Cognitive-Behavioral Therapy for Insomnia

Did you know that the first-line treatment for insomnia isn’t a pill? 

That’s right:  the American Academy of Sleep Medicine, the British Association of Psychopharmacology, the American College of Physicians and the European Sleep Research Society all recommend something else, and it’s something you’ve probably never heard of.

Are you ready for it?

The first-line treatment for insomnia is therapy. 

Cognitive-Behavioral Therapy for Insomnia, to be specific.

What is that, why is that, and how does it work?

What is Cognitive-Behavioral Therapy for Insomnia?

Cognitive-Behavioral Therapy for Insomnia, or CBT-I, is a 6-10 week treatment focused on the thoughts and behaviors that drive insomnia.  In short- and long-term trials, CBT-I alone or with medication is shown to be superior than medication alone, while avoiding side effects or drug interactions.

Why is CBT-I the first line treatment for insomnia? 

Insomnia is an interplay of many factors.  Two significant, modifiable factors are thoughts and behaviors.  Insomnia begets anxiety which begets insomnia.  The fear of not sleeping translates into more insomnia which creates more fear.  Many people modify their behavior to compensate, such as spending more time in bed, napping during the day to catch up on sleep, and avoiding activities in the evening.  Unfortunately, many of these behaviors actually make insomnia worse.  In a lot of ways, insomnia is a vicious cycle.

How does CBT-I work?

CBT-I starts with data and education.  In the first session, I will review your sleep history, screen for sleep and mental health disorders, and create a formulation for your insomnia, while you start a sleep diary.  In the next sessions, I will work with you to slowly break the cycle of insomnia by learning about sleep, finding the optimum bedtime and waketime, and creating habits that enhance sleep.  Throughout this process, I will work with you to steadily decrease anxiety and again make sleep a pleasant experience.  Most patients experience significant improvement in their sleep and increase their confidence to address insomnia in the present and future.

 Schedule a free 15-minute consultation today to start tackling your insomnia!

Sources:

1.) Ramakrishnan K, Scheid DC. Treatment options for insomnia. afp. 2007;76(4):517-526.

2.) Wilson S, Anderson K, Baldwin D, et al. British Association for Psychopharmacology consensus statement on evidence-based treatment of insomnia, parasomnias and circadian rhythm disorders: An update. J Psychopharmacol. 2019;33(8):923-947.

3.) Qaseem A, Kansagara D, Forciea MA, Cooke M, Denberg TD, for the Clinical Guidelines Committee of the American College of Physicians. Management of chronic insomnia disorder in adults: a clinical practice guideline from the american college of physicians. Ann Intern Med. 2016;165(2):125.

4.) Riemann D, Baglioni C, Bassetti C, et al. European guideline for the diagnosis and treatment of insomnia. Journal of Sleep Research. 2017;26(6):675-700.

5.) Manber, R., Friedman, L., Siebern, A.T., Carney, C., Edinger, J., Epstein, D., Haynes, P., Pigeon, W., & Karlin, B. E., (2014). Cognitive Behavioral Therapy for insomnia in Veterans: Therapist manual. Washington, DC: U.S. Department of Veterans Affair