The American Academy of Sleep Medicine lists Cognitive Behavioral Therapy for Insomnia (CBT-i) as one of a small number of recommended insomnia treatments. CBT-i works by addressing the root causes of many cases of insomnia — incorrect thoughts, behaviors, and beliefs toward sleep.
The treatment has been found to be more effective than sleeping pills, the positive effects persist over the long term, and the treatment is not associated with any of the side effects linked to sleeping pills.
A systematic review published in the Annals of Internal Medicine combined data from 20 CBT-i trials involving over 1,000 individuals with chronic insomnia. The review found that compared to those who didn't receive CBT-i, on average, those treated with CBT-i:
- Fell asleep 20 minutes faster
- Spent 30 fewer minutes awake during the night
As the review pointed out, these improvements are at least as good as those seen when patients are prescribed zolpidem (Ambien) or eszopiclone (Lunesta) — yet the benefits of CBT-i continue even when treatment ends.
As a result of these findings, the American College of Physicians recommends that all adult patients receive CBT-i as the initial treatment for chronic insomnia disorder.
CBT-i scarcity and the alternatives
Unfortunately, it can be hard to find qualified CBT-i therapists, so primary care physicians may still be more likely to prescribe sleeping pills rather than refer someone with sleep difficulties to a CBT-i practitioner.
This has led to an increase in the number of technology-based sleep solutions, such as sleep trackers and virtual sleep coaches — but research suggests that only about half of participants adhere to technology-mediated insomnia treatments.
Is a technology-based insomnia treatment right for you?
A study published in the Journal of Medical Internet Research found the following issues were barriers to adherence:
- Filling out a daily sleep diary
- Not feeling in control of the process
- A lack of belief that the solution was working
When it comes to adhering to technology-based insomnia treatments, the following personality traits were found to be important:
- Optimism
- Determination and motivation
- Positive attitude and strong commitment
Based on feedback from focus groups, researchers suggest the following design principles may help when it comes to improving adherence:
- Automatic sleep tracking
- Personalized sleep coaching
- Compliments on progress, when merited
- Regular reminders, to prevent forgetfulness
- A forum or other community-building component
- Built-in traditional functionality (e.g., an alarm clock)
If you feel that you lack the motivation and determination identified as predictors for success, you may want to look into a more personalized solution.
Personalized sleep coaching
Studies have found that CBT-i delivered by non-clinician sleep coaches can, in fact, be effective at improving sleep in those with chronic insomnia.
One study, published in the Journal of the American Geriatrics Society, involved 159 adults over the age of 60 who had been suffering from insomnia for at least three months.
The study found that, compared to those who received five sessions of general sleep education, those who received five sessions of CBT-i from non-clinician sleep coaches:
- Fell asleep faster
- Spent less time awake
- Enjoyed increased sleep efficiency
Participants also recorded improved sleep scores as measured by the Pittsburgh Sleep Quality Index and the Insomnia Severity Index.
Furthermore, those who received the CBT-i intervention were still sleeping better by the above measures a full year after treatment.
Conclusion
- If you suffer from chronic insomnia, talk to your doctor.
- Ideally, CBT-i should be the first treatment option you try.
- Technology-based insomnia treatments may not be right for you.
- Personalized sleep coaching, even from non-clinicians, may be more beneficial.