Cognitive Behavioral Therapy for Chronic Insomnia


Jennifer Martin, PhD, AASM board of directors' member and professor of medicine at UCLA discussed CBI-T and some of the challenges in treating patients with chronic insomnia.

Jennifer Martin, PhD, board of directors, AASM, and professor of medicine, University of California-Los Angeles

Jennifer Martin, PhD

The American Academy of Sleep Medicine (AASM) recently published a new clinical practice guideline that strongly recommends multi-component cognitive behavioral therapy (CBT) for chronic insomnia disorder (CID; CBT-I) in adults.

The AASM conducted a scientific review of published literature to answer patient, intervention, comparison, and outcomes (PICO) questions on behavioral and psychological treatments of CID in adults. It focused on patient-reported outcomes (PROs) of sleep quality, sleep latency, wake after sleep onset and remission and responder rates.

NeurologyLive reached out to Jennifer Martin, PhD, board of directors, AASM, and professor of medicine, University of California-Los Angeles, and an author of these new guidelines, to learn more about the strengths of CBT-I. She also discussed some challenges in treating CID.

NeurologyLive: What are some of the challenges in treating CID?

Jennifer Martin, PhD: The biggest challenge that we face in terms of treating insomnia is getting patients to talk to their healthcare providers about their sleep. We know that a number of people are suffering from chronic insomnia problems, but they're reluctant to actually bring it up with their doctor or reach out for help.

How do these new guidelines align with current therapies used for chronic insomnia?

The new guidelines that were just recently released by the AASM highlight how effective behavioral and psychological treatments for insomnia disorder can be. The specific strong recommendation, the treatment that we think will work for most patients, is CBT-I. This is already the most widely used treatment for chronic insomnia disorder in terms of behavioral and psychological approaches. So, what the guidelines do is really emphasize that this is something that patients should look for, that insurance companies should pay for, and that providers should be able to provide for patients who want it.

Could you give a quick overview on how CBT-I works?

CBT-I is a brief treatment that focuses on cognition, so, what people think and their beliefs and attitudes, and the behaviors that people engage in that might be negatively affecting their sleep. So usually, the treatment starts by trying to understand those 2 things — the person's behaviors around sleep and their beliefs and attitudes and thoughts around sleep. Behaviors entail what time they go to bed, when they get up, what they do when they're in bed and what they do if they can't sleep at night. So, if a person walks around all day, worrying about having a hard time falling asleep that night, we address that and try to come up with a healthier approach as part of the treatment. The treatment usually lasts between 4 and 8 sessions total. Usually, it's completed over a period of about 1 to 2 months. So, I also encourage people that, you know, CBT for insomnia doesn't work overnight, but it's pretty quick. Most patients experienced some improvement in their symptoms within the first couple of weeks. And again, within a couple of months, a lot of patients experience complete remission of their symptoms.

What are the strengths of CBT-I?

The main strength of CBT-I is that it works for so many different kinds of patients. One of the things that was explored in the guideline is whether these treatments work, for example, if people also have medical problems or other mental health conditions. And one of the really remarkable things about CBT-I is that even in patients who had chronic medical issues, depression, or anxiety issues along with their insomnia, the treatment is still very effective. I think one of the most valuable aspects of CBT-I is that it's a treatment approach that works for just about everybody.

Transcript edited for clarity.

Edinger JD, Arnedt JT, Bertisch SM, et al. Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine clinical practice guideline. J. Clin. Sleep Med. Published online November 9, 2020. doi: 10.5664/jcsm.8986
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