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Treatments

WHAT IS IT?

Cognitive behavioral therapy for insomnia (CBTI) is a type of therapy for sleep problems.

CBTI can help you identify thoughts and behaviors that are causing sleep problems and replace them with better habits. CBTI helps you figure out if your sleep environment is good. It covers strategies for stress reduction and relaxation. Your therapist will have you keep a sleep diary, to check your habits and schedule. CBTI also involves a stretch of nights with less sleep, to reset your body’s rhythms.

It is offered in group or individual sessions, on the phone, online, and through paid apps. The number of sessions varies.

Working with a therapist will likely be more successful than using a CBTI app. People are more likely to follow the whole program if they have to report to a therapist. The sleep deprivation portion of the therapy is very important and can be hard to stick to without a therapist.

OUR BOTTOM LINE:  DOES IT HELP?

YES. There is strong evidence that cognitive behavioral therapy for insomnia works for sleep problem. And, unlike sleep medications, it has no risks.  It is as effective or even more effective that sleep medicines in the short term, and  works better in the long term. The effect of sleep medicines goes away when they are stopped. While CBTI continues to work because it addresses the underlying causes of sleep problems. The effect lasts for at least a year after therapy.

HELPS FOR THESE SYMPTOMS

common-insomnia

SLEEP PROBLEMS & INSOMNIA

CBTI decreases overall sleep problems in women with menopause symptoms – and it keeps on working after the therapy is done. In one study of a telephone-based program, 70% of women had no clinically significant insomnia at the end of the study compared to only 24% of women in the control group.

common-depression

MOOD, ANXIETY & DEPRESSION

While not studied specifically in menopausal women, CBTI does improve anxiety and depression in those with sleep problems.

MAY HELP FOR THIS SYMPTOM

common-hot-flashes

HOT FLASHES AND NIGHT SWEATS

CBTI does not decrease the number or severity of hot flashes or night sweats. However, CBTI does decrease how much hot flashes interfere with women’s’ daily lives.

POTENTIAL RISKS & SIDE EFFECTS

There are no risks with CBTI.

QUALITY OF LIFE EXPECTATIONS

In addition to helping with sleep, CBTI improves overall menopause related quality of life, including areas of vasomotor symptoms, sexual functions, and psychosocial symptoms.

IF I WANT TO TRY THIS TREATMENT WHAT ARE MY NEXT STEPS?

Look online for CBTI therapists in your area. Some geographic areas or insurance providers publish a directory of providers. You can look for a certified sleep center on the American Academy of Sleep Medicine website. Check to see what is covered by your insurance.

As a first step, you can make sure that your “sleep hygiene” (sleep environment) is good. Here are suggestions from the American Association of Sleep Medicine:

  • Keep a regular sleep schedule. Get up at the same time every day, even on weekends or during vacations.
  • Set a bedtime that is early enough for you to get at least 7 hours of sleep.
  • Don’t go to bed unless you are sleepy.
  • If you don’t fall asleep after 20 minutes, get out of bed.
  • Establish a relaxing bedtime routine.
  • Use your bed only for sleep and sex.
  • Make your bedroom quiet and relaxing. Keep the room at a comfortable, cool temperature.
  • Limit exposure to bright light in the evenings.
  • Turn off electronic devices at least 30 minutes before bedtime.
  • Don’t eat a large meal before bedtime. If you are hungry at night, eat a light, healthy snack.
  • Exercise regularly and maintain a healthy diet.
  • Avoid consuming caffeine in the late afternoon or evening.
  • Avoid consuming alcohol before bedtime.
  • Reduce your fluid intake before bedtime.

(Source: http://sleepeducation.org/essentials-in-sleep/healthy-sleep-habits)

NOT USED FOR THESE SYMPTOMS

  • Heavy irregular periods
  • Low sex drive
  • Pain during sex
  • Vaginal pain, not during sex
  • Bladder control problems
  • Brain fog / cognitive issues
  • Dry eyes
  • Dry hair & skin
  • Physical aches & pains
  • Palpitations
  • Weight gain
FOR HEALTH CARE PROVIDERS & THOSE WHO WANT MORE OF THE SCIENCE

Insomnia is a major public health problem. It is highly prevalent and can have a profound impact on daily life. Cognitive behavioral treatment for insomnia (CBTI) is the preferred treatment. A recent meta-analysis found that CBTI had significant effects on: insomnia severity index, sleep efficiency, Pittsburgh sleep quality index, wake after sleep onset and sleep onset latency, number of awakenings, and sleep quality. Face-to-face treatments of at least four sessions seem to be more effective than self-help interventions or face-to-face interventions with fewer sessions. Results are the same for patients with or without comorbid disease, younger or older patients, and those using or not using sleep medication.

REFERENCES

American Sleep Association. (2007). Sleep hygiene tips. Web: https://www.sleepassociation.org/about-sleep/sleep-hygiene-tips/. Crowley, K. (2011). Sleep and sleep disorders in older adults. Neuropsychology Review, 21(1), 41-53.

Carney CE, Edinger JD, Kuchibhatla M, et al. Cognitive Behavioral Insomnia Therapy for Those With Insomnia and Depression: A Randomized Controlled Clinical Trial. Sleep. 2017;40(4):zsx019. doi:10.1093/sleep/zsx019

Cheng P, Luik AI, Fellman-Couture C, et al. Efficacy of digital CBT for insomnia to reduce depression across demographic groups: a randomized trial. Psychol Med. 2019;49(3):491‐500. doi:10.1017/S0033291718001113

Guthrie KA, Larson JC, Ensrud KE, Anderson GL, Carpenter JS, Freeman EW, Joffe H, LaCroix AZ, Manson JE, Morin CM, Newton KM, Otte J, Reed SD, McCurry SM.Effects of Pharmacologic and Nonpharmacologic Interventions on Insomnia Symptoms and Self-reported Sleep Quality in Women With Hot Flashes: A Pooled Analysis of Individual Participant Data From Four MsFLASH Trials.Sleep. 2018 Jan 1;41(1). doi: 10.1093/sleep/zsx190.

JAMA Intern Med. 2016 Jul 1;176(7):913-20. doi: 10.1001/jamainternmed.2016.1795. PMID:27213646 Free PMC Article

McCurry SM, Guthrie KA, Morin CM, Woods NF, Landis CA, Ensrud KE, Larson JC, Joffe H, Cohen LS, Hunt JR, Newton KM, Otte JL, Reed SD, Sternfeld B, Tinker LF, LaCroix AZ. PMID:29165623 Free PMC Article

Telephone-Based Cognitive Behavioral Therapy for Insomnia in Perimenopausal and Postmenopausal Women With Vasomotor Symptoms: A MsFLASH Randomized Clinical Trial.

Trauer JMQian MYDoyle JSRajaratnam SMCunnington D.Cognitive Behavioral Therapy for Chronic Insomnia: A Systematic Review and Meta-analysis. Ann Intern Med. 2015 Aug 4;163(3):191-204. doi: 10.7326/M14-2841.

van Straten A1van der Zweerde T2Kleiboer A2Cuijpers P2Morin CM3Lancee J4. Cognitive and behavioral therapies in the treatment of insomnia: A meta-analysis. Sleep Med Rev. 2018 Apr;38:3-16. doi: 10.1016/j.smrv.2017.02.001. Epub 2017 Feb 9.

Ye YY, Zhang YF, Chen J, et al. Internet-Based Cognitive Behavioral Therapy for Insomnia (ICBT-i) Improves Comorbid Anxiety and Depression-A Meta-Analysis of Randomized Controlled Trials. PLoS One. 2015;10(11):e0142258. Published 2015 Nov 18. doi:10.1371/journal.pone.0142258

Last reviewed July, 2021

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