Could cognitive behavioural therapy help to treat insomnia?
The program emphasises an increase in sleep quality, as opposed to time asleep, and led to significant benefits.
Insomnia’s very common – about a third of Australians will experience it at some point in their lives. The good news is that it will usually resolve itself – it can be triggered by stress or changes to the sleep environment and will go away once those environmental factors go away.
For some though, insomnia is a chronic condition that can go on for months or years and it can have debilitating effects on a person’s life and work. General practitioners are typically the first point of contact – so what can they do to help?
In a Canadian review of the evidence, they explored something called ‘cognitive behavioural therapy for insomnia,’ or CBT-I. You will have heard of regular CBT – commonly used to treat anxiety and depression – but CBT-I is a different program altogether.
It focuses on four components, with two of those being especially important. Stimulus control therapy involves attaching the bed to sleep only – only going to bed when you feel sleepy, staying out of bed when you’re awake.
Sleep restriction therapy is a prescription for when you sleep and when you wake up – it may even mean going to bed later than you normally would – so that your drive to sleep (what’s sometimes called sleep pressure) is higher and you’re more likely to sleep uninterrupted.
Then there’s a typical cognitive behavioural therapy component – challenging negative thoughts around sleep – and a relaxation component.
The researchers found that when all four of these were delivered in a six week program that was delivered by a qualified professional, people did have improved sleep. They fell asleep faster, they didn’t wake up as much or for as long during the night, and they felt better about the sleep they were getting.
Funnily enough, those who were treated didn’t sleep a minute longer than those who weren’t treated – but the quality of sleep they were getting was higher and that made all the difference.
The costs of insomnia to productivity and the economy are high, so a short program with a good success rate for improving sleep in insomniacs is welcome news.
Drugs for sleep aren’t typically recommended for long-term use – and the evidence suggests they may actually worsen sleep quality when used for extended periods of time. A CBT-I program is a much gentler alternative.
Last Reviewed: 29/04/2020
© Norman Swan Medical Communications.
For reference: Machado, et al (2019). Cognitive behavioural treatment for insomnia in primary care: a systematic review of sleep outcomes. British Journal of General Practice doi: 10.3399/bjgp19X705065.