AAN 2022 | Cognitive behavioral therapy is the gold standard treatment for insomnia
Michelle Jonelis, MD, Redwood Pulmonary Medical Associates, Redwood City, CA, talks on the recommendation for cognitive behavioral therapy (CBT) as the gold standard treatment for insomnia. In recent years, data has accumulated demonstrating the superiority of CBT over pharmacologic approaches, with regards to long-term outcomes. Through relaxation training, cognitive restructuring, and psychoeducational interventions, CBT can effectively treat insomnia in many patients. Dr Jonelis notes the lack of universal access to psychological interventions, commenting on ongoing initiatives to improve access, as well as what care providers can do for their patients where these services are not available. Small interventions such as exercise, social contact, increasing sunlight exposure, and stopping daytime dozing can have a substantial impact on a patient’s sleep. This interview took place at the American Academy of Neurology 2022 Congress in Seattle, WA.
Transcript (edited for clarity)
The goal of me talking at the American Academy of Neurology Meeting is to just let everybody know that the recommended treatment for insomnia these days is not actually medications anymore, but it is cognitive behavioral therapy for insomnia, a structured psychological intervention where you help people break the cycle between bad days and bad nights, and you teach them techniques to improve their sleep schedule and to correct misleading thoughts that they have about sleep...
The goal of me talking at the American Academy of Neurology Meeting is to just let everybody know that the recommended treatment for insomnia these days is not actually medications anymore, but it is cognitive behavioral therapy for insomnia, a structured psychological intervention where you help people break the cycle between bad days and bad nights, and you teach them techniques to improve their sleep schedule and to correct misleading thoughts that they have about sleep. Something called dysfunctional beliefs about sleep. And I’m on a committee through the Society for Behavioral Sleep Medicine to try to make cognitive behavioral therapy for insomnia, more accessible to primary care providers and other physician providers, such as neurologists. And I’m talking as part of that, trying to spread the word about this. We’ll be launching a webpage soon that has lots of resources and tries to make it as easy as possible.
But I want people to know that is the recommended treatment. And of course, many people actually, despite our best efforts, don’t have access to cognitive behavioral therapy for insomnia. So in those cases, a lot of people are still using medications. And if that’s you, you’re using medications, don’t feel bad about it. Right, that’s the tool that you have, so of course that’s what you’re going to use. But we really do know that in the long run CBTI is more effective than medications so you really do have to view medications as a substandard treatment, a temporary treatment. You have to reassess. These are not great things for people to be on in the long run, and that’s just what I want to teach people.
The other goal of the presentation is to tell people about just some simple things that they can do. So full CBTI is great. There’s a lot of people that really do need cognitive behavioral therapy for insomnia. Somebody who’s really complicated, severe insomnia, definitely refer those people. But because again, it’s not so easy to get CBTI and not everybody needs full CBTI, there’s sometimes really easy things that you can do that will make a huge difference for a lot of patients. So the sleep ends up really being a byproduct of how they spend their days. So for a patient with dementia, who’s wandering at night and up all night, really what you need to do for those patients is get a day history. How are they spending their days and how are they spending their nights? And you put some interventions into the day, like getting them to do a little bit of exercise.
I’ve seen incredible results with somebody just using an exercise bike for five minutes a day, which seems like it would do nothing, but amazingly their sleep is fixed. Getting them sunlight during the day, getting them outdoors, getting them social contact. That is how you fix that person. Stopping them from dozing during the day, treating their sleep apnea. That’s how you get that person with dementia to sleep through the night. It’s not going to be with your Seroquel or these medications, which is the only tool people have had, so that’s why they’re using it. But I just want to let people know about another way to look at things.
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