![]() ![]() Hypnotic medications have been linked to exacerbation of depression and suicidal ideation in people with depressive disorders, cognitive and behavioral changes, and possible driving impairment and motor vehicle accidents. If CBT-I alone is not effective, ACP advises clinicians and patients to discuss the benefits, harms, and costs of short-term pharmacological treatment and decide together whether to add on such treatment. Self-help books and videos also offer CBT-I instruction. Face-to-face intervention has the greatest evidence of efficacy, the editorial said, but telephone and web-based programs may help alleviate the current shortage of practitioners. Patients generally maintain gains after completing treatment and understand how to manage insomnia if it recurs.ĬBT-I usually is provided in individual or group sessions lasting four to eight weeks. CBT-I improves sleep and daytime functioning in 70 to 80 percent of treated persons, often without supplemental medication, according to an accompanying editorial. People with persistent insomnia frequently complain of fatigue, poor cognitive function, mood disturbance, and distress or difficulty with daytime performance.ĬBT-I combines several nonpharmacological interventions to help patients learn strategies to enhance sleep, examine beliefs and practices that hinder sleep, and adopt behaviors to promote sleep. Insomnia coexists with many mental and physical disorders. More women than men are diagnosed with chronic insomnia the disorder also occurs more often in older adults. They often awaken too early and feel unrefreshed by sleep. These individuals report they have had trouble falling or staying asleep at least three nights a week for three months or more. Thus, the committee concluded, “CBT-I provides better overall value than pharmacologic treatment.”Īn estimated 6 to 10 percent of American adults meets DSM-5 diagnostic criteria for insomnia disorder, the guideline noted. “However,” it noted, “because CBT-I is noninvasive, it is likely to have fewer harms, whereas pharmacologic therapy can be associated with serious adverse events.” Information on a CBT-I training course offered by the University of Pennsylvania can be accessed here.Įvidence to compare CBT-I and pharmacologic treatment directly is insufficient, the committee found. “That knowledge may motivate some clinicians to seek further training and others to make more informed decisions on when and where to refer.” “CBT-I training can begin with taking a CBT-I CME course and/or reading a CBT-I manual,” he said. “I hope ACP’s report prompts more clinicians to seek CBT-I training. “Treatment of people with chronic insomnia gets complicated when you encounter patient resistance, and you always do,” Perlis said. A team of researchers led by Rachel Manber, Ph.D., a professor of psychiatry and behavioral sciences at Stanford University School of Medicine, reported these findings in the journal Sleep in February 2015.ĪCP’s report suggests CBT-I can be provided in primary care, but, Perlis said, given the limited number of trained and experienced CBT-I providers, that’s more a goal than present reality. At baseline, 32 percent of the veterans endorsed some level of suicidal ideation at final assessment, after five or fewer treatment sessions, 21 percent did. Treating insomnia concurrently with comorbid psychiatric disorders not only will improve sleep, but also may have a halo effect on those disorders, Perlis, who was not involved in developing the ACP guideline, told Psychiatric News.Īn evaluation of 405 veterans who presented for treatment of insomnia at the Veterans Affairs Health Care System nationwide, for example, found CBT-I reduced both insomnia severity and suicidal ideation. CBT-I works as well as hypnotic medications and has the added benefits of fewer adverse effects during treatment and long-term durability after treatment, said Michael Perlis, Ph.D., an associate professor of psychiatry and director of the behavioral sleep medicine program at the University of Pennsylvania School of Medicine. CBT-I May Improve Comorbid Psychiatric DisordersĪs the report from the American College of Physicians (ACP) suggests, chronic insomnia needs targeted treatment, specifically, cognitive-behavioral therapy for insomnia (CBT-I). ![]()
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