Cognitive-behavioral therapy proves to be a very effective insomnia
treatment that is often overlooked because few clinicians are skilled in its
use.
“Cognitive behavioral therapy (CBT) can be an important part of any
insomnia treatment regimen,” asserted Carl Hunt, M.D., director of the
National Center on Sleep Disorders Research.
“Physicians don't have to choose between CBT and medication,”
he added. “They don't debate whether to give patients with hypertension
an antihypertensive drug or urge them to watch their diet. They do
both.”
Comparative trials show CBT works as well as prescription hypnotics for
insomnia, a National Institutes of Health review panel noted (see article
above). In a study at Boston's Beth Israel Deaconess Medical Center, for
example, Gregg Jacobs, Ph.D., and colleagues compared CBT alone, zolpidem
alone, a CBT/zolpidem combo, and a placebo in 63 adults aged 25 to 64 for
eight weeks.
Participants kept sleep diaries and had three nights of home-based Nightcap
sleepmonitor recordings before and after treatment. Therapists taught CBT
participants how to identify and curb thoughts that elevate arousal and
interfere with sleep. They urged poor sleepers to reserve the bedroom for
sleep and sex, go to bed only when drowsy, arise at the same time each day,
and use other behavioral tactics known to benefit sleep.
At one-year follow-up, CBT users maintained therapeutic gains. Combination
treatment offered no advantage over CBT alone, Jacobs' group reported in the
September 2004 Archives of Internal Medicine. The beneficial effects
of CBT may continue long after formal treatment stops, the panel noted, while
those of sleep medications seldom do. Relatively few clinicians have expertise
in using CBT for insomnia, however. There are only about 50 certified
behavioral sleep medicine specialists in the United States and perhaps only
200 worldwide.
CBT specialists are exploring group treatment, training of nurse
practitioners or physician assistants as therapists, phone therapy,
bibliotherapy, Web-based self-help programs, and even—in
Holland—an eight-show television series to teach behavioral
interventions to the general public. In a study at the University of Glasgow,
Scotland, primary care nurses trained in CBT conducted six therapy sessions
with 139 people with insomnia, in groups of four to six people at a time. By
the last session, participants fell asleep faster and awakened less often at
night, Colin Espie, Ph.D., and colleagues reported in Behaviour Research
and Therapy in January 2001. One year later, participants maintained
their improvement and had increased their total sleep time. Moreover, 84
percent of those who initially had used hypnotics remained drug free.▪