Frequently Asked Questions about CBT-I

What is the downside to not seeking treatment for my insomnia?

Allowing insomnia to go untreated may have wide ranging negative impact your quality of life, work performance, and increase your risk for accidents and injuries. Of greater concern is the mounting evidence that chronic insomnia can adversely impact your medical health (e.g., hypertension, diabetes, cardiovascular disease) and psychiatric health (e.g., depression)

Is my insomnia likely to go away without treatment?

The research to date suggests that insomnia, when chronic (present for more than 3 months), is unlikely to go away without treatment.

Can my insomnia be managed with over the counter or naturopathic remedies?

Most self-management strategies have been shown to be ineffective (i.e., “will power,” “self-control,” naturopathic supplements, warm milk, tea, “night caps” with alcohol, etc.).

What is the preferred treatment for insomnia?

The first line of intervention for insomnia is Cognitive Behavioral Therapy for Insomnia (CBT-I). Treatment is based upon the concept that chronic insomnia lasting from months to years is maintained by physical, environmental, emotional, and behavioral factors that have little or nothing to do with what initially caused the insomnia. Accordingly, CBT-I targets the factors that have been shown to cause acute insomnia (the sleeplessness that comes to all of us from time to time) to become chronic and seemingly take on “a life of its own.”

How effective is CBT-I?

There is a large scientific literature that shows that behavioral interventions are as effective as medication in the short run and, unlike medications, produce durable results that last after treatment is discontinued. More than this, between 40-60% of the people that respond to CBT-I go on to recover normal sleep.

How long does treatment take?

In most cases, 4-10 weeks.

If I have insomnia along with another medical or mental health condition, can CBT-I still work for me?

Yes. CBT-I has been shown to be as effective for these kinds of insomnias as it is for insomnia that occurs in the absence of such complications. Moreover, successful resolution of your insomnia may in some cases reduce the severity and/or chronicity (and/or increase your tolerance) of other chronic illnesses you may have.

What can I expect treatment to be like?

Your treatment will begin with an extensive evaluation including a review of your medical and mental health histories and an assessment of the factors that are likely to be related to your insomnia (sleep schedule, sleep duration, what you do and don’t do when awake at night, etc.). Treatment will likely require that you complete a series of assessment questionnaires during your first visit and daily sleep diaries before and during treatment. Depending on the situation you may also be asked to undergo an objective assessment of your sleep (via actigraphy and/or an overnight sleep study).

Will I be prescribed sleeping pills?

While this is not a first line approach, there are instances where some form of medical therapy in addition to CBT-I is indicated. This may include the use of hypnotics or wake-promoting medications, alone or in combination with behavioral therapy. However, the typical goal of CBT-I is to help the individual learn how to sleep without need of chronic medication use.

Will I be required to discontinue using sleeping pills?

Each case is different and your clinician will likely collaborate with you to make a plan for treatment. In some cases, this may involve discontinuing medication before initiating treatment and in other cases medication reduction may be initiated during the course of treatment. As stated, the goal is often to help the individual to achieve good sleep without the use of sleep medications, but in most cases how to achieve this will be a collaborative effort between you, your prescriber, and your therapist. You will not be forced into a decision about your medication.

Will I have to come to the hospital for a sleep study?

Patients with chronic insomnia who do not have signs or symptoms of other sleep disorders are typically not brought in for sleep studies because they do not provide any new information about your sleep.