Treatment options
Psychoeducation
Education about normal sleep is an essential part of treating insomnia and other sleep disorders. Discuss the following topics with patients:
- average sleep need and individual variations in sleep need
- change in sleep need with age
- circadian rhythm and its importance in the patient’s ideal regular sleep schedule
- role of napping in compensating for lost sleep and its role in perpetuating chronic insomnia
- importance of sleep quality (versus sleep duration only)
- consequences of sleep deprivation
- effects of caffeine, nicotine, medications and alcohol on sleep.
Cognitive-behavioural therapy (CBT)
According to the cognitive-behavioural model, people with acute insomnia adopt behavioural strategies and cultivate sleep-related anxiety, fueled by unhelpful cognitions about sleep. These are independent of the original cause and perpetuate the condition even after the trigger is no longer present.
CBT-I is a short-term treatment (usually three to six sessions) that is beneficial for more than 70 percent of patients. A shorter, two-session behavioural version can be delivered in primary care settings. Since CBT-I eliminates maladaptive behaviours and cognitions that are at the root of the condition, it yields improvements that endure beyond the termination of treatment.
Ideally, patients participate in individually tailored CBT-I provided by a trained clinician such as a psychologist or, in complex cases, a behavioural sleep specialist. If this service is not available, online CBT-I is an option. There are also CBT-based self-help books and web-based resources that highly motivated patients may find useful. These resources are not equivalent to a full CBT-I program, so if they are not sufficiently helpful, recommend in-person CBT-I. Sleep clinics may have behavioural sleep specialists on site or they can suggest treatment providers. An internet search of psychology clinics may also find clinicians who provide CBT-I.