Cognitive behavioral therapy (CBT)—helping patients challenge and replace dysfunctional beliefs—should be used as the initial intervention to treat chronic insomnia when possible, suggest researchers from Melbourne Sleep Disorders Centre, The Burnet Institute, Monash University, and Western Health, all in Australia. According to their review of 20 studies, CBT for insomnia (CBT-i) had clinically meaningful effects.
The studies incorporated at least 3 of the following: cognitive therapy, stimulus control, sleep restriction, sleep hygiene, and relaxation. The main outcome measures were changes in sleep onset latency (SOL), wake after sleep onset (WASO), total sleep time (TST), and sleep efficiency (SE). The researchers assessed these endpoints immediately after treatment, 4 to < 6 months later, and 6 to 12 months later.
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At baseline, mean SOL was 57.6 minutes, WASO was 76.0 minutes, TST was 344.1 minutes, and SE was 71.8%. These improved by 19 minutes for SOL, 26 minutes for WASO, 7.6 minutes for TST, and 9.9% for SE. The “marked effects” were maintained at both early and late follow-up. For TST, the researchers say, initially small improvements may augment over time. The improvements in sleep time variables were associated with significant alleviation of symptoms when measured with subjective tools.
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CBT-i has advantages over pharmacotherapy, the researchers point out, such as no tolerance issues, adverse effects, and rebound insomnia. Moreover, unlike with hypnotics, the effects persist after treatment stops. They note that in a head-to-head trial of CBT and drugs, the effects of CBT lasted over 6 months of follow-up—a particular benefit in a condition in which nearly half of patients remain symptomatic over 10 years.
Source
Trauer JM, Qian MY, Doyle JS, Rajaratnam SM, Cunnington D. Ann Intern Med. 2015;163(3):191-204.
doi: 10.7326/M14-2841.
