Bilişsel Davranışçı Terapi-Uykusuzluk Protokolü ve Etkililik Çalışmalarının Gözden Geçirilmesi

Öz

Günümüzde uyku ile ilgili problemlerde artış görülmektedir. Hem ülkemizde hem de diğer ülkelerde uykusuzluk bozukluğunun (insomni) en sık karşılaşılan uyku bozukluklarından biri olduğu belirtilmektedir. Bu araştırma kapsamında, uykusuzluk bozukluğunun bilişsel davranışçı terapi temelli tedavisi ve bu tedavi yaklaşımının etkililiğini inceleyen çalışmalar gözden geçirilmiştir. Derleme için Medline, PsycINFO, PsycARTICLES, Web of Science, JStore veri tabanları incelenerek 2005-2019 yılları arasındaki Bilişsel Davranışçı Terapi Uykusuzluk Protokolünü (BDT-U) konu edinmiş çalışmalar incelenmiştir. İlgili alan yazına göre BDT-U’nun uykusuzluk belirtilerini azaltmada, uyunan uyku süresini artırmada, müdahaleden sonra elde edilen kazanımların korunmasında olumlu sonuçları mevcuttur. Yapılan bazı çalışmalarda müdahalenin bir kısım dezavantajlarının olduğu vurgulansa da sadece uykusuzluk bozukluğunun tedavisinde değil, uykusuzluk bozukluğu ile beraber görülen depresyon, anksiyete gibi rahatsızlıkların tedavisinde de bu müdahalenin etkili bir tedavi yöntemi olduğu anlaşılmaktadır. Uluslararası alan yazında sıkça kullanılan ve etkililiğinin araştırıldığı BDT-U protokolünün, ulusal alan yazında etkililik çalışmalarının henüz yapılmadığı görülmüştür. Bu nedenle yapılan çalışmada bu konu ile ilgili uluslararası alan yazında yapılan çalışmalar gözden geçirilmiştir.

Anahtar Kelimeler

• İnsomni,Uykusuzluk Bozukluğu,Uyku,Bilişsel Davranışçı Tereapi

Cognitive Behavioral Therapy - Insomnia Protocol and Review of Efficacy Studies

Abstract

Nowadays, problems related to sleep increase. Insomnia is one of the most frequently encountered sleep disorders in both our country and other countries. The studies investigating the cognitive behavioral therapy based treatment of insomnia disorder and the effectiveness of this treatment approach were reviewed in present study. For the review, the studies on the Cognitive Behavioral Therapy Insomnia (CBT-I) protocol between years 2005-2019 were examined via Medline, PsycINFO, PsycARTICLES, Web of Science, and JStore databases. According to the related literature, CBT-I has shown positive results in decreasing insomnia symptoms, increasing sleep time, and sustaining gains after intervention. Although it is emphasized that the intervention has some disadvantages in some studies, it is not only the treatment of insomnia disorder, but also it is an effective treatment method in the treatment of comorbid disorders such as depression anxiety with insomnia disorder. It is observed that the effectiveness of the CBT-I protocol, which is frequently used in literature and whose effectiveness has been investigated, has not yet been studied in the Turkey. For this reason, in the current study, the studies conducted in the field related to this subject are reviewed.

Keywords

• Insomnia,Sleep,Cognitive Behavioral Therapy

References

1. American Academy of Sleep Medicine (2005) International classification of sleep disorders: diagnostic and coding manual: 2nd ed. Westchester IL: American Academy of Sleep Medicine.
2. American Psychiatric Association. (2013) Diagnostic and statistical manual of mental disorders (DSM-5®) American Psychiatric Pub.
3. Archer M, Brown JS, Idusohan H, Coventry S, Manoharan A, Espie CA (2009) The development and evaluation of a large-scale self-referral CBT-I intervention for men who have insomnia: an exploratory study. Behavioural and cognitive psychotherapy, 37:239-248.
4. Aydın A, Selvi Y, Güzel-Özdemir P (2013) Depresyon Hastalarında Aleksitiminin Bedenselleştirme ve Uyku Kalitesi Üzerine Etkisi. Archives of Neuropsychiatry/ Nöropsikiatri Arşivi 50:65-69.
5. Aydın H, Özgen F (2001) Uyku, yapısı ve işlevi. Turkiye Klinikleri [Journal of Psychiatry], 2:79-85.
6. Aysan E, Karaköse S, Zaybak A, İsmailoğlu EG (2014) Üniversite Öğrencilerinde Uyku Kalitesi ve Etkileyen Faktörler. Dokuz Eylül Üniversitesi Hemşirelik Yüksekokulu Elektronik Dergisi, 7:193-198.
7. Baglioni C, Battagliese G, Feige B, Spiegelhalder K, Nissen C, Voderholzer U, Lombardo, C, Riemann D (2011) Insomnia as a predictor of depression: a meta-analytic evaluation of longitudinal epidemiological studies. Journal of affective disorders, 135:10-19.
8. Bastien CH, Morin CM, Ouellet MC, Blais FC, Bouchard S (2004) Cognitive-behavioral therapy for insomnia: comparison of individual therapy, group therapy, and telephone consultations. Journal of consulting and clinical psychology, 72:653.

9. Belleville G, Guay S, Marchand A (2011) Persistence of sleep disturbances following cognitive-behavior therapy for posttraumatic stress disorder. Journal of Psychosomatic Research, 70:318-327.
10. Blom K, Jernelöv S, Kraepelien M, Bergdahl MO, Jungmarker K, Ankartjärn L, Kaldo V (2015) Internet treatment addressing either insomnia or depression, for patients with both diagnoses: a randomized trial. Sleep, 38:267-277.
11. Braunwald E, Fauer AS, Kasper DL (2001) Harrison Textbook of Internal Medicine. (15.edition).
12. Brooks AT, Tuason RT, Chakravorty S, Raju S, Ritterband LM, Thorndike FP, Wallen GR (2018) Online cognitive behavioral therapy for insomnia (CBT-I) for the treatment of insomnia among individuals with alcohol use disorder: study protocol for a randomized controlled trial. Pilot and feasibility studies, 4:183.
13. Brooks AT, Wallen GR (2014) Sleep disturbances in individuals with alcohol-related disorders: a review of cognitive-behavioral therapy for insomnia (CBT-I) and associated non-pharmacological therapies. Substance abuse: research and treatment, 8:55.
14. Brower KJ, Krentzman A, Robinson, EA (2011) Persistent insomnia, abstinence, and moderate drinking in alcohol‐dependent individuals. The American journal on addictions, 20:435-440.
15. Buscemi N, Vandermeer B, Friesen C, Bialy L, Tubman M, Ospina M, Klassen TP, Witmans M (2005) Manifestations and Management of Chronic Insomnia in Adults. Evidence Report/ Technology Assessment No. 125. AHRQ Publication No. 05-E021-2. Rockville: Agency for Healthcare Research and Quality.
16. Buysse DJ, Angst J, Gamma A, Ajdacic V, Eich D, Rossler W (2008) Prevalence, course, and comorbidity of insomnia and depression in young adults. Sleep-New York Then Westchester, 31:473.
17. Cheng SK, Dizon J (2012) Computerised cognitive behavioural therapy for insomnia: a systematic review and meta-analysis. Psychotherapy and psychosomatics, 81:206-216.
18. Cohn T, Foster J, Peters T (2003) Sequential studies of sleep disturbance and quality of life in abstaining alcoholics. Addiction Biology, 8:455-462.
19. Cole MG, Dendukuri N (2003) Risk factors for depression among elderly community subjects: a systematic review and meta-analysis. American Journal of Psychiatry, 160:1147-1156.
20. Coleman RM, Roffwarg HP, Kennedy SJ (1982) Sleep wake dis­orders based on polysomnographic diagnosis: a national coopera­tive study. JAMA, 247:997-1103.Cunningham JE, Shapiro CM (2018) Cognitive Behavioural Therapy for Insomnia (CBT-I) to treat depression: A systematic review. Journal of psychosomatic research, 106:1-12.
21. Demir AU, Ardic S, Firat H, Karadeniz D, Aksu M, Ucar ZZ, Peker Y (2015) Prevalence of sleep disorders in the Turkish adult population epidemiology of sleep study. Sleep and Biological Rhythms, 13:298-308.
22. Dew MA, Reynolds CF, Houck PR, Hall M, Buysse DJ, Frank E, Kupfer DJ (1997) Temporal profiles of the course of depression during treatment: predictors of pathways toward recovery in the elderly. Archives of general psychiatry, 54:1016-1024.
23. Drake CL (2016) The promise of digital CBT-I. Sleep, 39:13-14.
24. Dyas JV, Apekey TA, Tilling M, Orner R, Middleton H, Siriwardena AN (2010) Patients’ and clinicians’ experiences of consultation in primary care for sleep problems and insomnia: a focus group. British Journal of Genetic Practice, 60:329- 333.
25. Edinger JD, Hoelscher TJ, Webb MD, Marsh GR, Radtke RA, Erwin CW (1989) Polysomnographic assessment of DIMS: empirical evaluation of its diagnostic value. Sleep, 12:315-322.
26. Edinger JD, Sampson WS (2003). A primary care “friendly” cognitive behavioral insomnia therapy. Sleep, 26, 177–182.
27. Edinger JD, Olsen MK, Stechuchak KM, Means MK, Lineberger MD, Kirby A, Carney CE (2009) Cognitive behavioral therapy for patients with primary insomnia or insomnia associated predominantly with mixed psychiatric disorders: a randomized clinical trial. Sleep, 32:499-510.
28. Edinger JD, Sampson WS (2003) A primary care “friendly” cognitive behavioral insomnia therapy. Sleep, 26:177–182.
29. Edinger JD, Wohlgemuth WK, Radtke RA, Marsh GR. Quillian, RE (2001) Efficacy of cognitive-behavioral therapy for treating primary sleep-maintenance insomnia. JAMA, 285:856-864.
30. Ellis J (2019) CBT-I and acute insomnia: considerations and controversies. Sleep Medicine Clinics. ISSN-556-407X (In Press)
31. Espie CA, Kyle SD., Williams C, Ong JC, Douglas NJ, Hames P, Brown JS (2012) A randomized, placebo-controlled trial of online cognitive behavioral therapy for chronic insomnia disorder delivered via an automated media-rich web application. Sleep, 35:769-781.
32. Falloon K, Arroll B, Elley CR, Fernando A (2011) The assessment and management of insomnia in primary care. British Medical Journal, 2342-2899.
33. Freeman D, Stahl D, McManus S, Meltzer H, Brugha T, Wiles N, Bebbington P (2012) Insomnia, worry, anxiety and depression as predictors of the occurrence and persistence of paranoid thinking. Social psychiatry and psychiatric epidemiology, 47:1195-1203.
34. Geer JH, Katkin ES (1966) Treatment of insomnia using a variant of systematic desensitization: a case report. Journal of Abnormal Psychology, 71:161–164.
35. Hachul H, Polesel DN (2017) Insomnia Pharmacotherapy: a Review of Current Treatment Options for Insomnia in Menopause. Current Sleep Medicine Reports, 3:299-305.
36. Hamoen AB, Redlich EM, Weerd AW (2014). Effectiveness of Cognitive Behavioral Therapy For Insomnıa: Influence of Slıght‐To‐Moderate Depressıve Symptom Severıty and Worryıng. Depression and anxiety, 31:662-668.
37. Heckler CE, Garland SN, Peoples AR, Perlis ML, Shayne M, Morrow GR, Kamen C, Hoefler J, Roscoe JA (2016) Cognitive behavioral therapy for insomnia, but not armodafinil, improves fatigue in cancer survivors with insomnia: a randomized placebo-controlled trial. Supportive Care in Cancer, 24:2059-2066.
38. Holbrook AM, Crowther R., Lotter A., Cheng C., King D (2000) Meta-analysis of benzodiazepine use in the treatment of insomnia. Canadian Medical Association Journal, 62:225–233.
39. Inman DJ, Silver SM, Doghramji K (1990) Sleep disturbance in post-traumatic stress disorder: a comparison with non-PTSD insomnia. Journal of Traumatic Stress, 3:429-437.
40. Johnson EO, Roth T, Breslau N. (2006). The association of insomnia with anxiety disorders and depression: exploration of the direction of risk. Journal of psychiatric research, 40:700-708.
41. Johnson JA, Rash JA, Campbell TS, Savard J, Gehrman PR, Perlis M, Garland SN (2016) A systematic review and meta-analysis of randomized controlled trials of cognitive behavior therapy for insomnia (CBT-I) in cancer survivors. Sleep medicine reviews, 27:20-28.
42. Kamen C, Garland SN, Heckler CE, Peoples AR, Kleckner IR, Cole CL, Perlis ML, Morrow, GR, Mustian KM, Roscoe, JA (2019). Social support, insomnia, and adherence to cognitive behavioral therapy for insomnia after cancer treatment. Behavioral sleep medicine, 17:70-80.
43. Koffel EA, Koffel JB, Gehrman PR (2015) A meta-analysis of group cognitive behavioral therapy for insomnia. Sleep medicine reviews, 19:6-16.
44. Krakow B, Germain A, Warner TD, Schrader R, Koss M, Hollifield M, Tandbeg D, Melendrez D, Johnston L (2001) The relationship of sleep quality and posttraumatic stress to potential sleep disorders in sexual assault survivors with nightmares, insomnia, and PTSD. Journal of traumatic stress, 14:647-665.
45. Kripke D (2000) Hypnotic drugs: deadly risks, doubtful benefits. Sleep Medical Review, 4:5-20.
46. Kupfer DJ, Shaw DH, Ulrich R, Coble PA, Spiker DG (1982) Application of automated REM analysis in depression. Archives of General Psychiatry, 39:569-573.
47. Kupfer DJ, Spiker DG, Coble PA, Neil JF, Ulrich R,Shaw DH (1980) Depression, EEG sleep, and clinical response. Comprehensive Psychiatry, 21:212-220.
48. Kupfer DJ, Spiker DG, Coble PA, Neil JF, Ulrich R, Shaw DH (1981) Sleep and treatment prediction in endogenous depression. American Journal Psychiatry, 138:429-434.
49. Kyle SD, Morgan K, Espie C (2009) Insomnia and health-related quality of life. Sleep Medine Review, 14:69-82.
50. Lancee J, van den Bout J, van Straten A, Spoormaker VI (2012) Internet-delivered or mailed self-help treatment for insomnia? A randomized waiting-list controlled trial. Behaviour Research and Therapy, 50:22-29.
51. Manber R, Edinger JD, Gress JL, San Pedro-Salcedo MG, Kuo TF, Kalista, T (2008) Cognitive behavioral therapy for insomnia enhances depression outcome in patients with comorbid major depressive disor-der and insomnia. Sleep, 31:489-495.
52. Meltzer LJ, Phillips C, Mindell JA (2009) Clinical psychology training in sleep and sleep disorders. Journal of clinical psychology, 65:305-318.
53. Merey Z, Boysan M, Ateş C (2008) Eğitim çalışanlarında uyku kalitesi ve tükenmişlik sendromu. Kriz Dergisi, 16:33-41.
54. Mitchell MD, Gehrman P, Perlis M, Umscheid, CA (2012) Comparative effectiveness of cognitive behavioral therapy for insomnia: a systematic review. BMC family practice, 13:1-12.
55. Morgenthaler T, Kramer M, Alessi C, Friedman L, Boehlecke B, Brown T, Swick T (2006) Practice parameters for the psychological and behavioral treatment of insomnia: An update. An American Academy of Sleep Medicine report. Sleep, 29:1415 – 1419.
56. Morin CM, Bootzin RR, Buysse DJ, Edinger JD, Espie CA, Lichstein KL (2006) Psychological and behavioral treatment of insomnia: Update of the recent evidence (1998 – 2004) . Sleep, 29:1398 – 1414.
57. Morin, CM, Colecchi CA, Ling WD, Sood RK (1995) Cognitive behavior therapy to facilitate benzodiazepine discontinuation among hypnotic-dependent patients with insomnia. Behavior Therapy, 26:733 – 745.
58. Morin CM, Culbert, JP, Schwartz, SM (1994) Nonpharmacological interventions for insomnia: A meta-analysis of treatment efficacy. American Journal of Psychiatry, 151:1172 – 1180.
59. Morin CM, Hauri PJ, Espie CA, Spielman AJ, Buysse DJ Bootzin RR (1999) Non-pharmacological treatment of chronic insomnia. An American Academy of Sleep Medicine review. Sleep 22:1134–1156.
60. Morin CM, Bootzin RR, Buysse DJ, Edinger JD, Espie CA, Lichstein KL (2006) Psychological and behavioral treatment of insomnia: update of the recent evidence (1998–2004). Sleep 29:1398–1414.
61. Morin CM, Bélanger L, LeBlanc M, Ivers H, Savard J, Espie CA, Merette C, Baillargeon L, Grégoire J P (2009) The natural history of insomnia: a population-based 3-year longitudinal study. Archives of internal medicine, 169:447-453.
62. Morse CD, Klingman KJ, Jacob BL, Kodali L (2019) Exercise and Insomnia Risk in Middle-Aged Women. The Journal for Nurse Practitioners. 15:236-240.e2.
63. National Institutes of Health. (2005) National Institutes of Health State of the Science Conference statement on Manifestations and Management of Chronic Insomnia in Adults, June 13 – 15, Sleep, 28:1049 -1057.
64. Neubauer DN, Pandi-Perumal SR, Spence DW, Buttoo K, Monti JM (2018) Pharmacotherapy of Insomnia. Journal of central nervous system disease, 10:1-7.
65. Norell-Clarke A, Jansson-Fröjmark M, Tillfors M, Holländare F, Engström I (2015) Group cognitive behavioural therapy for insomnia: Effects on sleep and depressive symptomatology in a sample with comorbidity. Behaviour research and therapy, 74:80-93.
66. Ohayon MM, Roth T (2003) Place of chronic insomnia in the course of depressive and anxiety disorders. Journal of Psychiatric Research, 37:9 – 15.
67. Ohayon MM, Shapiro CM (2000) . Sleep disturbances and psychiatric disorders associated with posttraumatic stress disorder in the general population. Comprehensive Psychiatry, 41:469 – 478 . doi: 10.1053/comp.2000.16568
68. Ohayon MM, Shapiro CM, Kennedy SH (2000) Differentiating DSM-IV anxiety and depressive disorders in the general population: Comorbidity and treatment consequences. Canadian Journal of Psychiatry, 45:166 – 172.
69. Okajima I, Komada Y, Inoue Y (2011) A meta-analysis on the treatment effectiveness of cognitive behavioral therapy for primary insomnia. Sleep Biological Rhythms, 9:24 –34.
70. Öztürk L (2008) Uyku ve Uyanıklığın Güncel Fizyolojisi. Turkiye Klinikleri [Journal of Pulmonary Medicine Special Topics], 1:5-10.
71. Öztürk O (2002) Uyku Bozuklukları, Ruh Sağlığı ve Bozuklukları. (9.Baskı). Ankara: Nobel Tıp Kitabevleri.
72. Parlakoğlu BA, Bilici M, Özbay SY (2013) Psikotrop ilaçların uyku üzerine etkileri. Turkiye Klinikleri [Journal of Psychiatry Special Topics], 6:46-52.
73. Pelin Z, Gözükırmızı E (2001) Uykunun Ontogenetik Özellikleri. Turkiye Klinikleri [Journal of Psychiatry], 2:67-68.
74. Perlis ML, Giles DE, Mendelson WB, Bootzin RR Wyatt JK (1997) Psychophysiological insomnia: the behavioral model and a neurocognitive perspective. Journal of Sleep Research 6:179–188.
75. Perlis ML, Jungquist C, Smith MT, Posner D (2005). Cognitive Behavioral Treatment of Insomnia. Springer: USA.
76. Pigeon WR, Campbell CE, Possemato K, Ouimette P (2013) Longitudinal relationships of insomnia, nightmares, and PTSD severity in recent combat veterans. Journal of psychosomatic research, 75:546-550.
77. Pigeon WR, Moynihan J, Matteson-Rusby S, Jungquist CR, Xia Y, Tu X, Perlis ML (2012) Comparative effectiveness of CBT interventions for co-morbid chronic pain & insomnia: a pilot study. Behaviour research and therapy, 50:685-689.
78. Querstret D, Cropley M (2012) Exploring the relationship between work-related rumination, sleep quality, and work-related fatigue. Journal of occupational health psychology, 17:341.
79. Randall C, Nowakowski S, Ellis JG (2018) Managing Acute Insomnia in Prison: Evaluation of a “One-Shot” Cognitive Behavioral Therapy for Insomnia (CBT-I) Intervention. Behavioral sleep medicine, 1-10.
80. Riemann D, Perlis ML (2009) The treatments of chronic insomnia: A review of benzodiazepine receptor agonists and psychological and behavioral therapies. Sleep Medical Review, 13:205-214.
81. Sarı ÖY, Üner S, Büyükakkuş B, Bostancı EÖ, Çeliksöz AH, Budak M (2015) Bir üniversitenin yurtta kalan öğrencilerinde uyku kalitesi ve etkileyen bazı faktörler. Koruyucu Hekimlik Bülteni, 14:93-100.
82. Sateia MJ, Nowell PD (2004) Insomnia. Lancet, 364:1959-1973.
83. Sateia MJ, Doghramji K, Hauri PJ, Morin CM (2000) Evaluation of chronic insomnia. An American Academy of Sleep Medicine review. Sleep, 23:243-308.
84. Schutte-Rodin S, Broch L, Buysse D, Dorsey C, Sateia M (2008) Clinical guideline for the evaluation and management of chronic insomnia in adults. Journal of Clinical Sleep Medicine, 4:487–504.
85. Smith MT, Perlis ML, Park A, Smith MS, Pennington J, Giles DE, Buysse DJ (2002) Comparative meta-analysis of pharmacotherapy and behavior therapy for persistent insomnia. American Journal of Psychiatry, 159:5–11.
86. Tang NK (2010) Brief CBT-I for insomnia comorbid with social phobia: a case study. Behavioural and cognitive psychotherapy, 38:113-122.
87. Taylor DJ, Lichstein KL, Durrence HH, Reidel BW, Bush AJ (2005) Epidemiology of insomnia, depression, and anxiety. Sleep, 28:1457-1464.
88. Taylor DJ, Mallory LJ, Lichstein KL, Durrence H, Riedel BW, Bush AJ (2007) Comorbidity of chronic insomnia with medical problems. Sleep-New York Then Westchester, 30:213.
89. Taylor DJ, Pruiksma KE (2014) Cognitive and behavioural therapy for insomnia (CBT-I) in psychiatric populations: a systematic review. International review of psychiatry, 26:205-213.
90. Thorndike FP, Ritterband LM, Gonder‐Frederick LA, Lord HR, Ingersoll KS, Morin CM (2013) A randomized controlled trial of an internet intervention for adults with insomnia: effects on comorbid psychological and fatigue symptoms. Journal of clinical psychology, 69:1078-1093.
91. Trivedi MH, Morris DW, Grannemann BD, Mahadi S (2005) Symptom clusters as predictors of late response to antidepressant treatment. The Journal of clinical psychiatry, 66:1064-1070.
92. Tümer A, İlhan B, Kartal A (2017) Gençlerde İnsomni Görülme Sıklığı. OPUS Uluslararası Toplum Araştırmaları Dergisi, 7:426-439.
93. van Straten A, Cuijpers P (2009) Self-help therapy for insomnia: a meta-analysis. Sleep Medicine Reviews, 13:61-71.
94. Vgontzas AN, Liao D, Pejovic S, Calhoun S, Karataraki M, Bixler EO (2009) Insomnia with objective short sleep duration is associated with type 2 diabetes: a population-based Study. Diabetes Care, 32:19801985.
95. Vincent N, Lionberg C (2001) Treatment preference and patient satisfaction in chronic insomnia. Sleep, 24:411–417.
96. Vitiello MV, Rybarczyk B, Von Korff M, Stepanski EJ (2009) Cognitive behavioral therapy for insomnia improves sleep and decreases pain in older adults with co-morbid insomnia and osteoarthritis. Journal of Clinical Sleep Medicine, 5:355-362.
97. Wagley J, Rybarczyk B, Nay WT, Danish S, Lund HG (2013) Effectiveness of abbreviated CBT for insomnia in psychiatric outpatients: sleep and depression outcomes. Journal of clinical psychology, 69:1043-1055.
98. Walsh JK (2004) Clinical and socioeconomic correlates of insomnia. Journal of Clinical Psychiatry, 65:13-9.
99. Watanabe N, Furukawa TA, Shimodera S, Morokuma I, Katsuki F, Fujita H, Perlis ML (2011) Brief behavioral therapy for refractory insomnia in residual depression: an assessor-blind, randomized controlled trial. The Journal of clinical psychiatry, 72:1651-1658.
100. Wilson SJ, Nutt D, Alford C, Argyropoulos S, Baldwin D, Bateson A, Espie C (2010) British Association for Psychopharmacology consensus statement on evidence-based treatment of insomnia, parasomnias and circadian rhythm disorders. Journal of Psychopharmacology, 24:1577 – 1601.
101. Wilson SJ, Nutt DJ, Alford C, et al (2010) British Association for Psychopharmacology consensus statement on evidence-based treatment of insomnia, parasomnias and circadian rhythm disorders. Journal of Psychopharmacology, 24:1577-1600.
102. Yıldız M, Ünal A (2017) Bipolar bozukluğu olan hastalarda uyku kalitesi, biyolojik ritim örüntüsü ve yaşam kalitesinin tedavi uyumuyla ilişkisi. Yaşam Becerileri Psikoloji Dergisi, 1:10-23.