How to Treat Insomnia Using Cognitive Behavioral Therapy

Insomnia has become one of the major healthcare problems in the United States, affecting six out of ten adults. The most commonly used treatment for insomnia is sleep medication, but a new study shows that cognitive behavioral therapy (CBT-I) can also help treat insomnia without the adverse effects of sleeping drugs.

According to the clinical practice guidelines released by American College of Physicians (ACP) in the Annals of Internal Medicine, CBT-I is a kind of treatment that can be conducted in group or individual therapy sessions. It can also be done through telephone, web-based modules and self-help books.

"Cognitive behavioral therapy for insomnia is an effective treatment and can be initiated in a primary care setting," said ACP President Wayne J. Riley, MD, MPH, MBA, MACP, in a statement.

Cognitive behavioral therapy combines different kinds of treatment, which include cognitive therapy around sleep, behavioral interventions such as sleep restriction and stimulus control, and education such as sleep hygiene (habits for a good night's sleep).

If by chance CBT-I is unable to help patients with insomnia, ACP advice doctors to talk with their patients whether a drug therapy should be added in the treatment. The doctor should discuss the potential health risks and benefits of sleep medications, as well as the cost of the drugs.

"Before continuing drug therapy, doctors should consider treatable secondary causes of insomnia such as depression, pain, enlarged prostate, substance abuse disorders, and other sleep disorders like sleep apnea and restless legs syndrome," said Dr. Riley.

Sleep medications are approved by the FDA to be used only for short-term, about four to five weeks. This makes CBT-I more practical because it can be used over longer periods.

Chronic insomnia is more prevalent in women and older adults. People with insomnia are most likely to experience fatigue, poor cognitive function, mood disturbance, and distress or interference with personal functioning. People diagnosed with chronic insomnia have symptoms that cause clinically significant functional distress or impairment for at least three nights every week for at least three months.