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For People With Chronic Insomnia, Try Cognitive Behavioral Therapy First Before Pills: Doctors

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Having trouble getting a shuteye? A doctors' group in the United States recommends turning to cognitive behavioral therapy (CBT) as the first line of treatment for chronic insomnia instead of reaching for the pill bottle.

Chronic insomnia is a real problem that affects 10 percent of the U.S. population, and the typical way of addressing it is by taking sleeping pills.

However, Dr. Thomas Tape of the University of Nebraska Medical Center warns that prescribing a pill is not the desirable first step to treat the sleep disorder.

With that in mind, the American College of Physicians (ACP) released new guidelines on Monday that described CBT as an effective method in conditioning the body to sleep again, especially because the therapy does not carry side effects.

"We want to get away from the overtendency to prescribe sleep medications," said ACP President Dr. Wayne Riley. "Clearly CBT can be a very nice tool in the toolkit."

Recommending Cognitive Behavioral Therapy

Chronic insomnia is defined as the difficulty of falling or staying asleep, and it is more common in women and older adults. The sleep disorder can induce fatigue, mood disturbance and poor thinking and can take a toll on productivity.

Initially, the ACP did not find enough evidence to directly compare drug treatment and CBT, but the group then added a review of published research that indicated CBT's effectiveness, mentioning its plausibility in primary care setting.

Before doctors recommend CBT to patients with insomnia, they should first rule out medical conditions that cause insomnia, such as restless leg syndrome, obstructive sleep apnea and prostate gland enlargement.

Doctors should also advise patients regarding behavioral factors that contribute to poor sleep, including alcohol drinking.

Additionally, if CBT does not work alone, then that is when doctors should discuss options with patients and consider adding drug therapy.

How Cognitive Behavioral Therapy Works

Although CBT involves keeping the bedroom dark or avoiding too much caffeine, experts say it is much more than that.

CBT is about reconditioning the body and brain away from habitual tossing and putting it back to normal sleep patterns, according to sleep medicine specialist Meg Lineberger. She was not involved with the guidelines.

The therapy is usually administered by psychologists or physicians trained in this form of psychotherapy. Four to six sessions of CBT are required to improve a person's condition.

Lineberger said the hardest part of CBT is sleep restriction. For a person who sleeps an average of 5.5 hours daily, an extra half-hour should be tacked.

The person should then count back the six hours from the wake-up time. If the person wakes up at 6 AM, then 12 midnight is the initial prescribed bedtime.

This helps build up the body's drive for sleep. Gradually, the patients then move to an earlier bedtime.

Meanwhile, American Academy of Sleep Medicine President Dr. Nathaniel Watson said patients with chronic insomnia are taught with realistic sleep expectations. He also suggested inexpensive apps that are available online such as ShutEye and Sleepio.

The ACP guidelines are featured in the Annals of Internal Medicine. Supporting evidence is also published in the same journal.

Photo: Clare Bell | Flickr

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