Therapy — not pills — should be the first approach for people suffering with insomnia, according to new guidelines from the American College of Physicians, an influential national internal medicine organization.
Insomnia affects about 10 percent of American adults. It results in fatigue, obviously, but also diminishes cognition, alertness and general health.
Sleeping pills do the trick for many people, but they are not meant as a solution for people with chronic insomnia, cautioned Dr. Wayne Riley who heads the American College of Physicians.
“The FDA has approved these medications for short-term use for the treatment of insomnia, four to five weeks, therefore patients should not use these medications for extended periods of time,” said Riley.
The organization recommends cognitive behavioral therapy as the first-line treatment for chronic insomnia; it has been shown to work for about 50 to 70 percent of patients.
“Although we have insufficient evidence to directly compare CBT to drug treatment for insomnia, it is clear that cognitive behavioral therapy is less harmful to patients. With sleep medications, there are several potential adverse effects,” he added.
When CBT is used to address sleep issues, patients first must learn a counterintuitive lesson.
“Less is more, less time in bed is better,” said Michael Perlis, director of the behavioral sleep medicine program at the University of Pennsylvania.
“If you are awake, spend that time somewhere else. Now executing that as part of your therapy is more complicated but that is the rule of thumb.”
While CBT may take several weeks of therapy, the effects last.
“And that’s where it really distinguishes itself from medical therapy,” he said. “There’s no pill on this planet that will give you sustainability of treatment gains after treatment is discontinued.”
CBT for insomnia starts with a careful assessment of sleep habits and teaches people skills to develop better sleep habits.