Behavioral therapy effective in treatment of insomnia

April 10, 2001

DURHAM, N.C. -- New clinical data show that changing a person's attitudes about sleep and teaching new habits is a promising treatment for insomnia and may be an alternative to medication for the treatment of persistent primary insomnia, a sleep disorder that affects up to 5 percent of Americans.

More than one-third of the adult population is bothered by insomnia at least some of the time and 10 percent to 15 percent have chronic, unrelenting insomnia, according to Jack D. Edinger, lead author of the study appearing in the April 11 issue of the Journal of the American Medical Association. Edinger is a medical psychologist with Duke University Medical Center and the Durham VA Medical Center.

"This study shows quite clearly that a cognitive behavioral insomnia therapy can be effective for people who have difficulty staying asleep at night," Edinger said. "Many patients were able to reach fairly normal levels of sleep with this treatment and without the use of sleeping pills, and the results lasted through six months of follow-up."

In terms of this study, cognitive behavioral therapy (CBT) is a treatment that combines changing an individual's beliefs and attitudes about sleep and then teaching that person how to implement new behavioral patterns or habits in order to improve sleep. For example, people are taught how to think about their sleep in a more constructive way (change of attitude) and also how to establish better sleep patterns by incorporating new habits such as getting out of bed at the same time each day (even if it means getting less sleep) and eliminating daytime napping.

The study also showed that the treatment leads to clinically significant sleep improvements within six weeks, Edinger noted.

CBT appears to be a promising, more universally effective treatment for insomnia, according to Edinger. Early results suggest CBT effectively addresses both sleep-onset and sleep- maintenance problems, and produces a better long-term outcome than do medication or placebo.

The study included 75 study participants with chronic primary sleep insomnia who were divided into three groups. Each group received either cognitive behavioral therapy, relaxation training or placebo therapy for six weeks. Those receiving cognitive therapy saw a 54 percent reduction in their wake time after sleep onset as compared to a 16 percent reduction for the group receiving relaxation therapy and 12 percent for the placebo group.

Currently, sedative hypnotics or antidepressants are often used for treating insomnia, but many experts feel that neither should be recommended for long-term treatment of chronic primary insomnia.
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The study was funded by the National Institute of Mental Health and is one of the only studies done to date in the area of behavioral insomnia research that has used a double-blind, placebo control group design.

Duke University Medical Center

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