![]() ![]() Several core components of CBT-I (e.g., sleep restriction and stimulus control) can be difficult to implement and often result in a short-term worsening of symptoms and patient discomfort. One potential explanation is poor adherence to treatment. In a study evaluating CBT-I for persistent insomnia in adults, 40 % did not report a significant treatment response and 61 % continued to experience insomnia symptoms following therapy. ![]() ĭespite the evidence that CBT-I is an effective intervention with lasting effects, there are still a significant number of individuals whose insomnia does not fully respond to CBT-I. Lastly, insurance reimbursement for CBT-I can be poor, particularly if delivered by non-physician mental health providers (e.g., psychologists). Second, despite solid efforts to increase the number of trained professionals and provide alternative delivery models, the reach of CBT-I remains limited in large part to major cities and academic medical centers. First, there is a lack of awareness among the general public and primary care providers to the existence of, and evidence for, CBT-I. Despite the endorsement of CBT-I as a first-line treatment for insomnia disorder from both the National Institutes of Health and the American Academy of Sleep Medicine, several barriers to accessing CBT-I remain. Strong evidence demonstrates that CBT-I and hypnotic medications are equally effective in the short-term, whereas the gains from CBT-I are significantly better maintained over time relative to hypnotic therapies. Considering the possible risks associated with prescription sleep aid use and the lack of efficacy data in various populations with chronic illness, it is important to provide patients with evidence-based alternatives that fit their unique needs.Ĭognitive behavior therapy for insomnia (CBT-I) is a highly effective non-pharmacological intervention for insomnia that is considered first-line treatment for chronic insomnia disorder. However, sleeping aids are associated with a number of negative health outcomes including increased risk for motor vehicle accidents, falls and fractures in the elderly, the development of comorbid psychiatric and medical conditions, and increased overall mortality, and may not be desired by patients with chronic medical illnesses. The most common treatment for trouble sleeping continues to be prescription sleep aids with recent estimates suggesting that 4 % of the US population (approximately 11 million people) endorsed its use within the preceding 30 days. A multi-national cross sectional survey of 25,579 individuals suggests that 35 % of the population reports some difficulty initiating and maintaining sleep, or non-restorative sleep at least 3 days per week, with 10 % reporting significant daytime consequences of poor sleep. Insomnia is a universal concern affecting individuals across the lifespan. ![]()
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