Does CBT-I Really Work?
Anyone who has experienced insomnia knows that it is a frustrating and challenging condition. Not only does it drain your daytime energy, but it makes going to bed, which should be restful, an upsetting and irritating experience.
With the internet littered with supposed remedies for insomnia, people who struggle with this issue rightfully want to know what the research shows. Treatment has become more focused on cognitive behavioral therapy for insomnia (CBT-I), and the obvious question is, “does it really work?”
The short answer is yes. It works for many people, and today we’ll explain what it is, why it works, and what the research tells us about this insomnia treatment.
What is CBT-I?
CBT-I is a treatment method that works to overcome negative thoughts and actions that undermine healthy sleep habits. It is a subset of cognitive behavioral therapy, which is talk therapy used to address many types of mental health issues.
CBT-I usually involves hour-long weekly meetings with a therapist for around 6-8 weeks, although the exact length depends on the specific situation.
There are typically a series of action steps to try out after each meeting. Some of these could include relaxation techniques, mindfulness meditation, and changes to sleep hygiene.
Changes to sleep hygiene can take many forms depending on the individual. For example, changes may include not staying in bed for more than 20 minutes if they don’t fall asleep during that time. Or it could involve a more consistent schedule for going to bed and waking up. The therapist customizes the plan, and it may require trying several different things to find those that work best.
Though the principles of CBT-I appear straightforward, guidance from a trained counselor or therapist, whether in-person or online, is important for its effectiveness.
Does CBT-I Work?
Studies have found it to be effective as a first treatment for insomnia and in many cases better than medications or a combination of CBT-I with medications.
In patients who have insomnia related to post-traumatic stress disorder (PTSD), CBT-I has also been effective at improving sleep.
A major benefit of CBT-I is that it does not require the use of any medications or supplements, avoiding the risks of side effects or dependence.
Because it provides tools for changing both thinking and behavior, improvements in sleep from CBT-I tend to be more durable and applicable to a range of situations. Thus, even though it is not a complete cure for insomnia, CBT-I can dramatically reduce sleeping problems for the long-term.
What Are the Downsides of CBT-I?
While CBT-I is a proven and well-regarded method for treating insomnia, it isn’t perfect.
One downside is that it doesn’t work for everyone. Though studies show excellent results and that it works as well or better than most medications, that doesn’t mean every patient sees improvements in their sleep.
Other downsides to CBT-I are logistical in nature. It can be a time-consuming process, requiring regular meetings over a period of months. This process can be expensive as well, although in many cases it is at least partially covered by health insurance.
To be effective, it is necessary to implement behavioral changes around sleep that may be difficult, especially if a person’s schedule is affected by work or family obligations.
Another logistical challenge is that CBT-I must be administered by a professional trained in utilizing this therapy. Because it is a relatively new field, some areas may have a limited number of health professionals with the appropriate background. Access to online CBT-I has been expanding to make it easier for anyone to get help and resources for this proven treatment.
How Do You Start CBT-I?
Whether you’ve already been diagnosed with insomnia or think that you might have insomnia, the best place to start is with your doctor. Your doctor can help make a referral to a practitioner of CBT-I and can recommend any other diagnostic testing or treatment that may be helpful in addressing your sleeping problems.
If you see a psychiatrist or psychologist, you can ask them if they have training in CBT-I or if they can refer you to someone who does.
Lastly, if seeing a professional in person is not an option for you, you can consider one of a number of CBT-I programs that are administered online. For example, Sleepio is a program developed by sleep experts that has shown solid results in clinical studies.