Chapter 20 - CBT-I in patients who wish to reduce use of hypnotic medication

Abstract

Cognitive-behavioral therapy for insomnia (CBT-I) is a first-line treatment for chronic insomnia disorder and can also be effective in reducing or eliminating hypnotic medication use among patients with insomnia. This chapter describes patterns of hypnotic medication use among patients with insomnia and the impact of CBT-I alone, and in conjunction with a medication taper, on patterns of hypnotic medication use. Practical aspects of conducting a medication taper in the context of CBT-I are discussed, including collaboration with providers, the timing of reduction, and options for schedules of medication reduction. Finally, use CBT-I and associated behavioral principles that can be used to facilitate hypnotic medication reduction are reviewed. This chapter is designed to inform CBT-I providers about how to effectively help patients who are regularly using hypnotic medications successfully reduce or eliminate use.