What is Insomnia and how is it treated



Insomnia is a very serious and frustrating health condition that affects roughly 15% of the general population. An occasional night of poor sleep is generally not considered much of a problem. However, when insomnia moves from the occasional night to a chronic condition where you find yourself struggling three to four nights per week or more, it can, over time, lead to significant problems with daytime function and can put some people at additional risk for depression, anxiety, and substance abuse, if left untreated.

Insomnia Symptoms

Insomnia symptoms can manifest in different ways. Some people have trouble getting to sleep, some have trouble staying asleep, some wake too early, and some just feel that their sleep is not refreshing; often, a mix of symptoms occur. Common daytime problems include fatigue, difficulties with attention and concentration, difficulty with work or school performance, irritability, decreased motivation, and continued worry about the inability to sleep and its consequences. 

Natural History of Insomnia

Some of you may also have had the rather unexpected experience of your insomnia developing "a life of its own". That is, the original upsetting experience that started the sleep difficulty is long gone but the insomnia remains. This kind of phenomenon can happen if you. like many others, spent a lot of time in bed stressed-out "trying" to sleep as a way to combat the problem. Unfortunately, the more you "try" to sleep the less likely you are to sleep, and spending a lot of time in bed stressed-out can condition the bed and bedroom to become a rather unfriendly place, evoking stress and wakefulness instead of relaxation and sleepiness. 

Treatment with Medications

The most common treatment for insomnia is sleep medication. While this group of medicines can be very effective particularly at the onset of symptoms, their long term use is generally not regarded by most sleep experts as a good strategy. Also, most people, at some point, begin feel that they want to get back to sleeping on their own; and when people succeed in this, it brings a great sense of self-satisfaction. 

Cognitive Behavioral Treatment for Insomnia

Again, while medications are useful, there is, fortunately, another strategy: Cognitive Behavioral Therapy for insomnia (CBT-I). This is a short-term psychotherapeutic, non-medication, treatment that can effectively address your difficulties with sleep, the counterproductive conditioning, the worry, and problems with daytime function. Most patients are able to complete treatment in 4 to 8 sessions. The first 1 to 2 sessions are devoted to completing a thorough assessment of your insomnia and its development along with a careful examination of any medical, psychiatric, and behavioral conditions that could be contributing to the problem. After the assessment process is completed, the remaining sessions are devoted to putting the initial treatment plan into action and making adjustments as indicated. 

There is Longstanding Support for CBT-I

For many years the practice guidelines set forth by both the Society of Behavioral Sleep Medicine and the American Academy of Sleep Medicine have deemed CBT-I a first-line treatment for chronic insomnia.

Most recently (2016), the American College of Physicians, provided the following recommendation based on their independent review of research.

"All adult patients should receive CBT-I as the first step in treating chronic insomnia.

If CBT-I alone does not help to improve insomnia, patients and clinicians should discuss medicines. Clinicians and patients should make a decision together after discussing the benefits, harms, and costs of medicines."