Insomnia: Is Therapy Better Than Sleeping Pills?

Treating Insomnia

While there may be ample reason to be proud of being a night owl, If you are one of the countless individuals who find themselves aimlessly staring at the ceiling every night, those accolades may not be much consolation. The CDC reports that an estimated 50 to 70 million adults in the United States suffer with some form of sleep disorder - enough to have sleeplessness declared as a public health problem.

So why are we so restless? The causes could be numerous. Many of us are stressed from the hectic events of our lives. Dealing with medical conditions like acid reflux, asthma, allergies, and kidney disease can also be a contributing factor - not to mention mental health concerns like anxiety and depression. More often than not, we turn to medications seeking relief.



However, sleeping pills may no longer be the first line of defense in treating insomnia. New guidance from the American College of Physician suggests that cognitive behavioral therapy should be a "first-line" treatment for insomnia.

While we can never underestimate the adverse public health consequences of sleep loss (accidents and injuries), the effect on our quality of life is immeasurable. Sleep deprivation is known to have negative effects on our cardiovascular, immune, and nervous systems and is a risk factor for obesity, diabetes, and hypertension. Finding effective methods of mitigating the problem has become a matter of critical importance.

 The good news is that a growing body of evidence points to cognitive behavioral therapy as a highly effective treatment. A 2014 study utilizing CBT-I (cognitive behavioral therapy for insomnia) revealed that that just one hour of talk therapy helped 73% of the participants to improve sleep quality. Similar research from the Journal of Clinical Sleep Medicine saw 86% of patients reduce insomnia. And even more promising are results from a 2015 study published in the Annals of Internal Medicine revealing that CBT-I was more effective in treating insomnia than common medications used to induce sleep.

CBT for insomnia has been assessed in over 100 randomly controlled tests, and the results show that on average 70% of people with even very long term poor sleep obtain lasting benefit from the treatment.
— Sleepio


Conventional wisdom would indicate that simply finding a way to close your eyes and shut down your body would be a more effective means of dealing with sleep deprivation. So, the question arises: how does CBT-I help to treat insomnia? Details from the Mayo Clinic offer a good synopsis of some of the components of CBT-I:

Stimulus control therapy. Helps to remove dynamics that condition your mind to resist sleep. Set a consistent bedtime and wake time and avoid naps, use the bed only for sleep and sex.  If you can't go to sleep within 20 minutes, leave the room and return when you're sleepy.

Sleep restriction. Simply lying in bed while you're awake can form a habit that leads to poor sleep. Treatment can train you to reduce the time you spend in bed - causing partial sleep deprivation and making you more tired the next night. Once your sleep improves, time in bed can be gradually increased.

Sleep hygiene. This dynamic in treatment challenges you to change the lifestyle habits that influence sleep (smoking, excessive caffeine late in the day, excessive alcohol, poor exercise regimen). Education also focuses on direct behavioral modifications that can improve sleep, such as winding down an hour or two before bedtime.

Sleep environment improvement. Methods for creating a comfortable sleep environment. Guidance for keeping your bedroom quiet, dark and cool, removing the TV from the bedroom, and hiding your clock from your direct view.

Relaxation training. Mindfulness approaches can be very effective in helping you to calm your mind and body. In this mode of treatment, you may practice meditation, imagery, and muscle relaxation.

Remaining passively awake. Also known as paradoxical intention, this form of treatment involves avoiding any effort to fall asleep. The paradox is that worrying that you can't sleep can actually keep you awake. Learning to let go of this anxiety can help you to relax and make it easier for you to fall asleep.



Why are we not seeing more use of CBT-I in the medical community? Well, it’s new, only some clinicians know how to do it, and often it’s easier to take pills, than to embark on a 12 session therapy program. Not to mention the immediacy factor and relief and reassurance from having a sleeping pill. Cognitive behavioral therapy requires much more effort and active engagement as well as finding a trained clinician and time and resources for therapy.   

However, an important consideration is the risk of medications compared to the potential long-term benefits of CBT-I. Naturally, medications should not be completely ruled out, but the growing body of research supporting a cognitive approach gives us a viable alternative. If you are struggling with insomnia, consider working with a qualified psychotherapist to help you get on the road to recovery.