Therapy, Not Meds, Should Be First Treatment for Chronic Insomnia, Physician Group Says

By Perry, Susan | MinnPost.com, May 3, 2016 | Go to article overview

Therapy, Not Meds, Should Be First Treatment for Chronic Insomnia, Physician Group Says


Perry, Susan, MinnPost.com


The first-line treatment for people struggling with chronic insomnia should be therapy rather than pills, according to new recommendations released Monday by the American College of Physicians (ACP).

Not just any therapy, however. The ACP recommends a specific form known as cognitive behavioral therapy for insomnia, or CBT-I, which helps people change both their beliefs and their behaviors about sleep.

Although CBT-I requires more time and effort than popping a pill, it has shown to be an effective treatment for chronic insomnia. The therapy also has none of the adverse side effects associated with prescription sleeping pills, which can include daytime drowsiness, dizziness, hallucinations and behavioral problems.

Adverse reactions to sleeping medications send thousands of Americans to hospital emergency departments each year.

A Minnesota-led review

The recommendations -- which are guidelines for physicians -- are based on an in-depth review of existing studies on CBT-I. The review was led by Michelle Brasure of the Minnesota Evidence-based Practice Center, a collaboration between the University of Minnesota and the Minnesota VA Health Care System.

After analyzing 60 studies, Brasure and her colleagues concluded that CBT-I is an effective treatment for chronic insomnia based on almost all the sleep outcomes that were measured. They also found that CBT-I has a much lower potential for harm than medication.

CBT-I typically involves six to eight sessions in which people "are encouraged to change sleep and daytime habits, alter nonproductive sleep schedules, and modify beliefs about insomnia," explains Dr. Roger Kathol, an adjunct psychiatry professor at the U of M in an editorial that accompanies the new guidelines and evidence review.

The therapy has been shown to resolve or lessen the symptoms of chronic insomnia in 70 percent to 80 percent of people who are treated, he adds.

CBT-I also has the advantage of helping people "develop mastery of effective sleep behaviors that they can call on if insomnia recurs," says Kathol. "This benefit contrasts with pharmacologic interventions, in which increased doses and/or new preparations are required."

A response to misuse

The ACP's guidelines acknowledge that prescription and over-the- counter medications may be needed to treat insomnia, but that they should be used only if CBT-I therapy fails to help -- and only for a short amount of time, usually four to five weeks. …

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