POEMs

CBT Effective for Chronic Insomnia

 

Am Fam Physician. 2016 Jan 1;93(1):60.

Clinical Question

How effective is cognitive behavior therapy (CBT) for patients with chronic insomnia?

Bottom Line

A five-component approach to changing patients' beliefs and behaviors surrounding sleep is effective, at least in the short term, in getting persons to fall asleep and stay asleep, although total sleep time is not increased. The interventions are not difficult, and many are part of typical sleep hygiene practice. (Level of Evidence = 1a –)

Synopsis

Although medication is the primary treatment of chronic insomnia, CBT has been extensively studied as well. To determine its effectiveness, these researchers searched five databases, including the Cochrane Library, and identified 20 studies of 1,162 patients. The CBT used in these studies comprised at least three of five components (see below) and was compared with inactive treatments. Two investigators independently determined the eligibility of studies, extracted the data, and evaluated for risk of bias. There was no evidence of publication bias, although the study qualities were not high (because most studies were not or could not be masked). There was significant heterogeneity among some of the results, especially for outcomes for which there were limited data. Compared with inactive treatments, onset of sleep was 19 minutes earlier, on average, at the end of the treatment period. Minutes spent awake after first falling asleep were significantly fewer (by an average 26 minutes) at the end of treatment. However, overall sleep time did not increase significantly with treatment. Some, but not all, studies found a benefit that persisted after completion of therapy.

Components of CBT for insomnia:

  1. Cognitive therapy: aimed at dysfunctional beliefs and attitudes toward sleep and insomnia

  2. Stimulus control: avoiding nonsleep activities in the bedroom

  3. Sleep restriction: limiting time in bed to match perceived sleep duration to assure that more than 85% of time spent in bed was spent sleeping

  4. Sleep hygiene: typical measures of sleep scheduling and alcohol, caffeine, and nicotine intake

  5. Relaxation techniques: meditation, mindfulness, and so forth

Study design: Meta-analysis (randomized controlled trials)

Funding source: Self-funded or unfunded

Setting: Various (meta-analysis)

Reference: Trauer JM, Qian MY, Doyle JS, Rajaratnam SM, Cunnington D. Cognitive behavioral therapy for chronic insomnia: a systematic review and meta-analysis. Ann Intern Med. 2015; 163( 3): 191– 204.

POEMs (patient-oriented evidence that matters) are provided by EssentialEvidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, please see http://www.essentialevidenceplus.com. Copyright Wiley-Blackwell. Used with permission.

For definitions of levels of evidence used in POEMs, see http://www.essentialevidenceplus.com/product/ebm_loe.cfm?show=oxford.

To subscribe to a free podcast of these and other POEMs that appear in AFP,search in iTunes for “POEM of the Week” or go to http://goo.gl/3niWXb.

This series is coordinated by Sumi Sexton, MD, Associate Deputy Editor.

A collection of POEMs published in AFP is available at http://www.aafp.org/afp/poems.

 

 

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