Cognitive Behavioral Therapy Effective Treatment for Chronic Insomnia

According to research, a majority of people experiencing chronic insomnia can experience a normalization of sleep parameters through the use of cognitive behavioral therapy for insomnia (CBT-I).

Insomnia is a common sleep complaint that occurs when you have one or more of these problems:

You have a hard time initiating sleep.
You struggle to maintain sleep, waking up frequently during the night.
You tend to wake up too early and are unable to go back to sleep.
You sleep is nonrestorative or of poor quality.

These symptoms of insomnia can be caused by a variety of biological, psychological and social factors. They most often result in an inadequate amount of sleep, even though the sufferer has the opportunity to get a full night of sleep. Insomnia is different from sleep deprivation, which occurs when an individual does not have the opportunity to get a full night of sleep. A small percentage of people who have trouble sleeping are actually short sleepers who can function normally on only five hours of sleep or less.

There are two types of insomnia – primary and secondary. Primary insomnia is sleeplessness that cannot be attributed to an existing medial, psychiatric or environmental cause (such as drug abuse or medications). Secondary insomnia is when symptoms of insomnia arise from a primary medical illness, mental disorders or other sleep disorders. It may also arise from the use, abuse or exposure to certain substances.

The research results indicate that 50 percent to 60 percent of participants with chronic sleep onset insomnia, sleep maintenance insomnia or both experienced remission of their primary sleep difficulty. Among the 64 participants who completed five or more CBT-I treatment sessions, there were significant improvements on presenting complaints, as well as all other measures, including sleep efficiency, average nightly awakenings, total sleep time and average nights of sleep medication use per week.

According to lead author Ryan Wetzler, results of the study indicate that multi-component CBT-I can be an effective approach for those experiencing chronic insomnia even when anxiety and depression are part of the clinical picture.

"CBT-I teaches strategies to 'reset' the bodily systems that regulate sleep," said Wetzler. "Since these systems also play a role in regulation of mood, pain and other bodily processes, skills developed through CBT-I may also have a positive impact on mood, anxiety, pain and other associated medical or psychiatric conditions."

The study gathered data from 115 patients who had visited the Insomnia Treatment Program and Behavioral Sleep Medicine Clinic. Study participants included those with complaints of prolonged (more than 30 minutes) sleep onset latency (SOL), sleep maintenance insomnia (SMI), or both sleep onset and sleep maintenance insomnia (SOMI), and who had attended at least two treatment sessions. Participants were between the ages of 14 and 81 years, and 65 percent of the sample was female.

The multi-component, CBT-I program included comprehensive evaluations of patients' habits, attitudes and knowledge concerning sleep. The program was designed to involve six to seven treatment sessions. Specific strategies included education on sleep regulating systems, sleep scheduling recommendations, sleep hygiene education, sleep consolidation therapy, stimulus control therapy, relaxation training, cognitive therapy and mindfulness training.

According to Wetzler, a related study found that of participants who completed at least four treatment sessions of CBT-I, 78 percent of those using sleep medication for three or more nights per week were able to completely discontinue use of sleep medications. Findings from this study indicate that those who discontinued use of sleep medications not only stopped using drugs to sleep but also slept better than when they were taking sleep medications.
References:
1. Ryan Wetzler, et al. Effectiveness of a Cognitive-Behavioral Treatment Program for Chronic Insomnia. American Academy of Sleep Medicine.
2. Image by ArneCoomans.

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