CBT for InsomniaCBT for insomnia (CBTi) is clearly preferable to taking sleeping medications for most people. Studies show that cognitive behavioral therapy is associated with greater improvements in sleep quality than sleeping medications, and that those improvements are more durable, and, particularly in the elderly, sleeping medications are associated with significant adverse effects, including an increase in mortality.

But it can be a hard sell to a patient who is sure that what he or she needs is a better sleep medication.

A recent study of veterans treated for insomnia provides another measure of the value of CBTi: it was associated with a significant reduction in suicidal ideation as well as a significant reduction in depressive symptoms. However, the reduction in suicidal ideation was not entirely accounted for by a reduction in depressive symptoms, even when controlling for depressive symptoms CBTi was associated with reduced thoughts about suicide.

We have referred a number of people to the CBTi program developed by University of Virginia researchers which you can access from this website (the link is at the bottom of the page) and everyone who was completed the program has reported significant improvements in sleep quality. The hard thing has been getting people to consider CBTi as a treatment for significant insomnia. Perhaps this study will convince some of the skeptics.

Reference

Trockel M, Karlin BE, Taylor CB, Brown GK, Manber R. Effects of cognitive behavioral therapy for insomnia on suicidal ideation in veterans. SLEEP 2015;38(2):259–265.