Treatment is very effective and can often resolve insomnia relatively quickly—especially considering that some individuals with chronic insomnia have struggled with sleep concerns for years, if not decades.
Cognitive Behavioral Therapy for Insomnia (CBT-I) guides patients through a series of changes in sleep-related behaviors. The focus is on addressing three main factors that contribute to the persistence of insomnia:
- Conditioned arousal through stimulus control
- Identifying and eliminating habits developed in an effort to improve sleep but that have become ineffective
- Reducing sleep-related worry and other sources of heightened arousal
I work to identify the most relevant targets for behavior change and help individuals overcome obstacles to making the necessary—and often difficult—adjustments in sleep-related behaviors. This allows individuals to concentrate their energy on the changes most likely to produce meaningful improvements in their sleep.
The majority of individuals respond to this treatment fairly quickly. Some experience significant changes after only two therapy sessions. Most improve after four to six sessions, though some may need more. These interventions can be completed in collaboration with other providers and have been shown to be helpful for individuals currently being treated for other mental health conditions (such as depression, anxiety, borderline personality disorder, trauma-related concerns, and eating disorders) or physical conditions (including cancer, fibromyalgia, chronic pain, obstructive sleep apnea, and others). People may become more responsive to these other medical and mental health treatments once their sleep improves. I will work in collaboration with your provider to address sleep concerns while you continue your other treatments.
My areas of expertise:
Insomnia
Nightmares
Circadian Rhythm Sleep/Wake Misalignment
Parasomnias
Hypersomnia
Narcolepsy
CPAP compliance
Depression
Grief/Loss
Anxiety
Trauma
Substance Use
Gambling
What is the preferred treatment for insomnia?
The first line of intervention for insomnia is Cognitive Behavioral Therapy for Insomnia (CBT-I). Treatment is based upon the concept that chronic insomnia lasting from months to years is maintained by physical, environmental, emotional, and behavioral factors that have little or nothing to do with what initially caused the insomnia. Accordingly, CBT-I targets the factors that have been shown to cause acute insomnia (the sleeplessness that comes to all of us from time to time) to become chronic and seemingly take on “a life of its own.”
How effective is CBT-I?
There is a large scientific literature that shows that behavioral interventions are as effective as medication in the short run and, unlike medications, produce durable results that last after treatment is discontinued. More than this, between 40-60% of the people that respond to CBT-I go on to recover normal sleep.
How long does treatment take?
In most cases, 4-10 weeks.
If I have insomnia along with another medical or mental health condition, can CBT-I still work for me?
Yes. CBT-I has been shown to be as effective for these kinds of insomnias as it is for insomnia that occurs in the absence of such complications. Moreover, successful resolution of your insomnia may in some cases reduce the severity and/or chronicity (and/or increase your tolerance) of other chronic illnesses you may have.
What can I expect treatment to be like?
Your treatment will begin with an extensive evaluation including a review of your medical and mental health histories and an assessment of the factors that are likely to be related to your insomnia (sleep schedule, sleep duration, what you do and don’t do when awake at night, etc.). Treatment will likely require that you complete a series of assessment questionnaires during your first visit and daily sleep diaries before and during treatment.
Will I be prescribed sleeping pills?
While this is not a first line approach, there are instances where some form of medical therapy in addition to CBT-I is indicated. This may include the use of hypnotics or wake-promoting medications, alone or in combination with behavioral therapy. However, the typical goal of CBT-I is to help the individual learn how to sleep without need of chronic medication use. I am not a prescriber, but will work in collaboration with your medical provider to determine the best course of treatment.
Will I be required to discontinue using sleeping pills?
Each case is different and your clinician will likely collaborate with you to make a plan for treatment. In some cases, this may involve discontinuing medication before initiating treatment and in other cases medication reduction may be initiated during the course of treatment. As stated, the goal is often to help the individual to achieve good sleep without the use of sleep medications, but in most cases how to achieve this will be a collaborative effort between you, your prescriber, and your therapist. You will not be forced into a decision about your medication.
This information is provided by the Perelman School of Medicine at University of Pennsylvania who is a leader in behavioral sleep medicine.