Behavioral treatment of disease-related chronic insomnia in a hemophiliac
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Hemophilia represents a congenital chronic disorder characterized by recurrent unpredictable internal hemorrhages with accompanying acute bleeding pain. The medical management of a 38-year-old hemophiliac with severe classic hemophilia was further complicated by a high titer Factor VIII antibody, increasing the life-threatening status of a severe hemorrhage. The patient had a one-year history of less than 2 hours of sleep per night as a result of daily chronic tension and intrusive cognitions about the dangers of his illness. A treatment package consisting of progressive muscle relaxation, meditative breathing, cognitive refocusing, and stimulus control procedures resulted in an average of 6 hours per night of uninterrupted sleep; improvement was maintained over a 27-week follow-up period. The treatment is discussed within the context of the behavioral medicine approach in hemophilia comprehensive care. © 1980.
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