June 10, 2015 -- Can you talk away your insomnia?
Cognitive behavioral therapy, better known as ''talk therapy'' or CBT, helps people with an ongoing case of the sleep disorder improve their shut-eye, according to a review of research on the topic.
The approach works because it gets to the root of the problem: why you can’t sleep.
After therapy, people with insomnia fell asleep about 20 minutes more quickly and took less time to fall back asleep after waking, studies show.
The effects also seemed to last. The studies had various follow-up periods, ranging from 1 to 12 months. Other research has found the effects of talk therapy on insomnia continued over a 6-month follow-up, researchers say.
But talk therapy didn't seem to result in more total sleep time -- only about 7 minutes.
In helping people manage their insomnia, "the total amount of sleep isn’t the focus or what is important,” says David Cunnington, MBBS, a researcher at the Melbourne Sleep Disorders Center and senior author of the review. “What is more important is time taken to get to sleep and how much time is spent awake during the night. So improvements in those measures are key.”
Typically, you need four to six talk therapy sessions to learn the entire approach, Cunnington says. His team came to that conclusion after drawing data from 19 published studies. More than 1,100 men and women were in the studies.
"This really confirms that cognitive behavior therapy for insomnia is an effective strategy that works well beyond the treatment period, unlike medications, which only mask symptoms and don't address the underlying problems that actually perpetuate the insomnia," Cunnington says.
Up to 15% of adults have ongoing or "chronic" insomnia. The sleep disorder has been linked with anxiety, depression, high blood pressure, and type 2 diabetes. Insomnia is chronic if it happens at least 3 nights a week for a month or longer. Sleeping pills are linked with side effects, dependence, and tolerance problems, the researchers say.
"People with chronic insomnia worry about the lack of sleep and the impact of insomnia on daytime functioning," says Charles Morin, PhD, the Canada research chair on sleep disorders. He wrote an editorial to accompany the study. "That becomes a vicious cycle. The more you worry about sleep, the longer you stay awake. CBT is directly aimed at short-circuiting this cycle."
The new report, published this week, follows another small study published in the journal Sleep earlier this month. A single therapy session helped 60% of those with short-term insomnia sleep better, compared to just 15% who didn't get the session, researchers say.
Therapy for Insomnia: A Closer Look
"Once people have had trouble sleeping for a couple of months," Cunnington says, "they think and behave differently about sleep." That, in turn, continues the insomnia, he says.
A therapist for insomnia ideally helps you learn to:
- Identify misguided beliefs, such as unrealistic expectations about sleep and unrealistic fears about lack of sleep.
- Get up and leave the bedroom if sleep is slow in coming.
- Restrict sleep. People with insomnia get frustrated by time spent awake in bed.
- Examine your sleep habits. This includes avoiding alcohol, nicotine, and caffeine before bedtime.
- Practice relaxation techniques, such as meditation and breathing to ease anxiety.
Thinking Yourself to Sleep: Other Views
Therapy works quickly for treating insomnia, Morin says. "Unlike some other disorders, you can get quite far with maybe half a dozen clinical consultations (for insomnia)," he says.
Talk therapy as a treatment has been somewhat overlooked, he says, due to the view that insomnia has to be fixed quickly, and that often means writing a prescription for a sleeping pill, he says.
The review is solid, says Khalid Eltawil, MD, a sleep medicine specialist at UCLA Health.
He says it's important for a doctor to rule out other medical conditions that may be causing the problem.
Then, simple talk therapy techniques can lessen or get rid of your frustration over lack of sleep, Eltawil says. For example, get into the habit of not going to bed until you're tired -- even if that's 2 hours after your typical bedtime.
If you want to try talk therapy for chronic insomnia, ask your primary care doctor for a referral to a behavioral sleep-medicine specialist or other medical professional, psychologist, or therapist trained in the technique, Morin says.