Anyone who has been a new parent or a college student has experienced a sleepless night or two. In fact, the stress of daily life leads most people to have the occasional restless night, and many people keep over-the-counter sleep aids in their medicine cabinets.
For those with chronic insomnia disorder, however, both the symptoms and their traditional treatment—prescription sleep aids—can be harmful. As a result, the American College of Physicians (ACP) now recommends cognitive behavioral therapy for insomnia (CBT-I) as the first-line treatment for adults with chronic insomnia.
Chronic insomnia affects up to 10 percent of adults. The American Psychiatric Association defines insomnia as sleep difficulties occurring at least three nights a week for at least three months and cause significant distress or problems at work, school or other areas of life. The results of chronic insomnia can be devastating. Patients experience:
- Poor cognitive function
- Mood disturbances
- Distress or interference with personal functioning
Over time, it can affect their personal relationships and their ability to succeed at work.
“Insomnia can be an early symptom of depression and anxiety,” he said. “It can also be related to underlying sleep apnea.”
Insomnia can also be related to alcohol, smoking and even over-the-counter medications, which can affect sleep stages. Sleep aids and postsurgical pain medications can trigger insomnia when patients stop taking them.
Dr. Aziz sees patients who have struggled with insomnia for years.
“By the time they come to the Sleep Center, the patient may not even remember when or why their insomnia began,” he said. “It may originally have been related to a new house, finances, a baby—and what may have begun with stress about money has now become stress about the sleep itself.”
Because of their side effects and the potential for reliance on them, however, the U.S. Food and Drug Administration has approved prescription and over-the-counter sleep aids only for short-term use, such as for jetlag. The new ACP guidelines recommend that medications be used only while clinicians are working with the patient to teach CBT-I skills.
CBT-I consists of behavioral therapy and relaxation strategies combined with keeping a detailed sleep diary and engaging in:
- Stimulus control - pinpointing actions that may be prohibiting sleep
- Sleep restriction - eliminating naps and early bedtimes
- Sleep hygiene - creating routines and environments that encourage sleep
Dr. Aziz says that the beginning of treatment can be something of a catch-22, as patients give up naps or get up earlier and get even less rest as a result.
“The patient has to be very disciplined,” he said. “They have to change their sleep behavior and their sleep pattern, limit their exposure to stimulus and go to bed at the same time every day.”
Over time, patients learn skills to manage their sleep hygiene and thought patterns related to sleeping and they begin to experience more restful sleep.
“CBT-I gives them tools they can use anytime in the future, not just when they’re first being treated,” he said.
Dr. Aziz recommends that anyone struggling with insomnia reach out to their primary care provider. From there they can schedule an assessment at a sleep center to rule out any underlying or secondary disease.