New guidelines call for cognitive therapy for insomnia

May 4, 2016 Providence Health Team

If insomnia keeps you up at night, a sleeping pill might not be your best long-term solution. Cognitive behavioral therapy is a better choice, according to new guidelines from the American College of Physicians (ACP).

Researchers looked at 10 years of research before reaching that conclusion. Cognitive behavioral therapy for insomnia, known as CBT-I, involves changing habits and thinking patterns that get in the way of sleep. For example, a therapist may help a patient learn how to banish worrying thoughts while in bed. Other CBT-I techniques include:

  • Creating a bedroom environment that promotes sleep
  • Using your bed only to sleep, instead of a place to also read and watch TV
  • Limiting caffeine and alcohol, and routinely exercising

The ACP recommends combining sleep medication with CBT-I only if therapy alone doesn’t work.

Prescription sleep aid warnings

Six to 10 percent of adults suffer from clinically diagnosed insomnia, according to the physicians group. If you or someone you know has insomnia, you’re well aware of the debilitating effects – fatigue, poor cognitive function and moodiness, to name a few.

The physicians group said there was insufficient evidence to assess the benefits and potential harms of long-term use of sleeping pills. But it noted that the Food and Drug Administration has approved the use of sleep medication for stretches of four to five weeks and says that people with insomnia shouldn’t use sleeping pills for extended periods.

The group also noted that sleep medication carries warning labels. One recent study suggests some sleeping pills may double a person's risk of a car crash.

The ACP study acknowledges that while CBT-I may be difficult initially, over time it does seem to be effective and long-lasting.

The basics for a good night's sleep

Making sleep a priority can improve your health and well-being for the rest of your life. The National Institutes of Health (NIH) recommends you give yourself enough time to sleep.

The NIH also offers these tips, which are similar to techniques used by cognitive behavioral therapists:

  • Go to bed and wake up at the same time every day. For children, have a set bedtime and a bedtime routine.
  • Try to keep the same schedule on weeknights and weekends. Limit the difference to no more than about an hour. Staying up late and sleeping in late on weekends can disrupt your body clock's sleep-wake rhythm.
  • Use the hour before bed for quiet time. Avoid strenuous exercise and bright artificial light such as from a TV, smartphone or computer screen. The light may signal the brain that it's time to wake up.
  • Avoid heavy and/or large meals within a couple hours of bedtime. A light snack is ok. Also, avoid alcoholic beverages before bed.
  • Avoid nicotine and caffeine. Both substances can interfere with sleep. The caffeine effects can last as long as eight hours. So a cup of coffee in the late afternoon can make it difficult to fall asleep at night.
  • Spend time outside every day, if possible, and be physically active.
  • Keep your bedroom quiet, cool and dark.
  • Use relaxation techniques before bed (possibly those learned from your therapist).

If you believe you are a candidate for CBT-I, talk with your health care provider. You can find a Providence provider here.

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