Beyond the Sleeping Pill: Cognitive Behavioral Therapy for Insomnia

Contributed by Roberta Heale, Associate Editor EBN, @robertaheale, @EBNursingBMJ

There’s not a more frustrating than tossing and turning all night.  However, between 30-50% of adults identify ongoing sleep disturbances.  While restless sleep once in a while is a nuisance, insomnia is a different story. It can be a significant problem particularly with older adults who are at higher risk of depression, falls, stroke, decline in cognitive and overall functioning.  The risks are exacerbated when mixed with sleeping pills which, themselves, increase the risk of falls, fractures and mortality. 1

So what is there to offer a patient other than medication?  Turns out, a lot.  One treatment is showing great promise, Cognitive Behavioural Therapy-Insomnia, or CBT-I.  Using the same exploration of the interactions between thoughts, emotions and behaviours, the focus is on sleep.  Sleep patterns, sleep hygiene, anxieties and thoughts that run through a patient’s mind at night are addressed.  CBT-I requires a commitment from the patient to make changes to their routines and practice the techniques that are offered, however, the outcomes can be very good.

One study, reviewed in a commentary in the EBN journal, identifies the usefulness of CBT-I.  Check out: Cognitive–behavioural therapy for insomnia is effective, safe and highly deployable http://ebn.bmj.com/content/early/2017/04/12/eb-2016-102523  Encouragingly, although training is required to deliver CBT-I, but one does not need to be a healthcare professional to provide CBT-I therapy, which adds to the potential of this treatment.

Sleep permeates every part of our lives.  With so many adults struggling with insomnia, CBT-I is an encouraging, positive, non-pharmacological option.

1. Alessi  C, Martin  JL, Fiorentino  L, et al. Cognitive behavioral therapy for insomnia in older veterans using nonclinician sleep coaches: randomized controlled trial. J Am Geriatr Soc 2016;64:1830–8.

 

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