Cognitive behavioral therapy may work for chronic insomnia
Behavioral treatments are likely to be associated with fewer adverse effects.
Cognitive behavioral therapy (CBT) is an effective treatment for adults with chronic insomnia and should be the initial intervention for chronic insomnia when possible, a meta-analysis concluded.
CBT for insomnia involves 5 techniques: cognitive therapy to address fears and misconceptions about sleep, stimulus control to reinforce the association between the bed and sleeping, sleep restriction to limit nonsleep time in bed, sleep hygiene to reduce distractions while in bed, and relaxation techniques before bedtime.
Researchers conducted a meta-analysis of 20 randomized, controlled trials of 1,162 participants (64% female; mean age, 56 years) that applied at least 3 of the 5 techniques. The studies were published through March 2015 and assessed the efficacy of face-to-face, multimodal CBT against inactive comparators. Studies of insomnia coexisting with medical, sleep, or psychiatric disorders were excluded. Results appeared online first June 8 at Annals of Internal Medicine.
Marked and statistically significant improvements were seen with CBT for the outcomes of sleep onset latency (19.03 minutes; 95% CI, 14.12 to 23.93 minutes), wake after sleep onset (26 minutes; 95% CI, 15.48 to 36.52 minutes), and sleep efficiency (9.91%; 95% CI, 8.09% to 11.73%). There was a nonstatistically significant increase in total sleep time with CBT (7.61 minutes; 95% CI, −0.51 to 15.74 minutes).
The effect sizes found with CBT for insomnia are similar in magnitude to those seen in meta-analyses of hypnotics such as benzodiazepines, the authors wrote. Unlike hypnotics, effects of CBT persist after stopping treatment, with a study showing the techniques had 6 months of sustained effects, they noted, and drugs can lead to tolerance, adverse effects, and rebound insomnia after stopping.
“Therefore, because chronic insomnia is a condition in which nearly half of patients remain symptomatic over 10 years and behavioral treatments are likely to be associated with fewer adverse effects, [CBT for insomnia] has several advantages over pharmacotherapy,” the authors concluded.