Like all of us, insomnia is complicated.
Insomnia can be short-term (acute), lasting days to weeks. You're stressed for that test. You experienced a romantic breakup. You lost your job. You just learned of a death in the family. Your sleep suffers.
Insomnia can be long-term (chronic), lasting 3 months, years, or decades. Your acute insomnia doesn't get better. You're fatigued, irritable, anxious, and depressed. Your relationships feel less meaningful, less connected. Your work performance suffers. More stress. You worry about sleep. You try harder to sleep. This makes it worse. You're more fatigued. More irritable. The vicious cycle of chronic insomnia begins.
- International Classification of Sleep Disorders: Diagnostic and Coding Manual. 3rd Edition. Darien, IL: American Academy of Sleep Medicine; 2014.
- Mai E, Buysse DJ. Insomnia: Prevalence, impact, pathogenesis, differential diagnosis, and evaluation. Sleep Medicine Clinics. 2008;3:167-174.
The importance of sleep-focused assessment.
A critical step in overcoming your insomnia is determining why it's happening.
Coexisting health difficulties are the rule, not the exception.
Is your insomnia better explained by another sleep disorder? Another medical disorder? What about those changes in mood you've noticed impacting your sleep? Anxiety, depression, ADHD, PTSD, or substance use? Poor sleep makes your chronic pain worse, which makes it more difficult to fall asleep and stay asleep. What's going on? Where to begin?
A free 15-minute consultation with Dr. Curtis is one solution to consider.
What is the most effective treatment for insomnia?
Science-based Skills.
Although sleep medications can effectively manage insomnia for days or weeks due to life stressors, they're not recommended to treat insomnia lasting 3 months or longer.
Based on over 50 years of experimental evidence, the American College of Physicians and the American Academy of Sleep Medicine recommend Cognitive Behavioral Therapy for Insomnia (CBT-I) as the most effective treatment option for chronic insomnia disorder in adults.
CBT-I is a multi-component, individualized treatment involving daily monitoring of your sleep-wake pattern using a sleep diary, targeting specific patterns of behavior that are maintaining your insomnia disorder, and refining treatment until you’re able to regularly fall asleep and stay asleep without difficulty.
CBT-I has demonstrated greater long-term improvements in insomnia compared to a variety of sleep medications, including Ambien, Imovane, and Sonata, with no concern for side effects like dizziness, headache, daytime sleepiness, and re-emergence of insomnia when sleep medications are discontinued.
If you’re currently taking sleep medication, you can continue taking these medications during CBT-I treatment.
Depending on your treatment goals, it’s often possible to significantly reduce or eliminate your use of sleep medication during CBT-I treatment. This involves gradually lowering your dosage over multiple weeks in collaboration with your prescribing clinician while implementing CBT-I skills.
- Sateia M, Buysse DJ, Krystal AD, Neubauer DN, Heald JL. Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults: An American Academy of Sleep Medicine clinical practice guideline. Journal of Clinical Sleep Medicine. 2017;2:307-349.
- Qaseem A, Kansagara D, Forciea MA, Cooke M, Denberg TD. Management of Chronic Insomnia Disorder in Adults: A Clinical Practice Guideline From the American College of Physicians. Annals of Internal Medicine. 2016;165(2):125-133.
- Schutte-Rodin S, Broch L, Buysse D, Dorsey C, Sateia M. Clinical guideline for the evaluation and management of chronic insomnia in adults. Journal of Clinical Sleep Medicine. 2008;4(5):487-504.
- Edinger JD, Arnedt JT, Bertisch SM, et al. Behavioral and psychological treatments for chronic insomnia disorder in adults: An American Academy of Sleep Medicine clinical practice guideline. Journal of Clinical Sleep Medicine. 2021;17(2):255-262.
- Manber R, Carney CE. Treatment Plans and Interventions for Insomnia: A Case Formulation Approach. New York, NY: The Guilford Press; 2015.
- Sivertsen B, Omvik S, Pallesen S, et al. Cognitive behavioral therapy vs zopiclone for treatment of chronic primary insomnia in older adults: a randomized controlled trial. The Journal of the American Medical Association (JAMA). 2006;295(24):2851-2858.
- Smith MT, Perlis ML, Park A, et al. Comparative meta-analysis of pharmacotherapy and behavior therapy for persistent insomnia. The American Journal of Psychiatry. 2002;159(1):5-11.
- Morin CM, Bastien C, Guay B, Radouco-Thomas M, Leblanc J, Vallières A. Randomized Clinical Trial of Supervised Tapering and Cognitive Behavior Therapy to Facilitate Benzodiazepine Discontinuation in Older Adults With Chronic Insomnia. The American Journal of Psychiatry. 2004;161(2):332-342.
How long will it take to successfully treat my insomnia?
Although your total number of appointments will depend on your individualized treatment plan, clinical research trials and our own clinical experience delivering CBT-I suggest that most chronic insomnia disorders are successfully treated after only 4 to 8 weekly sessions following your initial clinical assessment.
- Edinger JD, Wohlgemuth WK, Radtke RA, Coffman CJ, Carney CE. Dose-response effects of cognitive-behavioral insomnia therapy: A randomized clinical trial. Sleep. 2007;30(2):203-212.
- Morin CM, Bootzin RR, Buysse DJ, Edinger JD, Espie CA, Lichstein KL. Psychological And Behavioral Treatment Of Insomnia: Update Of The Recent Evidence (1998–2004). Sleep. 2006;29(11):1398-1414.
- Manber R, Carney C, Edinger J, et al. Dissemination of CBTI to the non-sleep specialist: Protocol development and training issues. Journal of Clinical Sleep Medicine. 2012;8(2):209-218.