"If we treat you with Ambien you will sleep, but when we stop treating, you are likely to go back to not being able to sleep. CBT gives tools with which people can help themselves in the longer run. With CBT, the benefits endure," Hirskowitz tells WebMD.
But there are drawbacks.
"The disadvantage to CBT is that it is not widely available. In many locations, it is difficult to find a practitioner who knows how to do it properly," Hirskowitz says. "And it is time consuming."
That's just what Jacobs is trying to get around. He notes that his team gets results with just four half-hour sessions -- less than the six to eight CBT sessions common for other psychiatric treatments. True, he says, doctors and psychologists need training before they can treat insomnia with CBT. But not everyone with insomnia needs a top-notch CBT therapist.
"Whether a person will benefit from simple guidelines or in-depth CBT depends on the patient," Jacobs says. "Some can go on WebMD and see this article, or reference my book, Say Goodnight to Insomnia, and that is all they need. This is not something you necessarily have to find at a sleep clinic."
Elements of CBT for Insomnia
As its name implies, CBT has two parts: cognitive and behavioral.
The cognitive portion of CBT requires people with insomnia to recognize, challenge, and change the ways of thinking that keep them from falling asleep.
"It involves educating insomnia patients about the fact they often engage in distorted, stress-inducing behavior about insomnia," Jacobs says. "We place an emphasis on their worries and anxieties about how their insomnia will affect their next-day performance and long-term health. We educate them about research showing that in most cases their concerns are not accurate."
CBT therapists provide information to counter negative thoughts relating to their problem.
People with insomnia also have distorted ideas about how well they actually sleep.
"Insomnia patients say, 'I never slept at all last night,' or, 'It took me until 4 a.m. to fall asleep,'" Jacobs notes. "But if you measure their sleep, you see they slept for four or five hours. In therapy sessions, they learn their perceptions of sleep are not quite accurate. And in these sessions we role play a little bit to give them replacement sleep thoughts."