Recently, the American College of Physicians (ACP) recommended that doctors treat chronic insomnia with an approach that HealthPartners and Park Nicollet have already been using for several years.

In May, the ACP said Cognitive Behavioral Therapy for Insomnia (CBT-I) should be the first treatment for patients who are struggling with chronic insomnia, rather than sleeping medications.

While most people experience sleeplessness at some point, CBT-I treats patients who have chronic insomnia. It’s defined as losing at least 30 minutes of sleep for three or more nights a week for at least three months.

“At least 10 percent of adults have chronic insomnia and CBT-I is a very effective treatment,” explained David Weber, Regions Hospital Sleep Health and Insomnia Manager.

The Regions Hospital Sleep Health Center has several sleep psychologists who can provide CBT-I, including one who we recently hired in light of the new ACP guidelines. Additionally, CBT-I is available at the Park Nicollet Meadowbrook and Maple Grove clinics.

What is Cognitive Behavioral Therapy for Insomnia?

The therapy begins with patients recording their sleep habits. This includes when they’re awake at night and what they do to try to get back to sleep. Using that information, a custom treatment plan is created for each patient.

The primary goals of all treatment plans are to help patients:

  • Change their sleeping patterns to increase their natural ability to fall and stay asleep
  • Learn to associate the bed with sleeping and not with stimulating activities
  • Create healthy habits that improve their ability to sleep, such as having a dark bedroom or removing electronic gadgets
  • Learn how to relax at night
  • Reduce their anxiety about sleep

The initial goal of the treatment is to increase the patient’s ability to fall asleep and decrease the amount of time he or she spends awake in bed. Once accomplished, treatment shifts to increasing the amount of time the patient is asleep.

Which is better: CBT-I or sleeping pills?

In short, CBT-I is better in both in the beginning and over time. It can treat chronic insomnia on its own or along with medication. But CBT-I is just as or more effective than prescription sleep medicines during the first one to two months of treatment, and is much more effective long term. The best outcome from sleep medicines is temporary relief from insomnia, while CBT-I has resulted in both short- and long-term improvements. Often, chronic insomnia has gone away completely.

A three-year study completed at Regions Hospital in 2014 found patients who completed CBT-I spent 67 percent less time awake in bed and increased their average amount of sleep per night from 6.5 to 7 hours. There are other downsides to sleep medications that are not associated with CBT-I. For example, some sleep medications (e.g. eszopiclone, zolpidem and suvorexant) may increase the risk of dementia, driving impairment, fractures, injuries, and cognitive and behavioral changes, according to data from the US Food and Drug Administration. Other studies have linked them to increased cancer risk and excess mortality.

Looking to replace sleep medications with therapy as often as possible, HealthPartners first implemented CBT-I in 2011. Park Nicollet has had various forms of sleep therapy available for 20 years. For more information on CBT-I and sleep medicine, please contact our sleep experts.