Forget counting sheep and drinking warm milk, an effective way to tackle chronic insomnia is cognitive behavioural therapy, researchers have confirmed. The authors of a new study say that although the therapy is effective, it is not being used widely enough, with doctors having limited knowledge about it and patients lacking access. “There is a very effective treatment that doesn’t involve medication that should be available through your primary care service. If it’s not, it should be,” said Dr Judith Davidson, co-author of a new study on CBT for insomnia from Queen’s University in Ontario, Canada.
Chronic insomnia, in which individuals have difficulties dropping off or staying asleep at least three nights a week for three months or more, is thought to affect about 10-15% of adults. The condition is linked to health problems including depression, as well as difficulties in functioning and sometimes resulting in accidents. Sleeping pills are not recommended for long-term use and can have side-effects, as well as posing a risk of addiction. Instead, the main treatment for chronic insomnia is CBT – a programme of changes to the way an individual approaches and thinks about sleep. These include staying away from the bed when awake, challenging attitudes about sleep loss and restricting the number of hours spent in bed. Writing in the British Journal of General Practice, Davidson and colleagues report how they examined the results from 13 previously conducted studies on the provision of CBT for insomnia through primary care. In some studies, participants were also taking medication to help them sleep. The results showed CBT for insomnia was effective and led to improvements in sleep that lasted during a follow-up many months later.
Looking at results from four randomized control trials, with between 66 and 201 participants of mixed ages, the team found that participants fell asleep on average nine to 30 minutes sooner after completing a course of CBT for insomnia and experienced a reduction of between 22 and 36 minutes in the amount of time spent awake after going to sleep. By contrast, those who were just on a waiting list, or given treatment as usual, only experienced up to four minutes’ improvement in the time it took to drop off and a maximum of eight minutes’ improvement in time spent awake after going to sleep. The team said it seemed four to eight sessions of CBT were required for such improvements, with an additional trial finding little benefit when only two CBT sessions were offered to insomniacs. Davidson said the new study supported the idea that CBT for insomnia could and should be offered through GPs – patients’ usual first port of call – although, as with most of the studies, the therapy itself could be delivered by others such as nurses, social workers or other primary care services.
In the UK, she added, possibilities include increasing access through IAPT (improving access to psychological therapies) services, health visitors or even specialist apps and websites such as Sleepio, which is currently available free through in the NHS in some parts of south-east England. Prof Helen Stokes-Lampard, the Chair of the Royal College of GPs, welcomed the study. “CBT tailored to insomnia has been a first-line treatment option for some time, and we know many patients have found it beneficial, so it is really positive that its effectiveness has been shown by this research,” she said. But, she added, access to CBT through the NHS could be extremely difficult to come by in the community and was very variable across the country. “This needs to be addressed, firstly by realising the pledge made in NHS England’s GP Forward View – for every GP practice in the country to have access to one of 3,000 new mental health therapists by 2020-21 and by the provision of many additional psychologists trained to deliver formal CBT,” she said.
Credit: Nicola Davis for The Guardian, 30 July 2019.