Insomnia Treatment Recommendations

New Research on Insomnia

Insomnia remains one of the most troubling problems our clients have to deal with and insomnia treatment is always an important issue for us.  Recent updates to insomnia treatment guidelines from the American Academy of Sleep Medicine do not change our current practice radically, but they underline and strengthen the basic recommendation that Cognitive Behavioral Therapy (CBT) is the best approach, and the one to try first for all insomnia sufferers.

CBT for insomnia usually requires four to eight sessions with a trained therapist.  There are several multi-component behavioral strategies that may be employed, and three “single component” therapies: sleep restriction therapy, stimulus control, and relaxation therapy.  Educational content is also included for a clearer understanding of insomnia and its control.

Medication is only recommended as an adjunct to CBT, or if symptoms continue after CBT is completed.  Other studies have also shown that medication is generally less effective for insomnia than behavioral approaches.

Insomnia has historically been thought to be a more conditional and situational problem that would go away on its own, but a recent Canadian study has shown that symptoms of insomnia are remarkably consistent over time, meaning that both therapists and patients should give attention to starting treatment sooner.  Among more than 3,000 adults followed for five years, researchers found that 37.5% of those who started the study with insomnia still had it five years later.  This persistence of the condition was much higher than the study authors had predicted, and it suggests that clinicians should pay more serious attention to complaints of sleeplessness than they may have in the past.

An online program for CBT-Insomnia called SHUTi has been reviewed in MoodSurfing before, we have found that several of our clients say that the online program was helpful to them.  A small study recently looked at feasibility and acceptability of the online program with a cohort of older, rural women, and found that they also had success using SHUTi.  This suggests that care should be taken in stereotyping who may and may not be able to benefit from an online program.

For more information about sleep and insomnia, see MoodSurfing’s Sleep and Insomnia page.