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.