-sleep intrusions and worry are in their infancy, but that it is a promising area for future research.