Does Cognitive Behavioral Therapy (CBT) for Insomnia Work?


Does Cognitive Behavioral Therapy for Insomnia Work?
By Doug Bremner MD

The best treatment of insomnia is cognitive behavioral therapy (CBT). It is much better than medication to treat sleeplessness, and results in a significant improvement in sleep duration and quality without side effects.

To benefit from cognitive therapy, it is preferable if you can have a few sessions with a therapist trained in it. The first step it to replace negative thoughts (“I can’t sleep without medications”) with more positive ones (“If I take the time to relax, I can get to sleep without help from pills.”). The underlying theory is that you “retrain” your brain to learn to sleep peacefully and deeply again.

Changing sleep habits is the second piece of cognitive therapy. For example, using the bed and bedroom only for sleep (no working or TV-watching in bed), setting and maintaining a regular sleep schedule, eliminating daytime naps, and minimizing or avoiding all together caffeine, alcohol, stimulants, and heavy or extremely spicy meals four to six hours before going to bed. Relaxation techniques such as progressive muscle relaxation often help. It involves alternately contracting individual muscles and relaxing with exhalation; the individual goes progressively through the body one-muscle group at a time.

Behavioral changes are highly effective and persist for a longer period of time than drug therapy. About 80% of patients will show improvement. Time to fall asleep is reduced from 65 minutes to 35 minutes, an increase in sleep time of 30 minutes, and improved subjective ratings of sleep quality.

In a well conducted study 46 patients with insomnia were randomized to receive CBT, zopiclone, or placebo medication each night for six weeks.208 Sleep was assessed using sleep diaries and polysomnography. CBT included sleep hygiene, sleep restriction, stimulus control, cognitive therapy and relaxation. CBT was better than zopiclone for sleep efficiency, with an increase from 81% to 90% compared to zopiclone which stayed at 82% before and after treatment. CBT resulted in an increase in slow wave sleep and decrease in time spent awake at night. Six months after the end of treatment CBT resulted in better sleep efficiency using polysomnography than placebo or zopiclone. Since long term use of sleeping pills is not recommended, what this study shows is that people with chronic insomnia really need to make the effort to get sleep behavioral therapy treatment, or at a minimum educate themselves through reading or online about the principles that are promoted in the types of CBT programs utilized in this study.

Meditation and gentle yoga can also help some people fall asleep more easily as part of a cognitive therapy program or on their own. Insomniacs often spend too much time in bed trying to sleep, and the best thing to do is to get out of bed and read for a while or listen to soft music.

So before you go for a prescription sleeper, try some of these ‘side effect free’ alternatives instead!

J. Douglas Bremner, MD, is a researcher and physician and author of
‘Before You Take That Pill: Why the Drug Industry May be Bad for Your Health: Risks and Side Effects You Won’t Find on the Label of Commonly Prescribed Drugs, Vitamins and Supplements.’
http://www.beforeyoutakethatpill.com

More blog postings and articles on osteoporosis by Doug Bremner MD