The use of flotation rest in the treatment of persistent psychophysiological insomnia

Although relaxation techniques have been successful in treating sleep onset insomnia, research evidence of efficacy has traditionally focused on self-reported improvement measured during the course of treatment. Few studies have collected objective measures or long-term followup data. The present study used subjective and objective measures in evaluating the long-term effectiveness of the flotation form of the Restricted Environmental Stimulation Technique (REST) as a treatment for persistent, psychophysiological sleep onset insomnia. It was expected that treatment would reduce both measures of sleep latency over the long term. Flotation REST is a behavioural intervention that involves the use of a flotation tank. The tank is similar to a large, enclosed (dark and quiet) bathtub. A door on the side allows easy entry and exit. The floater lies suspended in a supine position with the face and ventral portion of the body out of the aqueous solution of MgSO₄. The solution has a specific gravity of 1.27 and a temperature of 34.2°C. Thirty-six volunteers (20 women and 16 men) with psychophysiological insomnia were randomly assigned to one of four conditions: flotation REST only, flotation REST with autogenic relaxation, autogenic relaxation only, or delayed treatment control. Each treatment group received four 2-hour treatment sessions within a fourteen-day period. During each session, 45 minutes were spent in treatment. The remainder of the two hours was devoted to tasks related to the study. Sleep latency was measured before treatment and one, four, and twelve weeks after treatment. Self-report latency was recorded at home in a daily sleep log. Objective latency data were collected via the Somtrak sleep assessment device (SAD machine), which was used at home. The SAD machine consists of a tone generator and timing device connected to a cassette recorder, all fitted inside a briefcase. During use, a one-second tone goes off every ten minutes, and simultaneously the tape begins to record for ten seconds. If the person hears the tone, a response of "I'm awake" is given and recorded. Paper and pencil measures of affect and arousal were collected during treatment and whenever sleep latency was measured. The results indicated that flotation REST (either by itself, or in combination with autogenic relaxation) was effective in reducing both subjective and objective sleep latency over the long term. Both flotation REST conditions were equally effective as the autogenic relaxation condition in reducing sleep latency after twelve weeks. Reductions in tension were correlated with reductions in subjective sleep latency and reductions in anger were correlated with reductions in objective sleep latency, all over the long term. People who reached their peak activity level late in the day took objectively longer to get to sleep than people whose peak activity level occurred earlier. It was concluded that flotation REST (on its own and in combination with autogenic relaxation) improved both subjective and objective sleep latency up to twelve weeks after treatment.

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