Chronic insomnia is a common condition that negatively affects a person’s health, physical and mental function, and quality of life, and cognitive behavioral therapy for insomnia (CBTI) is the “gold standard” for treatment, said Michael Vitiello, MD, Professor of Psychiatry & Behavioral Sciences, Gerontology & Geriatric Medicine, and Biobehavioral Nursing, University of Washington, Seattle, in a session at the recent Neurology Week virtual meeting.

“I’d like to emphasize that insomnia is a significant health problem and that it is a unique disorder, it is not simply a symptom,” states Dr Vitiello. “The estimates have been up to 10% of the population, particularly those with significant illnesses, may experience chronic insomnia.”

Chronic insomnia is not a secondary condition but often interactive with other comorbid conditions, particularly with mental health disorders and physical conditions, such as pain. “Developments in cognitive behavioral therapies are opening a wide range in our abilities to treat chronic insomnia,” explains Dr Vitiello.

Since 2016, CBTI has been recognized as the “gold standard” treatment for chronic insomnia, and CBTI should be used as the initial treatment and not an optional treatment. CBTI is “a multimodal treatment primarily behavioral in nature,” and includes the following components:

•       Sleep education

•       Review of sleep hygiene/habits

•       Sleep diary/log

•       Stimulus control therapy

•       Sleep restriction therapy

•       Relaxation techniques

•       Cognitive restructuring techniques

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In a comparison study from 1999, CBTI was assessed against pharmacotherapy, and both “were equally effective and comparable in their efficacy in the short term,” Dr Vitiello states. However, CBTI was rated as more favorable by patients and care givers than traditional pharmacotherapy, “but what was most interesting is that the CBTI-based improvements were still sustained at 2-year follow-up.” The findings from this study have been confirmed in subsequent studies over the last 2 decades.

Dr Vitiello highlighted 2 additional studies that focused on adults with uncomplicated chronic insomnia, as well as those with comorbid chronic insomnia, and the results were “surprisingly identical.” In both studies, sleep latency and wake after sleep onset were reduced, and total sleep time and efficiency were increased, reiterating that CBTI is an effective, durable treatment for chronic insomnia.

The final study Dr Vitiello discussed incorporated the use of CBTI for chronic insomnia with comorbid mental health and medical conditions. The comorbid conditions were not directly treated during this study, and only CBTI for insomnia was addressed. Yet, there was a significant effect size for pooled comorbid outcomes, especially relating to mental health disorders, such as anxiety and depression.

Dr Vitiello concludes that “CBTI is not only effective in durable treatment for sleep, but CBTI-improved sleep may have beneficial effects on the comorbid illnesses.”

—Heather Flint

Reference

Vitiello MV. Recent research advancements in treatment of chronic insomnia. Presented at: Neurology Week; July 14–18, 2021; Virtual.