Monday, March 11, is the sixth annual Insomnia Awareness Day, organized by the American Academy of Sleep Medicine (AASM), Society of Behavioral Sleep Medicine (SBSM), and American Alliance for Healthy Sleep (AAHS). This year’s theme is “Solutions for Sleepless Nights,” highlighting the effective treatments and trained providers available to help people who have chronic insomnia.
Insomnia involves difficulty falling asleep or staying asleep, or regularly waking up earlier than desired, despite allowing enough time in bed for sleep. Symptoms associated with insomnia include daytime fatigue or sleepiness; feeling dissatisfied with sleep; having trouble concentrating; feeling depressed, anxious or irritable; and having low motivation or low energy.
“Chronic insomnia can be a serious problem for some patients, impacting not just how a person sleeps at night, but also how a person feels or functions during the daytime,” says Jennifer Martin, PhD, a member of the AASM board of directors, in a release. “While anyone can have insomnia, it is more common in women, people who have other medical problems, such as chronic pain, and people who have mental health conditions such as depression.”
Insomnia is associated with an increased risk of various health problems. Research suggests that impaired sleep is a risk factor for Alzheimer’s disease, and a recent study found that people who have insomnia are 28% more likely to develop Type 2 diabetes than those without insomnia. These studies suggest that insomnia may be a potentially modifiable risk factor that could be targeted to prevent Alzheimer’s disease and diabetes.
Behavioral sleep medicine researchers and clinicians will gather Sept 12-15 at the first annual SBSM scientific meeting in Birmingham, Alabama, to discuss the high disease burden of insomnia and other sleep disorders.
While developing healthy sleep habits can help someone who has a mild or short-term case of insomnia, the most effective treatment for chronic insomnia is cognitive behavioral therapy for insomnia (CBT-I). The AASM Choosing Wisely statement recommends CBT-I as the treatment of choice for chronic insomnia.
As its name implies, CBT-I combines behavioral strategies, such as setting a consistent sleep schedule and getting out of bed when you are struggling to sleep, with cognitive strategies, such as replacing fears about sleeplessness with more helpful expectations. CBT-I recommendations are customized to address each patient’s individual needs and symptoms. While 6 to 8 sessions are typical, some patients improve more quickly, and a recent study shows that even a single session of CBT-I can reduce insomnia severity.
“Cognitive behavioral therapy is an incredibly effective and long-lasting treatment that is associated with changes in underlying physiology,” says SBSM president Donna Arand, PhD, who noted that new research using CBT-I shows a significant association between improvement in chronic insomnia and neural correlates of cognitive processes. Another study shows a decrease in regional brain activity in response to sleep-related sounds after CBT-I.
“For many people who have been unable to find an answer to their sleep problem, cognitive behavioral therapy may be the solution they need, and it is recognized by the American College of Physicians as a first line of treatment,” says Arand.
CBT-I is provided by psychologists and other clinicians who have training in behavioral sleep medicine. The online SBSM member directory makes it easy to find and contact a local CBT-I provider. A national board exam also has been established to identify additional qualified practitioners, and smart phone apps and online programs are being developed to deliver CBT-I based on evidence-based principles.
While CBT-I should be the first treatment offered for chronic insomnia, medications also can benefit some people, especially those who need short-term, quick relief. An AASM clinical practice guideline suggests that several medications can help select patients when supervised by a doctor. However, the guideline suggests that clinicians should not use the antihistamine diphenhydramine, the hormone melatonin, or the herb valerian to treat insomnia.
One of the keys to the effectiveness of CBT-I is that it empowers the patient with a proven strategy that can last a lifetime. CBT-I gives a sense of control back to the patient, who no longer must feel trapped in a cycle of frustration while tossing and turning in bed.
“Sleep should be the most pleasant, relaxing and restorative experience of the day, but sleep disorders are notorious for robbing us of that nightly pleasure,” says AAHS chair Patti Van Landingham, who has been living with narcolepsy for decades. “People who have chronic insomnia need to seek help so that they can experience the joy of sleep again.”
Talk to your doctor if you have insomnia or another sleep problem, such as snoring or restless legs at night. Your doctor may refer you to a CBT-I provider or an AASM-accredited sleep center for help.