Insomnia has a high prevalence rate, with 5% to 15% of adults meeting diagnostic criteria (Trauer, Qian, Doyle, Rajaratnam, & Cunnington, 2015). The impact is not limited to nighttime problems; rather, it can be considered a 24-hour problem that is known to affect functioning throughout the day (Morin, 2015). Furthermore, insomnia is also a significant risk factor for adverse health, psychological, and occupational problems (Morin, 2015).
Insomnia has been linked to anxiety and depression (Trauer et al., 2015). Often solutions or treatment of insomnia are related to pharmacological aid, with approximately 6-10% of adults in the US using hypnotics in 2010 (Trauer et al., 2015). Yet, given concerns of side effects and addictive properties of benzodiazepines, alternative interventions are being studied. Specifically, Cognitive-Behavioral Therapy for insomnia (CBT-i) has been shown to be an effective alternative to pharmaceuticals.
In general, CBT-i has five components: Cognitive Therapy, focusing on identifying negative beliefs about sleep and explaining how these beliefs relate to insomnia, then identifying alternative thoughts; Stimulus Control, attempting to maximize the association between the bed and sleep through behavioral changes (e.g., avoiding stimulating activity in the bedroom, such as watching television or using the computer); Sleep Restriction, behavioral instruction advising patients to only go to bed when sleepy in order to minimize lying awake time; Sleep Hygiene, educating and discussing good sleep practices (e.g., avoid daytime naps); and finally, Relaxation, teaching relaxation skills to use before bed (Trauer et al., 2015).
To investigate the efficacy of CBT-i, Trauer, Qian, Doyle, Rajaratnam, and Cunnington (2015) completed a systematic review and meta-analysis to examine the outcome of CBT-i compared to pharmacological interventions. Results indicate that after participating in CBT-i, patients fell asleep faster (19.03 minutes), spent less time awake in the middle of the night (26 minutes less), got more sleep overall (increase of 7.61 minutes), and improved self-efficacy about sleep by 9.91 percent. The authors concluded that CBT-i demonstrated similar levels of improvement compared to benzodiazepines for treatment of insomnia (Trauer et al., 2015). Of note, the authors did not compare CBT-i to other sleep aids (i.e., Z drugs or non-benzodiazepines [Lunesta, Ambien]), due to limited data regarding the long-term effects of such medications.
Overall, CBT-i was noted to be more sustainable overtime compared to pharmacological treatment and reported no adverse outcomes. Given that CBT-i requires more effort and commitment when compared to taking a pill, it becomes necessary to determine if CBT-i has a beneficial impact on quality of life, fatigue, and psychological distress (Morin, 2015). Ultimately, these findings demonstrate the efficacy of CBT-i and provide patients with a choice regarding treatment for insomnia.
Morin, C. M. (2015). Cognitive behavioral therapy for chronic insomnia: State of the science versus current clinical practices. Annals of Internal Medicine. Advance online publication. doi: 10.7326/M15-1246
Trauer, J. M., Qian, M. Y., Doyle, J. S., Rajaratnam, S. M. W., & Cunnington, D. (2015). Cognitive behavioral therapy for chronic insomnia: A systematic review and meta-analysis. Annals of Internal Medicine. Advance online publication. doi: 10.7326/M14-2841
Dannie S. Harris, M.A., M.A., M.A.Ed., Ed.S.
WKPIC Practicum Trainee