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Talk-based therapy addresses the cause of insomnia, improves
sleep without side effects
video | Read the
Philadelphia, June 9, 2015 -- An evidence review published in
Annals of Internal Medicine finds that patients with
chronic insomnia who undergo cognitive behavior therapy (CBT) can
improve sleep without drugs and without adverse outcomes. According
to the study authors, CBT works because it addresses the process
that drives insomnia - anxiety about time spent awake in bed.
Clinical chronic insomnia affects up to 15 percent of adults and
is associated with health issues such as anxiety, depression, and
type 2 diabetes. Pharmacological approaches to treating insomnia
are associated with tolerance, dependence, and adverse side
effects, which makes talk-based therapy an appealing option for
Researchers reviewed 20 published randomized controlled trials
assessing the efficacy of face-to-face, multi-component CBT on
overnight sleep in adults with chronic insomnia and no underlying
medical causes. They found that CBT helped patients enter sleep
about 20 minutes faster, reduced the amount of time spent awake
after falling asleep by nearly 30 minutes, and improved sleep
efficiency by almost 10 percent. Study authors say that these
findings are important because the psychological approach is safer
and better tolerated than medication and teaches skills that can be
maintained over time. They note that this approach takes
significant effort from the patient compared to taking a pill,
which could explain its underuse.
"I'm often surprised by how many different treatments patients
have tried -- from herbal supplements to internet resources to
medications -- without ever having tried cognitive behavioral
therapy for insomnia," said study author Dr. James Trauer, Sleep
and Respiratory Physician at Melbourne Sleep Disorders Centre.
"It's a lot of hard work but it does produce benefits."
CBT for insomnia includes five specific components that work
together to change a patient's thoughts and activities around sleep
and their sleep environment. Cognitive therapy aims to identify,
challenge, and replace dysfunctional beliefs and attitudes about
sleep; stimulus control helps strengthen the association between
bed and sleep; sleep restriction limits time spent in bed; sleep
hygiene recommendations address environmental factors, physiologic
factors, behavior, and habits that promote sound sleep; and
relaxation techniques help to limit cognitive arousal and reduce
muscular tension to facilitate sleep.
The author of an accompanying editorial notes that CBT is
unfamiliar and underused by medical practitioners. More research is
needed to determine if CBT for insomnia can improve the negative
health outcomes associated with chronic insomnia.
About Annals of Internal
MedicineAnnals of Internal
Medicine is one of the most widely cited peer-reviewed
medical journals in the world. The journal has been published for
88 years and accepts only about 7 percent of the original research
studies submitted for publication. Annals of Internal
Medicine has a 2013 impact
factor of 16.104, ranking it fifth out of 150 journals in the
category "Medicine, General & Internal." The journal is
published by the American College of Physicians (ACP). Follow
Annals on Twitter and Facebook.