What is the efficacy of cognitive-behavioral therapy (CBT) for insomnia?

Updated: Sep 11, 2018
  • Author: Jasvinder Chawla, MD, MBA; Chief Editor: Selim R Benbadis, MD  more...
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Answer

Multiple randomized, controlled trials have demonstrated the efficacy of CBT. Sleep latency, total sleep time, duration of wakefulness, and sleep quality have been shown to improve with CBT. From 50-75% of patients attain clinically significant improvement. CBT also improves the absolute amount of slow-wave sleep by 30%. Six-month follow-up has shown sustained efficacy for this treatment modality.

The American Academy of Sleep Medicine (AASM) evidence-based practice parameter found that CBT (all components), as well as individual components of stimulus-control, paradoxical intention, relaxation training, and biofeedback, were effective. [4] CBT has also been shown to be better in weaning patients from hypnotics than tapering medications alone.

Limitations of CBT are that providers must be trained in its use and that the technique is time consuming. Most studies of CBT used trained psychologists to work with patients for an average of 5.7 sessions over 6.5 weeks, with each session lasting at least 20-40 minutes. A study by Edinger et al showed that a total of 4 biweekly individual treatments represents the optimal dosing of CBT. [71] Obviously, this would not be practical for most primary care providers or neurologists. In addition, it is currently not known how effective CBT can be when administered by a nonpsychologist.

A study by Buysse et al determined that brief behavioral treatment for insomnia (BBTI) was a simple, efficacious, and durable intervention for chronic insomnia in older adults. [72] BBTI consisted of behavioral instructions delivered in 2 intervention sessions and 2 telephone calls.

Some sleep centers have behavioral medicine specialists who can administer CBT. Preliminary evidence by Morin indicated that providing written information about CBT can be helpful. [73] An Internet-based CBT learning program for patients is also available for a nominal cost (see CBTforINSOMNIA.com).


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