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Home » CBT for Insomnia

CBT for Insomnia

February 1, 2019
From The Carlat Psychiatry Report
Issue Links: Learning Objectives | Editorial Information | PDF of Issue
Chris Aiken, MDChris Aiken, MD. 
Editor-in-Chief of The Carlat Psychiatry Report. Practicing psychiatrist, Winston-Salem, NC. Dr. Aiken has disclosed that he has no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Each month, Editor-in-Chief Chris Aiken, MD, gives advice on a different practice challenge.

Dear Dr. Aiken: The January 2019 issue mentioned cogni­tive behavioral therapy for insomnia (CBT-i) as a good alter­native to sleep meds. It’s hard to find a therapist trained in CBT-i in my area. Are there any evidence-based self-help op­tions that I can recommend to my patients?

Dr. Aiken: Certified therapists are listed online at www.behavioralsleep.org, but they are few and far between. To bridge this gap, there’s been a lot of research on self-guided CBT-i, and the outcomes suggest it works about as well as the live version (Zachariae R et al, Sleep Med Rev 2016;30:1–10). I’ve collected some of the better-researched programs in the table. My top two options, Sleepio and SHUTi, are on a temporary hi­atus and are ab­sent from the table. These programs re­cently closed their doors to the gen­eral public so they can pursue FDA approval as digital therapeutics.

The day may soon come when we’re pre­scribing CBT-i apps instead of Ambien, and I’ll welcome that. Treatment guidelines already place CBT-i above hypnotics as the gold standard for insomnia. Safety is one reason, but there’s also evidence that CBT-i is more ef­fective over the long term (Beaulieu-Bonneau et al, Sleep 2017;40(3):zsx002). The therapy includes basic sleep hygiene, like avoiding daytime naps, but goes a few steps beyond that. At its core is a structured program of sleep restriction where patients raise their sleep drive by limiting their time in bed. A brief manual is available online at https://tinyurl.com/ycptj345.

Table: CBT for Insomnia: Self-Guided Options


Table: Table: CBT for Insomnia: Self-Guided Options


(Click to view full-size PDF.)

General Psychiatry
KEYWORDS cognitive_behavioral_therapy
    www.thecarlatreport.com
    Issue Date: February 1, 2019
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    Table Of Contents
    CME Post-Test - Dark and Light Therapy, TCPR, February 2019
    An Opioid Combo Falls Short in Depression
    Prazosin for Alcohol Use Disorders
    Does Mania Follow the Sun?
    CBT for Insomnia
    Light and Darkness in Bipolar Disorder
    Trintellix and Cognition: A Closer Look
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