CBT for Insomnia as the first line treatment

Cognitive behavioural therapy for insomnia (CBT-I) is considered the gold standard for treatment of insomnia. It is the preferred first-line treatment method compared to medication for chronic insomnia for reasons discussed in the post

CBT-I works by leveraging our sleep systems to address the causes of insomnia. Below, I discuss 5 benefits of CBT-I in treating chronic insomnia.

1. CBT-I is effective

Perhaps the simplest – and important – benefit of CBT-I is that it is effective. Meta-analysis continue to support efficacy of CBT-I in treating insomnia. Specifically, CBT-I improves both objective (e.g., how long it takes someone to fall asleep) and subjective sleep outcomes (subjective feelings of insomnia). Beyond sleep, CBT-I has been found to also improve other health outcomes, such as depression, anxiety, pain, and overall quality of life.

2. CBT-I improves confidence in being able to sleep well

From a more meta-cognitive perspective, CBT-I not only improves sleep but it improves our relationship with sleep. People who have been treated with CBT-I typically report that they feel more confident in their bodies natural ability to produce high quality sleep even if they have bad nights. This is called sleep self-efficacy.

3. CBT-I focuses on quality over quantity

CBT-I works by consolidating our sleep. Instead of taking a lot of time to fall asleep and wake up numerous times throughout the night, CBT-I ensures that our sleep is deep and restorative with minimal wake time in the night.

The treatment recognizes that our individual sleep needs are different. Some people may require more sleep and other may function well with less sleep. By focusing on quality, CBT-I ensures that each person meets their sleep needs and feels well-rested for the day.

4. CBT-I has relatively fewer side effects

Besides a bit of sleep deprivation for a few nights during the active parts of therapy, CBT-I is generally safe in terms of potential side effects. This is because CBT-I primarily relies on specific changes in the way we think or behave in response to a bad nights, rather than any outside influence.

This finding contrasts with medication, in which people can experience side effects, such as drowsiness, headache, or nausea according to an article by MayoClinic.

5. CBT-I is durable in the long-term

One other difference between CBT-I and medication is that CBT-I is durable even after treatment is completed. Research has found that the positive effects of CBT-I can last for at least 3 years after treatment. Moreover, research from our lab suggests that we don’t have to follow the rules of CBT-I forever to keep our treatment gains. You can have your cake and eat it too!

Final thoughts

There are numerous benefits to CBT-I when it comes to treatment of insomnia. That being said, there are limitations to all treatments of course. CBT-I can be a lot of work and take commitment to successfully benefit from this treatment. From a logistical perspective, CBT-I takes longer to work compared to medication, and is relatively expensive and inaccessible. There are self-help books on CBT-I should therapy from direct treatment providers not be an option.

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Best wishes,

P