CBT: Familiar Name, Different Approach

Despite their similar names, cognitive-behavioral therapy for insomnia (CBT-I) and for depression (CBT-D) tilt to opposite sides in their emphasis on behavior vs. cognition.

CBT-I strives to foster sleep-promoting behaviors, while CBT-D focuses more on correcting cognitive distortions (See Original article: Nonmedical Interventions Promising in Insomnia Treatment for more information).

“The biggest problem we see in people with chronic insomnia is excessive time spent in bed awake,” said Michael Sateia, M.D., of Dartmouth. “They pair being in bed with frustration.” Sleep specialists advise people to leave the bedroom when unable to sleep. This is one of several strategies known as stimulus control, aimed at strengthening cues for sleep.

CBT-I uses sleep restriction, a structured way to consolidate sleep. It also incorporates standard relaxation techniques to reduce tension at bedtime.

“While psychiatric disorders, most commonly mood disorders, unquestionably contribute to the development of insomnia,” Sateia said,“ in the course of these illnesses, insomnia often develops a life of its own.

“It's not realistic to expect that treatment of depression alone will resolve the sleep disturbance,” he said. “Patients need additional treatment directed specifically to insomnia. CBT-I is the first-line recommended treatment.”

Daniel Buysse, M.D., of the University of Pittsburgh School of Medicine, urges psychiatrists to teach patients with insomnia behavioral strategies before prescribing hypnotic medications and to use these methods even with those taking hypnotics. Simple behavioral strategies help many people, he noted, and avoid medication-associated side effects.