Treating Insomnia with Cognitive Behavior Therapy

At any given time, about 27% of the American population suffers from insomnia. Treating insomnia has become big business with the introduction of the newer, safer nonbenzodiazapine pills like Ambien, Sonata, and Lunesta. At the same time treating insomnia with cognitive behavior therapy has been presented as an alternative to sleeping pills.

Before any treatment for insomnia begins, patients should rule out any medical causes or mental illness such as depression or severe anxiety.

What is cognitive behavior therapy? Cognitive behavior therapy emphasizes the important role of thinking in how we feel and in what we do. It is important to identify the thinking that is causing unwanted feelings/behaviors and to replace thinking with thoughts that that to more desirable behaviors. For example, many people with insomnia think that losing sleep will be disastrous and worrying about this creates the very behavior they are trying to avoid.

Cognitive behavior therapy also teaches good sleep hygiene for people with insomnia and tries to correct the following causes of insomnia:

*Irregular sleep time
*Overuse of caffeine
*Daytime naps
*Overstimulation from too much food, loud music, evening sports, etc.
*Using the bed for activities other than sleep or sex

Arthur Speilman, co-author of "The Insomnia Answer" recommends the following to overcome insomnia:

*Don't worry about lost sleep, it's not a catastrophe.
*Do deep breathing for ten minutes while imagining a peaceful but engaging scene.
*Expose yourself to bright light as soon as you wake up to reset your biological clock.
*Keep a sleep log detailing when you wake, when you go to sleep, what you eat and drink, what medications you take. This may help you to find your triggers to insomnia.

Is cognitive behavior therapy more effective in treating insomnia than are sleeping pills? The evidence so far would seem to say yes.

A small study (50 people over age 50) done by Jack Edinger found that cognitive behavior therapy was more effective and longer lasting than pills.

Borge Sivertsen of the University of Beren, Norway compared cognitive behavior therapy to the sleeping pill zopicione. 18 people received cognitive behavior therapy, including instruction on sleep therapy and progressive relaxation. 16 people got the sleeping medication, and 12 were given a placebo. Treatment lasted for 6 weeks and then there was a follow up at 6 months.

At six months the people treated for insomnia with cognitive behavior therapy improved sleep efficiency by 9% while those who took zopicione actually got a little worse with decrease of 1% in sleep efficiency. It should be noted, however that zopicione is not one of the newer sleeping pills.

Thus the early evidence would seem to show that cognitive behavior therapy is more effective in treating insomnia than are sleeping pills. Initially, at least, the cost of cognitive behavior therapy is greater than that of taking sleeping pills. But over the long run, it is probably cheaper in terms of pill side effects, lost work, and diminished pleasure in life.