Book Review: Treating Sleep Problems—A Transdiagnostic Approach

The purpose of this book is to introduce a new and comprehensive type of cognitive behavioural treatment for insomnia (CBTi), which the authors have called “TranS-C,” for “transdiagnostic sleep and circadian intervention.” It is clearly aimed at psychologists who are already doing CBTi in their practice but who wish to have a broader set of treatments to offer. While the book has little to say about medication treatment for insomnia, it amply fulfills its purpose with a very detailed elaboration of the proposed multipronged attack on sleep disorders—it is not just a book about insomnia. The authors accurately note the modern conception of insomnia and depression as being a “two-way street,” in that sufficient sleep disruption from any cause appears to trigger depression, while depression has insomnia as one of its major symptoms. Over long follow-up, there are also other patients who demonstrate either pure insomnia or pure depression. These authors are extremely well qualified to write on this topic. Dr. Buysse is the lead author of the Pittsburgh Sleep Quality Inventory (PSQI), which is currently the most frequently used questionnaire in the world to assess subjective sleep quality. He is also a career-long author in the area of insomnia and cognitive behavioural treatment. Likewise, Dr. Harvey is an internationally respected authority in the field whose career focusses mainly on CBTi. The main thesis of the book is that existing psychological treatments for sleep disorders have been too narrowly focussed on insomnia and have not operationally included a large amount of recent neurobiological findings. The “transdiagnostic approach” that they propose is quite complex. It consists of unlinking existing treatments from particular disorders and looking at the problem much more broadly. One benefit is that patients with more serious and complex problems can be treated, such as a bipolar patient with severe insomnia and sleep apnea. Also, elements of other existing treatments have been incorporated in the method, such as chronotherapy and motivational interviewing. The major areas of focus for the new treatment are sleep schedule regularity, subjective satisfaction with sleep, alertness during the daylight hours, ability to sleep efficiently (i.e., few awakenings while in bed), timing of the patient’s sleep in the 24 hours, and sleep duration. They further subdivide the treatment into “cross-cutting modules,” “core modules,” and “optional modules.” Numerous tips and techniques for obtaining the sleep history initially are provided, as well as hints for interventions when the therapy sessions do not seem to be going well. This volume amounts to a core textbook for psychologists or other therapists doing CBTi. It is sufficiently detailed that a current practitioner could learn many of the therapy principles directly from the book, although medication treatment and continuous positive airway pressure for sleep apnea are described only briefly. Canadian Psychiatric Association