Cognitive behavior therapy for insomnia

Abstract

Sleep disturbances, including not being able to fall asleep easily/difficulty falling asleep, waking up frequently, or waking up too early and being unable to fall asleep again/resume sleep are diagnosed as insomnia if they cause significant disruption to daily life and are not caused by other sleep disorders such as pain or sleep apnea. Although insomnia is not considered a serious life-threatening condition, it has not only a high prevalence rate but also a high recurrence rate and tends to become chronic. Chronic insomnia patients tend to show common behavioral and cognitive patterns, typical of which are worrying about not being able to fall or stay asleep, excessive awakening because of this worry, limiting and reducing daytime activities or attempting to stay in bed for long periods to compensate for lack of sleep. These cognitive and behavioral characteristics are important contributing factors for the continuation of insomnia. To date, the most popular and effective treatment option/approach recommended by experts for insomnia is cognitive behavior therapy (CBT). CBT for insomnia consists of the following three non-pharmaceutical treatment elements: 1) behavioral elements such as stimulus control therapy, sleep restriction therapy, and muscle relaxation, 2) cognitive elements, and 3) educational elements focusing on sleep hygiene. However, there are barriers to insomnia patients receiving this treatment including accessibility and cost, despite the abundance of evidence demonstrating their effectiveness. Recently, online CBT for insomnia has become available as an alternative, and its emergence is providing a solution to the barriers to access.