![]() ![]() It should be noted that the core therapies for CBT-I substantially differ from other forms of CBT and it is for this reason that the abbreviation CBT-I denotes this form of CBT specifically for insomnia ![]() , in current clinical practice it is usually necessary to refer out to individuals with specialized training in this treatment. While a few research studies have examined the efficacy of nurse-led CBT-I in primary care settings ![]() Second, improvements from CBT-I are typically not seen until 3–4 weeks into treatment. First, during the first few weeks of treatment there is often an acute reduction in total sleep time that can lead to the side effect of increased daytime sleepiness which, for some, is enough to lead them to drop out of treatment. There are two main disadvantages to CBT-I. CBT-I is delivered over the course of 4–8 sessions that occur weekly or every other week for 30–60 minutes each. By changing sleep-related behaviors and thoughts, CBT-I may target those factors that cause insomnia to persist over time. This is accomplished by establishing a learned association between the bed and sleeping through stimulus control, restoring homeostatic regulation of sleep through sleep restriction, and altering anxious sleep-related thoughts through cognitive restructuring. The goal of CBT-I is to target those factors that may maintain insomnia over time, such as dysregulation of sleep drive, sleep-related anxiety, and sleep-interfering behaviors. CBT-I is a non-pharmacological approach to treatment comprised of several strategies. Perhaps the most important disadvantage is that medications are usually not curative, leading to long-term treatment over many years despite a lack of safety and efficacy data for their long-term use beyond 1–2 years.Īn alternative treatment approach is cognitive behavioral therapy for insomnia (CBT-I). The disadvantages are the potential for side-effects, dependence, and tolerance over time. The advantages of medications are that they are widely available and, when effective, lead to clinical improvement rapidly. Numerous trials have documented moderate efficacy with benzodiazepine receptor agonists The most common approach to the management of insomnia is medication treatment. , and is associated with increased overall health care costs In addition, there is evidence that insomnia may confer risk for medical illness including hypertension, heart disease, and diabetes Insomnia is independently associated with significant morbidity including fatigue, impaired concentration and memory, irritability, difficulty in interpersonal relationships, decreased quality of life, and increased risk of new-onset psychiatric illness There is now evidence to suggest that insomnia often persists following resolution of these ‘primary’ conditions, and that it generally does not spontaneously resolve over time if left untreated In the past insomnia was considered to be a symptom of these conditions with the assumption that treatment of these ‘primary’ conditions would lead to the resolution of insomnia, eliminating the need for targeted insomnia treatment. Insomnia can exist as a primary disorder or co-morbid with other conditions including depression ![]() compared to 33% in the general population The prevalence of insomnia in primary care patients is as high as 69% ![]()
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