Compared with the control group ...

Compared with the control group, patients with insomnia exhibit elevated total cerebral glucose metabolism on positron emission tomography in the waking or sleeping, increased beta activity and decreased theta and delta - activity on EEG during sleep, an increased level of metabolism during the day and higher levels of secretion of adrenocorticotropic hormone and cortisol. Insomnia secondary to other causes is more common than primary, it should be excluded or treated before the diagnosis of primary insomnia. While maintaining the insomnia, despite the treatment of secondary causes should begin therapy of primary insomnia. One individual patient can be observed several reasons for this violation. Violations of the circadian rhythm such as sleep disorders due to working shifts and sleep phase delay syndrome [delayed sleep phase syndrome] (lag period of sleep more than 2 hours in relation to the normal time), as well as insufficient sleep syndrome is voluntary, should be considered in the differential diagnosis, but they are not considered forms of insomnia. STRATEGIES AND EVIDENCE Methods behavioral therapy behavioral therapy methods (see table) include a group of techniques that focus on factors that contribute to chronic insomnia, regardless of the cause. Stimulus control therapy suggests that insomnia is an inadequate response to factors such as bedtime and bedroom furnishings (such as regular reading or watching television in bed instead of sleeping) and requires the patient to re-learn to associate bed with sleep. Therapy by sleep restriction comes from the fact that people suffering from insomnia, can learn to increase during sleep due to his suspension, voluntarily reducing the time spent in bed. Relaxation techniques are based on the hypothesis that insomnia is associated with gipervozbuzhdeniem. Mental component of such methods involves education about sleep needs, the correction of unrealistic expectations of the patient and discussion of his anxiety and an exaggerated perception of the consequences of poor sleep. Sleep hygiene education is aimed at external factors that may contribute to perpetuate the insomnia, such as noise in the bedroom, or caffeine. Table. Types of behavioral therapy therapy monitoring incentives Go to bed only when sleepy feel. Use the bedroom only for sleep and sex. If you are unable to fall asleep within 15-20 minutes, go into another room, read or enjoy other quiet activities, go to sleep, only feeling drowsy, repeat if necessary. Set a regular wake time regardless of the duration of sleep. Avoid daytime sleep. Sleep restriction therapy Snizhaytevremya stay in bed until the estimated total sleep time (at least 5 hours). Increase the weekly time prebyvanyai in bed for 15 minutes. When the alleged sleep efficiency (ratio of sleep time to time spent in bed) is at least 90 minutes.