What Can We Do For Insomnia?

Insomnia affects personal and societal health and has been linked to increased risk of cardiovascular disease, disability, psychological problems and greater utilization of health care. According to the U.S. Department of Veteran’s Affairs, insomnia can also negatively impact the endocrine, immune and nervous systems or may cause chronic medical conditions such as diabetes and high blood pressure to worsen. Insomnia can adversely affect quality of life for anyone but has an especially detrimental impact on older adults. Insomnia or sleep deprivation can affect short term memory, cause agitation or irritability, and lead to depression.

Cognitive behavioral therapy for insomnia (CBT-I) is a low cost, established treatment that has been proven to be effective in a number of randomized controlled trials. Furthermore, CBT-I has proven to be more effective in the long run compared to prescribed sleep medications.

It’s true that medications could be helpful. However, what we find is that more often than not, sleep medications are effective for only a short time helping with breaking up days of difficulty sleeping. Most patients want immediate relief and once they begin utilizing medications (over the counter or prescribed) they are often dissatisfied. The key to resolving poor sleep is to confront potential causes of difficulty such as anxiety, stress, or negative thought patterns. There may also be a need to address lifestyle choices including caffeine use, exercise, or disruptive work schedules.

CBT-I is an effective method for insomnia in both the short and long term. Some patients find relief in as early as four sessions. CBT-I utilizes a three- pronged approach to improve sleep: address sleep patterns, recognizing maladaptive behaviors, and arresting unhelpful thoughts and feelings. Some of the recommendations during CBT-I include: keeping a sleep diary, calculating sleep need, and decreasing caffeine intake.

Maybe some of our patients can benefit from CBT-I . . .  

Jacobs, G.,  Pace-Schott, E., Stickgold, R., Otto, M., (2004). Cognitive behavior therapy and pharmacotherapy for insomnia: A randomized controlled trial & direct comparison. Archives of Internal Medicine 164, 1888-1896. Doi:10.1001/archinte.164.17.1888.

Karlin, B., Trockel, M., Spira, A., Taylor, C., Manber, R., (2014). National evaluation of the effectiveness of cognitive behavioral therapy for insomnia among older versus younger veterans. International Journal of Geriatric Psychiatry 30, 308-315.

Morin, C., Culbert J., Schwartz, S., (1994). Nonpharmacological interventions for insomnia: A meta-analysis of treatment efficacy. American Journal of Psychiatry 151, 1172-1180.

 U.S. Department of Veteran’s Affairs (2017). Path to better sleep. Veteran Training. Retrieved from: https://www.veterantraining.va.gov/insomnia/index.asp.

 

 

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