11 May There may be a cure to your chronic insomnia. What’s the catch?
Are you someone who has suffered from insomnia for many years? Has your doctor recommended Cognitive Behavioral Therapy for Insomnia (CBTi) to you? If they haven’t yet, they might soon. Last week, the American College of Physicians made a recommendation that CBTi is the initial treatment for chronic insomnia disorder in a study published by the Annals of Internal Medicine. News outlets are taking notice. If you’re not familiar with this therapy, in brief, CBTi focuses on changing maladaptive behaviors and thoughts about sleep to improve difficulty falling and staying asleep (see also http://www.sleepeducation.org/treatment-therapy/cognitive-behavioral-therapy).
After delivering CBTi for at least the past 12 years, I have a few considerations that, in my opinion, you might want to take into account before jumping in. First, consider this: disturbed sleep is a symptom when it is due to stress, a psychological disorder, a medical disorder, or to a substance (like alcohol). Disturbed sleep is a chronic insomnia disorder when it is associated with distress and/or impairment perceived as due to poor sleep. Chronic insomnia is defined as insomnia occurring on at least 3 nights per week and for at least 3 months. Here are some additional considerations:
Do you think you might be depressed and this is contributing to your insomnia? How do you know if you are depressed? Have you had a low mood, loss of interest or pleasure, low energy, change in appetite, thoughts of death, feeling hopeless, guilty or helpless most of the time in the last 2 weeks? Although studies show that CBTi can be helpful in even severe depression, I find it is helpful for my clients to be sure their mood is adequately managed before they are able to fully engage in and benefit from therapy.
Do you worry about everything? Do you feel your worries are difficult to control and this contributes to your insomnia or feeling keyed up? If so, you may have generalized anxiety disorder. Again, although studies show that CBTi can be helpful even in those with generalized anxiety, if you have never seen a mental health professional or if you feel like you have been attending therapy and still don’t feel your anxiety is well managed, you may want to pursue alternative or additional therapies before jumping into CBTi. The reason for this is that CBTi is very sleep focused. We deliver cognitive therapy, but it is focused on sleep related thoughts. Certainly sleep related anxieties can develop out of generalized anxieties, but if these generalized worries seem to be playing a primary role, CBTi may not adequately treat these. CBT for anxiety might.
Do you struggle with motivation? Not high on the “follow through” scale? That’s cool, it’s just that CBTi might be very challenging for you. There is a LOT of work that is involved in this therapy. Everything from completing daily sleep diaries to charting your sleep disruptive thoughts- this therapy is collaborative and requires completion of homework. Unlike cardiology where we can send you home with a heart monitor, insomnia treatment relies on your subjective perception of what is going on with your sleep. Think of it like doing an experiment on yourself where you are collecting data. Data helps the clinician tailor the treatment.
Discouraged? Don’t be. CBTi has been shown to be as effective as a medication after 8 weeks and more effective than a medication after 2 years. Why? In part because you learn strategies to help you improve your sleep. Improvements can be seen after just 1 or 2 sessions (out of a total of about 4-6). If you have chronic insomnia and feel like you’ve tried most of the treatments out there, this one is definitely worth a shot.
If you have further questions about this topic, feel free to contact me firstname.lastname@example.org