Cognitive Behavioral Therapy vs. Pharmacological Treatments for Insomnia: Jennifer Martin, PhD

“Cognitive behavioral therapy (CBT) for insomnia doesn't work overnight, but it's pretty quick. Most patients experience some improvement in their symptoms within the first couple of weeks. Within a couple of months, a lot of patients experience complete remission of their symptoms.”

The most recent guidelines for the treatment of chronic insomnia disorder (CID) in adults published by the American Academy of Sleep Medicine (AASM) included a strong recommendation for the use of CBT for insomnia (CBT-I). Literature review demonstrated clinically meaningful improvements in critical outcomes and favorable information on cost-effectiveness of CBT-I.¹ A number of studies published in the past year have suggested it is both cost-effective and particularly effective for woman both during pregnancy and post-childbirth. 

In 2017, the AASM updated clinical guidelines for the use of pharmacologic treated of CID that emphasized that medications should mainly only be used if CBT-I fails. Only weak positive recommendations were given to agents such as suvorexant, eszopiclone, zaleplon, zolpidem, triazolam, temazepam, ramelteon, and doxepin, while weak negative recommendations were made for the use of trazodone, tiagabine, diphenhydramine, melatonin, tryptophan, and valerian.²

NeurologyLive reached out to Jennifer Martin, PhD, AASM board of directors, and professor of medicine, UCLA David Geffen School of Medicine, authors of the guideline, to learn more about CBT. Martin also discussed interactions between CBT and pharmacological treatments for CID.

REFERENCES

1. 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
2. Sateia MJ, Buysse DJ, Krystal AD, Neubauer DN, Heald JL. Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults: An American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2017; 13(2):307–349.