Future outlook of nonpharmacological treatments for insomnia in adults: clinical trial progress

Abstract

Meta-analyses [1,2], treatment guidelines [3] and a NIH State-of-the-Science Conference statement in 2005 [4] have concluded that the most widely evaluated nonpharmacological treatment for chronic insomnia in adults, cognitive-behavior therapy for insomnia (CBT-I), is efficacious. CBT-I is a multi component treatment consisting of stimulus control therapy, sleep restriction therapy, cognitive therapy, psychoeducation about sleep and sleep hygiene, arousal reduction procedures, such as relaxation and meditation, and methods for changing sleep–wake circadian rhythms such as the scheduling of exposure to bright light. See Bootzin and Epstein [5] for descriptions of the CBT-I components. Both hypnotics and CBT-I improve sleep [2]. An advantage that CBT-I has over the prescription of hypnotics is that following CBT-I, improvement is maintained for as long as 2 years after treatment is discontinued [4]. In contrast, after treatment with hypnotics ends, insomnia symptoms tend to reappear. One major challenge for the use of CBT-I is a shortage of clinicians trained to provide it. This has stimulated a number of new efforts to make CBT-I more available. New directions include: ■ Implementing large-scale training programs for clinicians by national providers such as the Veterans Health Administration;