Could Behavioral Therapy Help Treat Chronic Insomnia?

Findings from a new study suggest there is a useful psychological treatment to help patients deal with chronic insomnia.

A team led by James Trauer, MBBS, a researcher and physician from Melbourne Sleep Disorders Centre in Melbourne, Australia, sought to determine the efficacy of cognitive behavioral therapy for insomnia (CBT-i) on diary measures of overnight sleep in adults with chronic insomnia. Trauer and colleagues conducted randomized, controlled trials to assess the efficacy of face-to-face, multimodal CBT-i compared with inactive comparators on overnight sleep in adults with chronic insomnia, with studies of insomnia comorbid with medical, sleep, or psychiatric disorders excluded.
________________________________________________________________________________________________________________________________________________________________

RELATED CONTENT
Sleep Disruptions and Insomnia in Older Adults
Study: Persistent Insomnia Linked to Higher Risk of Death
________________________________________________________________________________________________________________________________________________________________

Two reviewers independently assessed study characteristics, quality, and data from searches of MEDLINE, EMBASE, PsycINFO, CINAHL, the Cochrane Library, and PubMed Clinical Queries from inception to March 31, 2015, supplemented with manual screening. Main outcome measures were sleep onset latency (SOL), wake after sleep onset (WASO), total sleep time (TST), and sleep efficiency (SE%).

Among 292 citations and 91 full-text articles reviewed, 20 studies including 1,162 participants—64% of whom were female, with a mean age of 56 years among participants. Approaches to CBT-i incorporated at least 3 of the following: cognitive therapy, stimulus control, sleep restriction, sleep hygiene, and relaxation. At the post-treatment time point, SOL improved by 19.03 minutes, WASO improved by 26 minutes, TST improved by 7.61 minutes, and SE% improved by 9.91%, with no changes apparently sustained at later time points. The researchers reported no adverse outcomes.

While the authors note that the study’s narrow inclusion criteria limited applicability of patients with comorbid insomnia and other sleep issues, they found that CBT-I is a “safe and effective psychological strategy to address chronic insomnia,” says Trauer.

He points out that this meta-analysis “looked only at studies that involved face-to-face contact with therapists,” adding that future research is needed to consider other methods for delivering care in more detail.

“Options include group therapy, guide books, and Internet-based platforms,” says Trauer, “some of which have been developed. But more work is needed.”

—Mark McGraw

Reference

Trauer J, Qian M, et al. Cognitive Behavioral Therapy for Chronic Insomnia: A Systematic Review and Meta-analysis. Ann Intern Med. 2015.