Why cognitive behavioral therapy (CBT) should be first-line treatment for chronic insomnia

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Cog­ni­tive behav­ioral ther­a­py offers a drug-free method for man­ag­ing insom­nia (Har­vard Health):

“Many peo­ple with insom­nia turn to sleep­ing pills, which often have unwant­ed side effects. Few of them know about an equal­ly effec­tive ther­a­py that tar­gets the root cause of insom­nia with­out med­ica­tions. Called cog­ni­tive behav­ioral ther­a­py for insom­nia, or CBT‑i, this short-term talk ther­a­py teach­es peo­ple to change the unpro­duc­tive think­ing pat­terns and habits that get in the way of a good night’s sleep…

In a review arti­cle in this week’s Annals of Inter­nal Med­i­cine, researchers com­bined data from 20 dif­fer­ent tri­als of CBT‑i involv­ing more than 1,100 peo­ple with chron­ic insom­nia. On aver­age, peo­ple treat­ed with CBT‑i fell asleep almost 20 min­utes faster and spent 30 few­er min­utes awake dur­ing the night com­pared with peo­ple who didn’t under­go CBT‑i.

These improve­ments are as good as, or bet­ter than, those seen in peo­ple who take pre­scrip­tion sleep med­ica­tions such as zolpi­dem (Ambi­en) and eszopi­clone (Lunes­ta). And unlike med­ica­tions, the effects of CBT‑i last even after the ther­a­py ends—at least six months, accord­ing to one study.”

Study: Cog­ni­tive Behav­ioral Ther­a­py for Chron­ic Insom­nia: A Sys­tem­at­ic Review and Meta-analy­sis (Annals of Inter­nal Med­i­cine). From the abstract:

  • Back­ground: Because psy­cho­log­i­cal approach­es are like­ly to pro­duce sus­tained ben­e­fits with­out the risk for tol­er­ance or adverse effects asso­ci­at­ed with phar­ma­co­log­ic approach­es, cog­ni­tive behav­ioral ther­a­py for insom­nia (CBT‑i) is now com­mon­ly rec­om­mend­ed as first-line treat­ment for chron­ic insomnia.
  • Pur­pose: To deter­mine the effi­ca­cy of CBT‑i on diary mea­sures of overnight sleep in adults with chron­ic insomnia.
  • Study Selec­tion: Ran­dom­ized, con­trolled tri­als assess­ing the effi­ca­cy of face-to-face, mul­ti­modal CBT‑i com­pared with inac­tive com­para­tors on overnight sleep in adults with chron­ic insom­nia, with stud­ies of insom­nia comor­bid with med­ical, sleep, or psy­chi­atric dis­or­ders excluded.
  • Con­clu­sion: CBT‑i is an effec­tive treat­ment for adults with chron­ic insom­nia, with clin­i­cal­ly mean­ing­ful effect sizes.

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