Sunday, April 22, 2018
Health

Cognitive behavioral therapy joins battle versus insomnia

Chicago Tribune

Dana Albright struggled with insomnia for more than a decade.

The Philadelphia teacher would sleep well one night, and then sleep less each night after that, until for a night or two she wasn't sleeping at all. She totaled two cars in fatigue-related accidents. She was prescribed a succession of sleep medications — Lunesta, Ambien, Zaleplon — but the drugs were ineffective or too expensive, or the side effects were too burdensome.

Then her doctor suggested something completely different: cognitive behavioral therapy for insomnia, or CBT-I, which is roughly six to eight talk therapy sessions focused on adopting sleep-promoting attitudes and behaviors.

"It's eight weeks, and it can change everything," Albright, 32, says of CBT-I.

She now sleeps an average of slightly less than eight hours a night, she says. She's much happier and more alert, and she has the energy she needs for her job.

The National Institutes of Health recognizes CBT-I as the preferred treatment for chronic insomnia, and a 2012 review of the medical literature in the journal BMC Family Practice found evidence that CBT-I is more effective in the long run (six months to two years) than sleep medications, with improvements along the lines of 30 to 60 minutes of total sleep time per night.

"What the studies in general show is that in the short run, while people are in treatment, medication and CBT-I are equally effective. But if you look over the long term, CBT-I has much better long-term gains than medication," says University of Pennsylvania assistant professor of psychology Philip Gehrman, a co-author of the 2012 study.

Yet, CBT-I has been slow to catch on, with only about 200 providers certified in the field by the American Board of Sleep Medicine (absm.org/bsmspecialists.aspx). There also are online options, such as cbtforinsomnia.com.

CBT-I involves sleep hygiene practices such as using the bed only for sleep and sex; relaxation exercises to combat sleep-related anxiety; and sleep-efficiency training, in which you limit the time you spend in bed lying awake.

"The theory behind it is that the sleep drive — the need for sleep — builds up and it gets to the point where it overrides the anxiety (about not being able to sleep)," Gehrman says.

The harder you try to fall asleep, the harder it is to do it, Gehrman adds, and sleep efficiency training shifts a patient's focus from trying to fall asleep to trying to stay up.

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