Setting Realistic Goals and Expectations

Before initiating treatment, it is useful to examine patients' expectations and to set treatment goals. The goals of therapy will vary according to the nature and severity of the sleep problem and the specific treatment modality. As a general rule, goals must be individualized, realistic, and operational. For instance, although all patients with insomnia wish to enjoy a good night's sleep, for some people this goal implies sleeping longer; for others, sleeping more deeply; and for still others, feeling more energetic during the day. When the objectives of therapy are defined operationally, it emphasizes the clinical relevance of selected treatment procedures and minimizes disappointments at the end of treatment. Even though the objectives may need to be redefined periodically as new information is gathered and the intervention is implemented, goal setting keeps the therapy focused and keeps the therapeutic alliance task oriented.

Inducing a sense of hope in distressed patients is often a necessary first step of therapy, but it is equally important to correct unrealistic expectations of a quick and permanent cure. Although most clinical interventions are likely to produce some therapeutic benefits, it is good clinical practice to educate patients about the range of potential outcomes that may be expected for a particular sleep disorder treated with behavioral, pharmacological, or combined treatment modalities. Because patients will often continue to experience some residual sleep disturbances even after undergoing treatment, the objectives of most therapies should be twofold: 1) improving sleep patterns and 2) teaching coping skills so that patients can manage residual difficulties after completing treatment.