If you regularly struggle to fall asleep or stay asleep, there's hope. Over 50 years of research, the American College of Physicians, and the American Academy of Sleep Medicine agree: The most effective treatment for chronic insomnia in adults is skill-based (not pill-based) and completed over an average of only 4 to 8 weekly sessions. Let's talk about it:
By Brian Curtis, Ph.D.
I have yet to meet the person who uses their wand to continue taking sleeping pills.
"I want to fall asleep and stay asleep naturally, like I used to. That would be AMAZING!"
This makes sense.
We don't want to take a pill for something we expect our body to do naturally.
It's a bummer to take suppositories (pun?) We're tired of taking sleeping pills (PUN!!)
And yet many of us who have lived with chronic insomnia - difficulty falling asleep, staying asleep, or waking up before we want to with difficulty getting back to sleep for 3 months or longer - are unaware that the gold standard, most effective treatment is skill-based, not pill-based.
Although sleep medications can effectively manage insomnia for days or weeks due to life stressors, they're not recommended to treat insomnia lasting 3 months or longer.
[Side note: The point here is NOT to bash medications. Stimulants like modafinil (Provigil) are the gold standard, first-line treatment for narcolepsy. Medications can be life-saving. They're just not the recommended treatment option for chronic insomnia].
Based on over 50 years of experimental evidence, the American College of Physicians (ACP) in 2016 and the American Academy of Sleep Medicine (AASM) in 2008, 2017, and 2021 recommend Cognitive Behavioral Therapy for Insomnia (CBT-I) as the most effective treatment option for chronic insomnia disorder in adults.
CBT-I is a skills-based treatment that has multiple components and is individualized according to your unique medical history, psychological history, social history, and sleep-wake pattern.
The treatment involves daily monitoring of your sleep-wake pattern, targeting specific patterns of behavior that seem to be maintaining your insomnia, and refining treatment over time until you're able to regularly fall asleep and stay asleep without difficulty.
CBT-I has demonstrated greater long-term improvements in insomnia compared to a variety of sleep medications, including Ambien, Imovane, and Sonata, with no concern for side effects like dizziness, headache, daytime sleepiness, and re-emergence of insomnia when sleep medications are discontinued.
And get that magic wand ready ...
Skills have no side effects.
They don't require a prescription.
They work for as long as you practice them. Perhaps for a lifetime.
On a personal note, I want you to know that even though our stories are different, as any two human stories are different, I also know what it’s like to struggle with sleep.
For 21 years, from age 10 to 31, I struggled with chronic insomnia.
I was the kid at sleepovers awake at 1:00 in the morning, watching my friends sleep.
My insomnia continued throughout elementary school, middle school, high school, and college.
I tried Benadryl, Unisom, ZzzQuil, and Ambien.
Pros: I could fall asleep faster.
Cons: Hours of morning grogginess, occasional headaches, and nausea.
It was better than insomnia ... some of the time.
Pills were the only tools I was offered.
After graduating college, I quit my corporate day job to begin what would become a long-term research collaboration with the medical director of our university sleep center.
This introduced me to the field of sleep medicine. The science of sleep.
What did over 50 years of this science say about my use of Benadryl, Unisom, ZzzQuil, and Ambien?
The most effective treatment for chronic insomnia is skill-based, not pill-based.
This blew my mind.
Why was I just learning about this now?
Why did my primary care providers only offer pills vs. skills?
Fortunately, our university sleep center had a full-time clinical psychologist on staff specializing in CBT-I
Not every sleep center offers CBT-I.
Few primary care providers can refer their patients with chronic insomnia to a qualified CBT-I provider.
There aren’t enough trained clinicians to go around.
This is a problem.
We need more clinicians specializing in behavioral sleep medicine to fix this problem.
Through ongoing practice of CBT-I skills, I’ve been free of chronic insomnia for the past 6 years (and counting).
As my wife Megan will tell you, I'm a more present husband, a more patient father, and a happier human now that sleep is no longer a constant struggle.
My hope is that this post will help people like us overcome our difficulties with sleep so we can focus on what truly matters: Building more meaningful lives with the people we love.
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