REPUBLIQUE ALGERIENNE DEMOCRATIQUE ET POPULAIRE

MINISTRE DEL L’ENSEIGNEMENT SUPERIEUR

ET DE LA RECHERCHE SCIENTIFIQUE

UNIVERSITE DJILLALI LIABES

FACULTE DES LETTRES, DES LANGUES ET DES ARTS
DEPARTEMENT DE LANGUE ANGLAISE

RESEARCH ABOUT
INSOMNIA
I Causes, Symptoms and Solution I

Presented by
Kerma Mohammed Moncef G3

Under the supervision of

Ms.Abdli
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2019 - 2020
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1.Abstract:

Insomnia is a mental disorder that has been increasing during this last
decade especially among the young generation, this research attempts to
identify and explain the nature of the Insomnia in addition to its symptoms and
causes and the consequences of chronic insomnia on both the body and the
mind and last but not least find a solution or set for solutions that aid in the fight
against insomnia and help finding a solution that fits most patients and grant a
greater chance for them to recover and heal. The methods used to deal with
insomnia in this research include the behaviourist and cognitive approach of
Bloomfield in addition to stimulus treatment and mindfulness treatment that
target mainly the pattern of negative behaviours that ultimately cause the
insomnia to proliferate, the result of using these type of treatments translate
directly in the recovery of several chronic patients in addition for them to gain
better and more restorative sleep pattern that aid in gaining better mental health
which shield the patients from getting other mental issues specially depression
that add to the severity of the situation.
The research is concluded by proclaiming that the attempted methods have
scientifically proven that the chronic disorder known as insomnia can be fixed
even for the helpless cases and that’s by conditioning the behaviour of patients
and their mental state hence granting them better chance for more effective
sleep that eventually cause the symptoms of insomnia to fade and consequently
healing them.

2.Introduction:
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The term insomnia is used in a variety of ways in the medical literature and
popular press. Most often, insomnia is defined by the presence of an individual's
report of difficulty with sleep. For example, in survey studies, insomnia is
defined by a positive response to either question, “Do you experience difficulty
sleeping?” or “Do you have difficulty falling or staying asleep?” In the sleep
literature, insomnia is sometimes used as a term to describe the presence of
polysomnographic evidence of disturbed sleep. Thus, the presence of a long
sleep latency, frequent nocturnal awakenings, or prolonged periods of
wakefulness during the sleep period or even frequent transient arousals are
taken as evidence of insomnia. Thus, insomnia has been thought of both as a
symptom and as a sign. However, for the purpose of this paper, the term
insomnia will be used as a disorder with the following diagnostic criteria: (1)
difficulty falling asleep, staying asleep or nonrestorative sleep; (2) this difficulty
is present despite adequate opportunity and circumstance to sleep; (3) this
impairment in sleep is associated with daytime impairment or distress; and (4)
this sleep difficulty occurs at least 3 times per week and has been a problem for
at least 1 month.
During the recent years, the increased numbers of population that suffer from
the symptoms of insomnia gravely increased in particular among the younger
population (from 18 to 25) which effect the physical and mental health of the
patients and overall lower their productivity in their everyday life. This pressing
issue became a real danger and serious threat which pose a question that need to
be answered: How to deal with Insomnia?
Unlike some common illnesses like psychosis or sleep paralysis, insomnia is
considered a disorder; a disorder is a condition associated with negative
consequences, and importantly, these consequences are not a normal result of
the condition but rather the result of some sort of pathological response in other
words, it is a result of a pattern of bad habits, these habits can be isolated and
tackled individually to break this chain of events and ultimately heal insomnia,
the methods used to achieve this results can only be done with the assistance of
behaviourism and stimulus treatment that is entirely based on Bloomfield
psychological studies, through conditioning patients behaviour by gradually
adjusting some variables the insomniac patients can be theoretically treated and
consequently restore their natural restorative sleep habits.

3.Literature review:
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Insomnia and sleep prevention issues have been widely associated with
somniphobia which means the irrational fear of sleep, bed , bedrooms and
anything that resemble the process of going to sleep, The relation between
Insomnia and somniphobia is well-established; a meta-analysis by Simon Parkin
(2008) concluded that avoiding bedrooms as much as possible by the insomniac
patients and going there only when they are completely exhausted helped them
getting better and more stable sleep process. However, in this research other
mental and physical factors have been neglected that are critical to the condition
and mental state of patients. In the light of these factors, researchers have
become increasingly interested in the effects of these external variables. Perloff
(2014) theorizes that the practicing sport or napping or taking long rides may
influence its impact on patient’s mental state, he also mentioned that addiction
to smokes or caffein or energy drinks or any type of artificial stimulates can
cause and increase the symptoms of insomnia. Several empirical studies have
focused on mental and psychological causes of insomnia in adolescent teenagers
(UCLA Health, 2014) and in young adults (MayoClinic, 2016; Sleepfoundation
2020; Cohen, Newton-John & Slater, 2017), while a systematic review by
Symon Parkin (2018) confirmed a relationship between poor mental condition
and overall bad state of brain and the appearance of insomnia.
Across these studies, there is consistent evidence that insomnia is indeed
linked with fear (somniphobia), mental and physical condition of the patients
and the overall all state of the body. Nonetheless, there is a lack of robust
research on more practical solutions that benefits from the direct predictable
scientific based psychology like behaviourism and stimulus treatment and
exploiting the ability to reverse engineer the symptoms of insomnia which is by
far the fastest and safest method that can be used on almost all patients.

4.Body:
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Prevalence of insomnia:

In order for better understanding of this phenomena, it is highly required to

calculate the estimates of the prevalence of insomnia which depends on the
criteria used to define insomnia and more importantly the population studied. A
general consensus has developed from population-based studies that
approximately 30% of a variety of adult samples drawn from different countries
report one or more of the symptoms of insomnia: difficulty initiating sleep,
difficulty maintaining sleep, waking up too early, and in some cases,
nonrestorative or poor quality of sleep. Conclusions from the NIH State-of-the-
Science Conference held in June 2005 indicate that the addition of a diagnostic
requirement that includes perceived daytime impairment or distress as a
function of the insomnia symptoms results in approximately 10% prevalence of
insomnia. Finally, the application of more stringent diagnostic criteria, such as
the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition
(DSM-IV), which includes the additional requirements that insomnia symptoms
persist for at least 1 month and do not exclusively occur in the presence of
another sleep disorder, mental disorder, or the direct physiological effects of a
substance or medical condition, yields current prevalence estimates of
approximately 6%. Several well-identified risk factors for insomnia were
reported by the State-of-the-Science Conference in June 2005. Age and gender
are the most clearly identified demographic risk factors, with an increased
prevalence in women and older adults. While the cause of this increased risk in
the elderly is not well defined, it may be due to the partial decline in
functionality of sleep control systems that may contribute to insomnia in this
older population. Importantly, the presence of comorbid medical conditions is
also a significant contributor to the increased prevalence of insomnia in the
elderly. Additionally, in women, insomnia is more prevalent with both the onset
of menses and menopause. Comorbid medical disorders, psychiatric
disorders, and working night or rotating shifts all represent significant risks for
insomnia. It is important to recognize that these factors do not independently
cause insomnia, but rather they are precipitants of insomnia in individuals
predisposed to this disorder. In fact, chronic illnesses are a significant risk for
insomnia. It is estimated that the majority of people with insomnia
(approximately 75%–90%) have an increased risk for comorbid medical
disorders, such as conditions causing hypoxemia and dyspnoea,
gastroesophageal reflux disease, pain conditions, and neurodegenerative
diseases. Importantly, a variety of primary sleep disorders as well as circadian
rhythm disorders are frequently comorbid with and often lead to insomnia.
Among the primary sleep disorders, restless legs syndrome (RLS), periodic limb
movement disorders (PLMD), and sleep-related breathing disorders (snoring,
dyspnoea, sleep apnoea) often present with an insomnia symptom. 
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This is especially true among the elderly. Among younger individuals, difficulty
falling asleep is often associated with a phase delay syndrome. However, in the
elderly, phase advance syndrome results in reports of difficulty initiating sleep,
maintaining sleep, and experiencing early morning awakenings. The most
common comorbidities associated with insomnia are psychiatric disorders. It is
estimated that 40% of all insomnia patients have a coexisting psychiatric
condition. Among these psychiatric disorders, depression is the most common,
and insomnia is a diagnostic symptom for depressive and anxiety disorders.

Effects of insomnia:

Due to its chronicity, insomnia is associated with substantial impairments in

an individual's quality of life. In several studies, insomniacs reported decreased
quality of life on virtually all dimensions of the 36-item Short Form Health
Survey of the Medical Outcomes Study (SF-36), which assesses 8 domains: (1)
physical functioning; (2) role limitation due to physical health problems (role
physical); (3) bodily pain; (4) general health perceptions; (5) vitality; (6) social
functioning; (7) role limitations due to emotional health problems (role
emotional); and (8) mental health. One study compared SF-36 results in groups
of mild and severe insomnia patients with groups of patients diagnosed with
depression or congestive heart failure (CHF). Severe insomnia patients had
numerically greater loss of function than patients with CHF in reported pain,
emotional effects, and mental health effects. Additionally, insomnia patients
also reported more physical problems than patients with depression.
Research has shown that among the daytime consequences of insomnia, the
increased occurrence of accidents poses the greatest health risk. Insomniacs are
2.5 to 4.5 times more likely than controls to have an accident. In a sample of
8,625 community respondents in France, Léger et al. reported that 8% of
insomniacs and 1% of non-insomniacs had an industrial accident in the past 12
months. Work productivity is also compromised among insomniacs due to
work-related problems (ie, higher rates of absenteeism, decreased concentration,
and difficulty performing duties). Kuppermann and colleagues found that
individuals reporting a current sleep problem were more likely than good
sleepers to have decreased job performance and to have been absent from work
in the last month due to health problems. Simon and VonKorff evaluated
insomnia in a staff-model health maintenance organization population
(N=1,962). After adjusting for age, gender, and chronic disease, days of
restricted activity due to illness and days spent in bed were about twice as
common among insomniacs compared with non-insomniacs. Additionally,
mean total health care expenditures were 60% higher in the insomnia group
relative to the controls.
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Population- and clinic-based studies have demonstrated a high rate of

psychiatric comorbidities in patients with chronic insomnia. In fact, insomnia is
more frequently associated with psychiatric disorders than any other medical
illness. For example, in the Epidemiologic Catchment Area study, 40% of
insomniacs had a comorbid psychiatric disorder compared with 16.4% of those
with no sleep complaints. Additionally, depression and anxiety are the most
common comorbid psychiatric disorders in insomniacs. It has traditionally been
assumed that insomnia is secondary to the psychiatric disorder; however, given
the chronicity of insomnia, it is possible that in some, if not most, cases the
insomnia precedes the psychiatric disorder. In fact, it is possible that insomnia
represents a significant risk for the development of a subsequent psychiatric
disorder. In a large-scale European population-based study (N=14,915), it was
found that insomnia more often preceded rather than followed incident cases of
a mood disorder. This effect is even more pronounced for relapses of the mood
disorder, where in 56.2% of cases, insomnia symptoms preceded symptoms of a
mood disorder relapse. In contrast, in chronic insomnia patients with a
comorbid anxiety disorder, the first occurrence of anxiety or a relapse preceded
insomnia in most instances.
To further understand the relation of sleep and psychiatric disorders, several
longitudinal studies have examined the evolution of psychiatric disorders
among insomnia patients. These studies used follow-up periods ranging from 1
to 40 years, with the majority using a 1- to 3-year follow-up period. In all of
these studies, insomnia has been found to confer a substantial risk for the
development of a depressive disorder. Typically, the relative risk was
approximately 5 (range 2–40), and in all cases it was statistically significant.
While some studies also reported an increased risk for anxiety or drug abuse,
neither of these was consistently found. Finally, longitudinal studies in subjects
with affective disorders show that depressed patients who experience
improvements in sleep will also experience a more rapid antidepressant
response; while those patients whose insomnia persists will have a short time to
relapse. What is clearly needed are clinical trials to assess the impact of
insomnia therapy on incidence of depression as well as the time to relapse in
depressed patients who are in remission.
The question then arises as to whether insomnia causes depression, vice versa,
or both. The close association of insomnia with depression is likely related to
common underlying pathophysiological mechanisms for sleep and mood
regulation that make the individual vulnerable to both conditions. Data have
shown that both the diagnosis of insomnia and the severity of the sleep
disturbance are related to overactivation of the hypothalamic-pituitary-adrenal
(HPA) axis and the hypersecretion of cortisol. Recent evidence suggests that
there may be some neuroendocrine and clinical similarities between insomnia
and depression. Corticotropin-releasing factor (CRF) dysregulation has been
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implicated in the pathogenesis of psychiatric disorders such as depression as

well as in the mediation of hyperarousal seen in primary insomnia. This
abnormality might represent the common risk factor, and therefore, it is quite
possible that both disorders would respond to the same therapeutic intervention
(eg, corticotropinreleasing hormone antagonists)

Experimenting insomnia:

In order validate the proclaimed consequences of chronic insomnia above I

(the researcher) conducted the Russian sleep experiment which was invented
during the Soviet-Era as an attempt to improve the Russian soldiers resilience
toward sleep prevention hence granting them strategic advantages during war
since the required time for their bodies to rest would theoretically be
significantly less than normal, however unlike the original experiment that
forced the test subjects to remain awake for eleven days with no rest which
resulted in permanent brain damage for most of the subject, my attempted
experiment require only 72 hours (three days) of no sleep that would cause for
me to experience the symptoms of chronic insomnia, during this period of sleep
prevention I attempted several cognitive and reaction and attention span tests at
different times to measure the difference in brain function between normal and
insomniac and the results was recorded and translated into graphs which will be
displayed and analysed bellow.
Day1:

In the first day (24 hours) of experiment nothing of significance require

mentioning except slight physical and mental exhaustion by the end of the 24
hours, in the reaction test I scored 0.3 second which is slower by 0.05 then the
typical human reaction speed 0.25 second, my cognitive ability remained intact
since I was able to recognize people and understand what they’re talking and
my attention span was 10 seconds which is 2 seconds longer then natural span
of 8 seconds.
Day2:

In the second day (48 hours) of experiment the mild symptoms of exhaustion
became stronger and I experienced an overall sense of weakness in addition my
reaction speed greatly decreased from 0.3 second to 0.93 second which is 0.68
second slower than the natural response and my cognitive ability slightly
decreased and it became harder to focus on what others say and my attention
span scored 15 which is 5 second longer then the last test.
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Day3:

In the Third and last day (72 hours) of experiment the exhaustion became
extreme and I was unable to function or do even the most simple tasks, even
thinking became hard and I start to experience slight hallucination, at this point
I had the symptoms of an insomniac patient and the result of my tests have
decreased even more, the reaction test scored over 1.5 seconds which at this
speed doesn’t even count as a reaction, my cognitive ability got mildly
inaccurate and I couldn’t focus on what others say nor understand it, the
attention spam was much longer about 20 seconds and by the end of the
experiment my body started to get numb and started to force me into sleep even
when I attempted to resist the frontal lobe of the brain which is responsible for
the consciousness was already failing therefor the subconscious part of the brain
which resemble the brain stem along with the inner spine cord stem cells took
control and force me to sleep hence ending the experiment.
Results of the experiments:

Response Time Expirement

1.6

1.4

1.2

0.8

0.6

0.4

0.2

0
Day 1 Day 2 Day 3

Insomnic Response Diffrence to Natural

From analysing the graph above the correlation between the time staying
awake and the extended time of reaction is apparent, hence the blue columns
represent the abnormal time of response the insomniac has that kept increasing
in relation to time as same as the orange columns that represented the difference
between the abnormal time of reaction in a given day with the supposed natural
reaction of a normal person.
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Attention Span Test

25

20

15

10

0
Day 1 Day 2 Day 3

Insomniac Span Diffrence Between Series 3Normal Span

The graph represent the effect of insomnia on the attention span, as viewed in
the graph above the longer the brain remain without sleep the longer and slower
the attention span get as represented by the blue columns, this increase con go
up as to double the time of attention of a regular person which is represented in
the grey columns, however the change is gradual which is represented by
orange columns that keep increasing in relation to the number of days past
proving that sleeplessness indeed effect the psychological aspect of brain.
Note: the attention span in the context of this experiment doesn’t mean how
longer a person can focus on a given object and remain focused but rather how
long does a person zone out (lose the chain of his thought) when staring or
looking at a given object.
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Cognitive experiment

Insomniac
Normal Cognitive
CognitiveState
State

Visual
Visual Auditory
Auditory
Sensory
Sensory Unrecognized
Unreconized

The charts above represent both the cognitive ability of the insomniac person
and the normal person which were extracted from the previously mentioned
experience hence the chart on the right is at the end of the 72 hour and show in
comparison to the normal state illustrated on the left the drastic change in the
overall receptive ability of the brain, for instance the dominate receptive sensor
in the normal state is visual, that is to say the eyes dominate this chart for how
important they contribute in the ability of any given person to recognize and
analyse the environment surrounding it; however in the insomniac state the
function of eyes is greatly reduced due to the prevention of sleep, the part of
brain that is responsible for processing the visual information into recognizable
data cant function properly and result in blurry vision and in some severe case
it leads to hallucinations, other important organ is the ears which unlike what
commonly know is not only responsible for the audible input but also a vital
organ that grant the body stability and balance thanks to a small and fragile
organ in the inner ear which means that in addition for being worse and more
difficult for the insomniacs to hear and understand language, it is even more
hard to preserve their balance when performing any activity that require
dynamic movement, the sensory system that relate to the biggest part of the
body that is the skin also suffer from the sleeplessness that because the outer
layer of the brain (the crust) is responsible for intercepting and interpreting all
the information the skin has to give which is a ludicrous amount given the fact
that the skin is in continuous contact with external stimulant either the cloth or
the air or even the skin itself, this big amount of information becomes a burden
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to the brain that will eventually cause addlepated and misinterpreted

information, that’s why many chronic insomnia patients report cases of
irrational rush all over their skin or piercing pain in parts of their body though
the medical checks show no straight cause for them to experience that type of
pain, that because their brain is unable to function properly over extended
amount of awakening.
This sensory issues in addition to the preceding problems lead to the increase
of the amount of the unrecognizable information that directly translate in seeing
the patient hallucination or hearing voices and feeling odd and otherworldly and
at this stage it is urgent to force the patients into sleep to prevent further damage
that can be permanent.

Dealing with insomnia:

Based on the behaviourism and stimulus approaches, three major tools to deal
with the insomnia were selected as an attempt to fix this and heal the chronic
patients:
Cognitive behaviour therapy for insomnia (CBT)
All participants received four 1-hour intervention sessions following a standard
CBT for primary insomnia protocol (Carney & Edinger, 2008). The majority of
this intervention was behaviourally oriented, with one session focused on
cognitive strategies, including constructive worry and cognitive restructuring
worksheets.
Cognitive therapy (CT)
The four CT sessions were comprised of CT components as described in Harvey
(2005) and Harvey et al. (2007). Individual insomnia formulations, based on the
cognitive model, were derived to conceptualise each participant's cognitive
maintaining factors (Harvey, 2006). Cognitive restructuring and tailored
behavioural experiments (Perlis, Aloia, & Kuhn, 2011; Ree & Harvey, 2004)
were developed to assist in reversing the cognitive maintaining factors:
unhelpful beliefs about sleep (Morin et al., 2002), worry about sleep (Tang &
Harvey, 2004), monitoring for sleep-related threats, and misperception of sleep
(Harvey & Tang, 2012).

Mindfulness-based therapy (MBT)

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The four MBT sessions focused on the development of mindfulness skills with
session content based on the approach described by Segal et al. (2002). In-
session meditations were included during each session, and participants were
encouraged to listen to mindfulness meditation recordings (e.g., sitting
meditation) 6 days out of 7 at times of the day that suited them. Additionally,
participants were assigned informal mindfulness tasks each week (e.g., mindful
eating and any other activity whereby attention is focused on one activity over a
period of time). The 3-Minute Breathing Space was also introduced for bringing
formal meditation practice into daily life. Participants were encouraged to carry
out the practice of 3-Minute Breathing Space three times daily at set times and
also at any other times when they felt stressed. Barriers and benefits of practice
were discussed at each session. A recurrent theme in the MBT sessions was the
awareness of present moment experience without judgment.

Two major findings arose from the current study. First, as expected, MBT was
associated with significant improvement in mindfulness measures compared to
CT. This is in contrast to the CT process measures that were significantly
improved by both CT and mindfulness treatment interventions. Second, the CT
composite process measure strongly predicted variance in insomnia severity at
posttreatment, but contrary to prediction, this result did not differ significantly
across CT and MBT. Unlike the CT process measure composite, the
mindfulness process measure composite at posttreatment did not significantly
predict change in insomnia severity. The first finding that MBT produced
change in cognitive processes is striking given that the version of MBT in the
current study did not incorporate any direct work on modifying unhelpful
thoughts, beliefs or behaviours. Others have noted that mindfulness-based
approaches raise awareness of thoughts and feelings in ways that allow a
disengagement from ruminative processes (Nolen-Hoeksema, 1991), seeing
them as ‘mental events’ and not accurate reflections of reality (Segal et al.,
2002). The current results are consistent with the notion that mindfulness-based
approaches may not only alter metacognitive processes but cognitive processes,
such as monitoring, distorted perception and cognitive content. This is in line
with research suggesting cognitive change can result from therapies other than
CT. For example, an investigation of MBT in the treatment of insomnia
suggested that dysfunctional beliefs about sleep and thought-control strategies
change with MBT (Larouche et al., 2014). Additionally, in a trial of CBT and
pharmacotherapy, Morin and colleagues (2002) found that the degree of belief
change during both treatments was predictive of treatment response, but CBT
produced more belief change than did pharmacotherapy. Further, Eidelman et
al. (2016) found that dysfunctional beliefs are modified not just by CT but also
by BT, a treatment that does not explicitly aim to modify cognitive processes
such as unhelpful beliefs. Finally, Garland, Rouleau, Campbell, Samuels, and
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Carlson (2015) implemented a mindfulness-based cancer recovery intervention

and found improvements in insomnia and dysfunctional beliefs about sleep.
These studies, together with the current results, are consistent with the notion
that change in cognitive processes is important and that it is achievable via CT
or MBT. The finding that CT process measures changed in each of CT and
MBT is particularly noteworthy, given the second finding that the cognitive
process measures independently predicted insomnia severity over and above
pretreatment insomnia severity scores. Harvey et al. (2017) found a consistent
result in finding that a composite CT process measure mediated treatment
outcome in both CT and behaviour therapy (BT) for insomnia. The results of the
current study and that of Harvey et al. support the cognitive model of insomnia
in providing evidence for the importance of cognitive change in insomnia
treatment (Harvey, 2002, 2005). Importantly, these results suggest that CT is
not the only method for treating these cognitive maintaining factors. Indeed, BT
and MBT appear to also be effective. The finding that cognitive processes
predict treatment outcome suggests that (1) understanding how best to alter
cognitive processes may assist optimisation of treatment effectiveness, and (2)
that treatment research should include other therapies in addition to CT/CBT in
the quest to maximise cognitive change. Moving now to the prediction that the
mindfulness process measure would predict treatment effects. Findings were
contrary to this prediction in that the mindfulness process measure composite
did not relate to treatment outcome. Research by Ong et al. (2009) examined the
effects of an integrated CBT/MBT approach to insomnia treatment, finding that
although the treatment was effective, it did not bring about changes in the
mindfulness process measure, the Kentucky Inventory of Mindfulness Skills
(KIMS). This suggests a lack of relationship between the mindfulness process
measure and treatment outcome, and in this way is consistent with the current
findings. Ong et al. suggested that the exposure to mindfulness was perhaps not
enough to sufficiently develop mindfulness skills. In response to this result, Ong
and Sholtes (2010), in a single case study, revised their integrated CBT/MBT
intervention by extending the number of sessions from 6 to 8, including an all-
day meditation retreat. KIMS scores were increased in the case study. Where
the current results differ is that the mindfulness process measure score did
change with a short, four-session MBT intervention. The fact that process
measure change was not associated with an improved treatment outcome is
puzzling. In essence, an improvement in mindfulness suggests that participants
undergoing MBT had improved skills in observing, describing, acting with
awareness, and accepting without judgment. However, it appears that unless this
also resulted in a change in cognitions about preoccupation with sleep,
dysfunctional thoughts about sleep and/or decreased safety behaviours,
insomnia was not likely to change. Further research could therefore focus on
what facilitated this cognitive change for the MBT participants. There are
several study limitations to note; the first is that the sample size of the current
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study may not have had sufficient power to detect significant difference
between treatments on the cognitive process measures. There was a trend
toward CT being associated with a larger difference on the cognitive process
measure compared with MBT, but it only approached statistical significance.
Second, it may be that the CT process measures were more sensitive to change
in the current study than the MBT process measures. The CT measures were
developed for use in insomnia, whereas the MBT measures were developed for
transdiagnostic use. Third, although video recordings were reviewed during
regular supervision of the therapist by experts in each approach, no formal
fidelity treatment checks were carried out. The design of the study could also be
improved by the posttreatment measures being collected by someone
independent to the delivery of the treatment. However, the fact we collected an
objective physiological measure that showed the same response pattern to the
self-report measures suggests this was not a major flaw (see Wong et al., 2016).
In summary, there is evidence that both CT and MBT are effective treatments
for insomnia. There is also evidence that CT produces change in cognitive
process measures and that MBT brings about change in both mindfulness and
cognitive process measures. The current results support that changing the
content of unhelpful thoughts/beliefs (as in CT) or the relationship with
unhelpful thoughts/beliefs (as in MBT) results in a reduction in unhelpful
cognitive processes. Finally, the results of this study underscore the importance
of cognitive factors as mediators in insomnia, given that they were significantly
related to treatment outcome regardless of treatment condition.

5.Conclusion:

To conclude, from what has been studied and illustrated above we come to
the understanding that insomnia is a chronic decease with life threatening
effects on the patients that cause them difficulty to be receptive towards their
environment either visual or auditory or sensory in addition to the decreased of
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response time and attention span that eventually cause many patients to become
clinically unproductive which is a life ruining problem, however it is still an
approachable problem that can be tackled and fixed through behaviourism and
cognition therapy , and since the insomnia is a disorder it is more encouraging
to be delt with, since by the adjustment of certain behaviours either by stimulus
based therapy or mindfulness these behaviours fade bringing drastic change to
the life of patients that can hopefully recover completely.

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