Talk Therapy May Be Key to Treating Insomnia

A woman lays in bed, unable to fall asleep, looking at a clock.
  (Image credit: Sleep problems photo via Shutterstock)

For people with insomnia — that includes nearly one in five American adults — the most common treatments are sleeping pills and cognitive behavioral therapy, sometimes called talk therapy. Although both treatments have their benefits and risks, experts are increasingly recommending cognitive behavioral therapy, or CBT, instead of pills.

Research has suggested CBT can be as effective as drugs in treating chronic sleep problems. In fact, CBT has been shown to improve not only insomnia but overall well-being and some symptoms of depression. Meanwhile, a recent study suggested that taking sleeping pills to treat insomnia may shorten people's lives.

"There are major benefits for CBT over medication," said Dr. David Plante, a sleep specialist at the University of Wisconsin. "You have long-termbenefits, even after the treatment is done, which isn't usually the case for sleeping pills."

CBT can treat insomnia without the use of sleeping pills. With the help of a sleep specialist, a person with insomnia learns to develop good sleeping habits and is taught skills to cope with sleep anxiety.

Sleeping pills can be a benefit for the short-term

Nearly a fifth of U.S. adults find it difficult to fall asleep every night for days or weeks, according to the National Institutes of Health.

Insomnia can last several weeks, and it can be a sign of other health problems,including sleep apnea, restless leg syndrome, substance abuse or mental disorders.

"Chronic insomnia is a public health issue," Plante said. "With any patient, we try to weigh the benefits and risks of appropriate treatment."

Although some studies suggest the use of sleeping pills can be dangerous, experts still see them as beneficial for the short term.

"It’s worthwhile to use sleep medications if someone is going through acute stress, or grief, for probably a month," said James Findley, a behavioral sleep specialist at the University of Pennsylvania. "But after that, they should be tapered off."

Sleeping pills tend to work quickly in relieving symptoms, but they carry the risk of becoming addictive, Findley said, and they don’t help treat the underlying causes of sleep problems.

"Some people have tried multiple medications, but they become less effective over time," he added.

Limited availability

While CBT is widely viewed as effective for insomnia, it isn’t always available for everyone.

Often, people who live in remote areas don’t have access to specialists trained in CBT, or they can’t find a specialist within their health care provider network.

Furthermore, Plante said, "sometimes patients may not want to do psychotherapy. They don’t want to invest the time."

Studies have shown that on average, it takes about eight weeks of CBT before sleep improves, according to Findley.

But unlike sleeping pills, results tend to last, and the treatment helps with the problems connected with insomnia, such as depression and anxiety.

In a study by the American Academy of Sleep Medicine, CBT was effective in treating up to 80 percent of people. Researchers also found that study participants maintained their sleep improvement for at least six months.

"We’re always trying to minimize medication use and find other ways to treat insomnia," Plante said.

Experts often urge people with sleep problems to avoid caffeine and alcohol in the evening and avoid late-hours exercising or eating.

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