"Insomnia refers to difficulties in falling or staying asleep that result in personal distress; affect one's daytime performance, mood, and general psychological well-being; and are not directly caused by a medical condition or the effects of drugs." (Spiegler, 2016, p. 475) With infant and childhood sleep problems which "usually involve refusal to go to bed, difficulty in settling down and fallings asleep, and nighttime awakening and crying" (Spiegler, 2016, p. 476) extinction is typically used and "parents refrain from attending to their child after placing the child in bed...attention is withheld if the child refuses to get into bed or to go to sleep and if the child wakes up and cries during the night...highly effective...have been shown to last at least 2 years after the treatment ends...simple for parents to learn and implement." (Spiegler, 2016, p. 476) "Adult insomnia is maintained primarily by three antecedent conditions: inappropriate setting events for sleeping, excessive muscle tension, and excessive worry. Three behavior therapies are used to change these maintaining conditions: changing setting events, progressive relaxation training, and cognitive restructuring, respectively." (Spiegler, 2016, p. 477) For changing setting events, clients are instructed to 1)Get into bed only when sleepy; 2) Use the bed only for sleeping with the exception of sexual behavior but only if you will be sleepy afterwards, otherwise engage the activity elsewhere; 3) Get out of bed if you do not fall asleep within 15 minutes and return when you are sleepy again; 4) Get up at the same time every morning and 5) Do not take naps.