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Insomnia treatment: Cognitive behavioral therapy instead of sleeping pills

Insomnia is a serious disorder and effective insomnia treatment can be crucial to getting the sleep you need. Until now, there were few safe, effective, non-drug insomnia treatments.

By Mayo Clinic staff

Insomnia is a widespread condition that's characterized by a difficulty in falling asleep, staying asleep or getting restful sleep. Like many people who experience insomnia, you may have turned to sleeping pills for relief.

However, new research and sleep studies show that your attitudes about sleep and certain behaviors are often the root cause of insomnia. Changing those attitudes and behaviors can lead to better sleep.

What's so good about a good night's sleep?

Sleep is essential for good physical and mental well-being. Natural sleep restores your body and mind and provides enough dreaming time (REM sleep) to sustain learning, memory and mood.

If you're sleep deprived, you're more likely to develop infections, and have high blood pressure, cardiovascular disease and diabetes. You may also be more prone to make mistakes on the job, take longer to recover from stress, have problems with learning and memory, and experience depression and irritability.

Problems with sleeping pills

There are times — such as during periods of pain or grief — when sleeping pills may help those who experience sleep deprivation. In addition, several hypnotics are now approved by the Food and Drug Administration for indefinite use.

However, many sleeping pills shouldn't be taken for more than a few days to a few weeks. Because they can be habit-forming, some people take these drugs far longer. Others may increase their dosage as the pills become less effective over time. Sleeping pills can also:

  • Mask the real causes of poor sleep, such as depression, heart trouble, asthma and Parkinson's disease, and delay treatment of these disorders
  • Interact with other medications or alcohol, often with serious, even deadly, results
  • Cause next-day grogginess or rebound insomnia — an inability to sleep that's worse than the original problem
  • Lead to high blood pressure, dizziness, weakness, nausea, confusion, short-term amnesia
  • Cause bizarre behavior that goes beyond traditional sleepwalking to include "sleep binge eating," "sleep shoplifting" and "sleep driving" — none of which the person remembers

Cognitive behavioral therapy: A tool for treating insomnia

Cognitive behavioral therapy (CBT) has emerged as a treatment for insomnia that's an effective alternative to sleeping pills, even for people with severe or chronic sleep problems.

CBT is a relatively simple, short-term treatment that has long been used to treat a range of conditions, including depression, panic attacks, anxiety, eating disorders and substance abuse. Studies have shown that psychological and behavioral factors play an important role in insomnia and that CBT can be effective in treating insomnia. A 2006 review of insomnia treatment studies conducted by the American Academy of Sleep Medicine found that CBT can help improve sleep and that benefits can be sustained over a long period of time.

CBT can benefit nearly everyone, including older adults who have been taking sleep medications for years, people with physical problems such as restless legs syndrome, and those with primary insomnia, a lifelong inability to get enough rest.

What's more, the effects seem to last — a year after CBT, most people still show benefits from the therapy and sleep more soundly than before. And there is no evidence that CBT has adverse effects.

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References
  1. Means M, et al. Nonpharmacologic treatment of insomnia. Current Treatment Options in Neurology. 2008;10:342.
  2. Kristo D. Cognitive behavioral therapy. American Academy of Sleep Medicine. http://www.sleepeducation.com/Treatment.aspx?id=5. Accessed Nov. 10, 2008.
  3. What is cognitive behavioral therapy? National Sleep Foundation. http://centers.sleepfoundation.org/site/c.dpIOK2OAJoG/b.2465999/k.5971/What_is_Cognitive_Behavioral_Therapy.htm. Accessed Nov. 10, 2008.
  4. Morin C, et al. Psychological and behavioral treatment of insomnia: Update of the recent evidence (1998-2004). SLEEP. 2006;29:1398.
  5. Schutte-Rodin S, et al. Clinical Guideline for the evaluation and management of chronic insomnia in adults. Journal of Clinical Sleep Medicine. 2008;4:487.
  6. Whitworth J, et al. Which nondrug alternatives can help with insomnia? The Journal of Family Practice. 2007;56:836.
  7. Morgenthaler T, et al. Practice parameters for the psychological and behavioral treatment of insomnia: An update. SLEEP. 2006;29:1415.
  8. Harvey A, et al. An open trial of cognitive therapy for chronic insomnia. Behavior Research and Therapy. 2007;45:2491.

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Jan. 16, 2009

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