Philadelphia — An evidence review published in Annals of Internal Medicine finds that patients with chronic insomnia who undergo cognitive behavior therapy (CBT) can improve sleep without drugs and without adverse outcomes. According to the study authors, CBT works because it addresses the process that drives insomnia – anxiety about time spent awake in bed.
Clinical chronic insomnia affects up to 15 percent of adults and is associated with health issues such as anxiety, depression, and type 2 diabetes. Pharmacological approaches to treating insomnia are associated with tolerance, dependence, and adverse side effects, which makes talk-based therapy an appealing option for appropriate patients.
Researchers reviewed 20 published randomized controlled trials assessing the efficacy of face-to-face, multi-component CBT on overnight sleep in adults with chronic insomnia and no underlying medical causes. They found that CBT helped patients enter sleep about 20 minutes faster, reduced the amount of time spent awake after falling asleep by nearly 30 minutes, and improved sleep efficiency by almost 10 percent. Study authors say that these findings are important because the psychological approach is safer and better tolerated than medication and teaches skills that can be maintained over time. They note that this approach takes significant effort from the patient compared to taking a pill, which could explain its underuse.
“I’m often surprised by how many different treatments patients have tried — from herbal supplements to internet resources to medications — without ever having tried cognitive behavioral therapy for insomnia,” said study author Dr. James Trauer, Sleep and Respiratory Physician at Melbourne Sleep Disorders Centre. “It’s a lot of hard work but it does produce benefits.”
CBT for insomnia includes five specific components that work together to change a patient’s thoughts and activities around sleep and their sleep environment. Cognitive therapy aims to identify, challenge, and replace dysfunctional beliefs and attitudes about sleep; stimulus control helps strengthen the association between bed and sleep; sleep restriction limits time spent in bed; sleep hygiene recommendations address environmental factors, physiologic factors, behavior, and habits that promote sound sleep; and relaxation techniques help to limit cognitive arousal and reduce muscular tension to facilitate sleep.
The author of an accompanying editorial notes that CBT is unfamiliar and underused by medical practitioners. More research is needed to determine if CBT for insomnia can improve the negative health outcomes associated with chronic insomnia.
About Annals of Internal Medicine
Annals of Internal Medicine is one of the most widely cited peer-reviewed medical journals in the world. The journal has been published for 88 years and accepts only about 7 percent of the original research studies submitted for publication. Annals of Internal Medicine has a 2013 impact factor of 16.104, ranking it fifth out of 150 journals in the category “Medicine, General & Internal.” The journal is published by the American College of Physicians (ACP).