Although sleep problems tend to send people reaching for pills, the American College of Physicians has released new guidelines that recommend cognitive behavioral therapy (CBT) - a form of psychotherapy - before turning to sleeping medication for those with long-term insomnia.
The guidelines suggest that CBT is effective for people with chronic insomnia. This form of treatment combines talk therapy, behavioral interventions and education. Only when this treatment alone does not work should people speak to their doctors regarding the addition of drug therapy into their treatment plan.
"We know chronic insomnia is a real problem that patients present within our [doctors'] offices," said Wayne Riley, president of the American College of Physicians (ACP). "We want to get away from the overtendency to prescribe sleep medications, and clearly CBT can be a very nice tool in the toolkit."
One of the biggest advantages of CBT is its ability to create long-lasting effects and teach patients methods of managing their insomnia symptoms.
"It empowers patients to tackle their insomnia," said Nathaniel Watson, president of the American Academy of Sleep Medicine. "And since there is no medication involved, you can avoid the cost and potential side effects of medications long-term."
Despite the new guidelines pushing CBT for long-term insomnia, they are not meant to discourage people from seeking the benefits of sleeping medication.
"We looked at [the issue] very broadly; we don't say don't use a medication, we say, give your patient a trial... and if they come back still having problems sleeping, maybe add short-term use of a medication," Riley said. "We try to counsel against using [medication] longer than 10 to 14 days because we know dependence can be an issue."
CBT incorporates many sleep-related issues into treatment, including light levels, temperature and other aspects of the sleep environment. However, it also teaches patients realistic expectations, including expecting poor sleep every now and then.
"I think right now in this country we have a low sleep IQ and it's a problem," Watson said. "I would encourage people to prioritize sleep in their lives, including creating a better sleep environment. The bedroom should be reserved for the three S's - sleep, sex and sickness. And parents should model a good sleep environment, including [promoting] consistent bedtimes and wake times on weekdays and weekends."
The new guidelines were released May 3 in the Annals of Internal Medicine.
