CBTi: Cognitive Behavior Therapy for Insomnia

The research on the effectiveness of Cognitive Behavior Therapy for Insomnia (known as CBT-I or CBTi, for short) keeps rolling in.  In a just-published article in the Southern Medical Journal, entitled “Cognitive Behavioral Therapy in the Treatment of Insomnia,” the authors Haynes, Talbert, Fox, and Close discuss the studies that support the use of this CBT approach for people who suffer from insomnia.

Up to 30% of U.S. adults have insomnia

The authors note that, in the U.S., up to 30% of the adult population suffers from insomnia and that insomnia is associated with significant physical and mental health problems.  If someone has insomnia, the probability of their also having problems with the diabetes precursor “metabolic syndrome” and diabetes itself, along with high blood pressure and heart disease is significantly elevated.  They maintain that insomnia sufferers utilize medical services at a higher rate than individuals without insomnia.

Insomnia is associated with a wide variety of physical and mental health problems

Insomnia is often associated with a wide range of mental health problems.  Anxiety, bipolar disorder, depression, and other mental disorders frequently co-occur with insomnia.  Please see our blog article on the findings that CBTi can be both an effective treatment for depression as well as for insomnia.

The authors in this article review the studies establishing the effectiveness of CBTi alone and also review CBTi’s effectiveness when compared to common prescription sleep aids. Their review of the studies of CBTi vs placebo (i.e., inactive interventions) concluded that CBTi was effective in significantly reducing the symptoms of insomnia.

Cognitive behavioral therapy for insomnia is as effective or more effective than sleep medications

More relevant to most of us, they also reviewed studies comparing the effects of CBTi against a number of common sedative-hypnotics (sleep medications) such as benzodiazepines (the family of medications that Valium, Xanax, Ativan, Klonopin are a part of) and non-benzodiazepines (such as Ambien/zolpidem) and found that, in these studies, CBTi was as effective or more effective than medications.  Further, CBTi did not have the harmful side effects of the sleep medications, such as:

• daytime drowsiness
• mood alterations
• memory impairment
• myalgia (muscle pain)
• dizziness
• hallucinations
• risk of falls and fractures
• possibility of addiction

CBTi is also very helpful for older adults

The authors also reviewed the usefulness of CBTi with older adults, noting that adults 65 years or older have two times the rate of insomnia of younger adults. They note that older adults fall more frequently than younger adults and these falls often end in serious injury or even death.  Unfortunately, the use of sleep medications greatly increases the risk of falls in this population.  One study found that the use of sedative-hypnotics increased by 22% the fall risk in elderly individuals. The authors suggest that the use of CBTi as the primary intervention for insomnia, with its lack of side effects, may be warranted.

CBTi  “offers an attractive alternative to the long-term efficacy and safety concerns associated with sedative-hypnotics…”

The authors conclude that cognitive behavior therapy for insomnia (CBTi) “offers an attractive alternative to the long-term efficacy and safety concerns associated with sedative-hypnotics and the adverse effects of other commonly used sleep medications.”

As a review for those of you who are wondering what CBTi is, the CBTi treatment approach is made up of the following components:

• Sleep hygiene
• Stimulus control
• Sleep restriction
• Cognitive therapy
• Relaxation training

(For added detail about this, please read our blog “CBTi: Umm, what exactly is it?”

We, here at the Glendale and Torrance offices of the Cognitive Behavior Therapy Center of Southern California, are trained in the expert delivery of CBTi. If you are having sleep difficulties, please reach out to us. You deserve a good night’s sleep!

Author Dr. Rodney Boone is the Founder and Director of CBT SoCal, has taught as a former member of the faculty in UCLA’s Department of Psychiatry, and practices in Glendale and Torrance, CA.