Cognitive Behavior Therapy for Insomnia (CBT-I)
CBT-I is an evidence-based non-drug approach based on the concept that chronic insomnia (lasting more than 4 weeks) is maintained by a variety of physical and behavioral factors that have little or nothing to do with the initial acute insomnia (one or two days). The factors that actually maintain the chronic insomnia are in fact the ones targeted in treatment.
Research has clearly shown that CBT-I helps treatment for anxiety and depression work even better. Improved sleep leads to improved mood.
Treatment goes beyond basic sleep hygiene and typically includes: education on the many factors that can interfere with sleep, developing healthy and effective sleep behaviors, learning skills for calming the mind and managing stress, individualized sleep-wake scheduling programs (including sleep consolidation and stimulus control) eliminating sleep-incompatible behaviors, and the use of properly timed light exposure to reset the sleep-wake body clock. These procedures are often complemented with relaxation training and cognitive therapy, based upon the treatment plan.
A goal of CBT-I is to teach patients the tools they need to maintain improvements in sleep, particularly when they experience events that previously contributed to insomnia. Although each person’s situation is unique, on average, 4 to 12 sessions are typically required to improve upon sleep and continue sleeping well. Relapse prevention strategies are discussed in detail to maintain gains.
Patients need not discontinue their sleep medications before or during CBT-I. It is a personal decision that is often made alongside a discussion with the prescribing physician. Very frequently, patients start CBT-I because they are unable to continue receiving sleep aids, or they need to taper off and sleep well once and for all without them for a variety of reasons. CBT-I teaches patients the skills necessary to do just this. Many patients are able to either discontinue or successfully reduce their reliance on sleep aids once finishing treatment.
Clinical studies have shown that CBT-I is highly effective, producing long-lasting results that are comparable to or exceed those of sleeping pills. The American College of Physicians (ACP) recently deemed CBT-I to be the “first line” treatment option for insomnia, before medication interventions.