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Therapy Is More Effective than Medication for Insomnia

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If you have chronic insomnia, you’ve probably tried exercise, reading before bed, magnesium tablets and a host of other things, and it is unlikely that these efforts paid off in full. At some point, you probably also considered that last resort, sleeping pills. Well, there is something that researchers and government health bodies are suggesting that you try first. It’s called Cognitive Behavioural Therapy for Insomnia, or CBT-I.

The case for CBT-I as the go-to response for insomnia is compelling. An article published in Annals of Internal Medicine in 2015 reviewed data from 20 separate CBT-I trials, which involved over 1,100 participants with chronic insomnia. One study showed that, after six weeks, people who were treated with a combination of CBT-I and sleep medications got to sleep 20 minutes faster, and had 30 minutes more sleep-time than those on medications alone. In the longer-term, patients who received CBT-I alone maintained a 68% remission from insomnia, while those continuing with a combination of medication and CBT-I managed just 48% remission.

CBT-I addresses unhelpful behaviours and thought patterns around sleep. A variety of methods are used, including reducing stimuli before bed, and meditation and relaxation techniques. Perhaps the most singular contribution that CBT-I brings to the table is to counsel patients concerning their thoughts and feelings. Thinking of the bedroom as a battleground (for example, dreading not being able to sleep, and the consequences this will have the next day) are in fact a huge part of the problem for those suffering from insomnia. And this is where CBT-I shines.

Because CBT-I depends upon behavioural and attitudinal changes, the patient is required to do quite a bit of homework. So the success of CBT-I depends largely upon the patient’s commitment. While there are no studies done on the enjoyability of CBT-I, it is well-documented that many fail to complete their sessions and their homework. In this way, sleep health is like so many other health issues — it takes some commitment to implement the solution.


Insomnia: prevalence, consequences, and effective treatment – The Medical Journal of Australia. 2013

Overcoming insomnia. – Harvard Mental Health Letter, Harvard Health. February 2011.

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