Nonpharmacologic treatment of insomnia

Abstract

Insomnia is a widespread and debilitating disorder. Regardless of the initial cause, it may assume a chronic course perpetuated by psychological and behavioral factors. Although sedative-hypnotic medications are the most common treatment for insomnia, they pose certain risks such as adverse effects and dependence. Furthermore, medications target symptoms and fail to address the underlying perpetuating mechanisms. There are many nonpharmacologic treatment options for insomnia, including cognitive/behavioral methods, relaxation strategies, and complementary and alternative medicine (CAM) approaches. Most CAM therapies lack sufficient scientific evidence to recommend their use. Over the past 30 years, cognitive-behavioral therapies have emerged as the treatment of choice for chronic insomnia. These therapies target behavioral, cognitive, and conditioning factors underlying insomnia, thereby restoring normal sleep-wake functioning. The effectiveness of these therapies is well established. They compare favorably to pharmacologic approaches, with the added benefits of few or no adverse effects and no risk of abuse or dependence. Perhaps most importantly, behavioral insomnia therapies offer a potential cure for the insomnia, instead of the symptom-focused approach provided by medications. Despite the proven success of cognitive-behavioral therapies, they are not widely available to patients with insomnia because of a paucity of behavioral sleep specialists. Efforts are now being made to disseminate these treatments to meet the demand. Emerging therapies hold promise for further refinement and development of successful treatments.

Efficacy of a behavioral self-help treatment with or without therapist guidance for co-morbid and primary insomnia -a randomized controlled trial

“…However, many individuals with insomnia would prefer non-pharmacological treatment if available [9,10]. Cognitive behavioral therapy (CBT) has been shown to be effective for insomnia [11-13], and is therefore considered treatment of choice [14,15]. Still, CBT is provided only to a minority, at least partially due to the limited availability of CBT therapists [16] and high initial costs [17].…”

Moderate Exercise Plus Sleep Education Improves Self-Reported Sleep Quality, Daytime Mood, and Vitality in Adults with Chronic Sleep Complaints: A Waiting List-Controlled Trial

“…For example, CBTs are quite unknown and little used among physicians [21]. Further, trained cognitive behavioral therapists are rare [22]. To bridge the gap between the high prevalence of insomnia and the low accessibility of CBT, regular physical activity has been proposed by sleep experts as another option for a better night sleep [23, 24].…”

Cognitive Behavior Therapy Ameliorates Non-Motor Symptoms in Parkinson's Disease

“…The effects seem to last. Patient's sleep is better than before even a year after CBT [30]. In our study, subjective sleep quality, daytime dysfunction scores and actual sleep latency were significantly improved under CBT intervention.…”