Behavioral Therapy in the treatment of Insomnia.




Archives of Internal Medicine

Related Monographs

Consumer Data: Insomnia, Sleep Disorders
Professional Data: Insomnia, Sleep Disorders


Good health and happiness are impossible when we are robbed of sleep for very long. For many people, this is all too often a way of life. One of mankind's oldest complaints, insomnia is the chronic inability to fall asleep or to stay asleep. While everyone occasionally experiences a sleepless night now and then without harm, long-term insomnia can be debilitating. After yet another night of inadequate sleep, insomnia sufferers typically report impaired mental and physical abilities, diminished memory, reduced alertness, and slow reaction times.1 Chronic lack of sleep threatens the well-being, productivity, and safety of millions of Americans.

Conventional treatment of insomnia includes the use of antihistamines, a class of sleep medications called "benzodiazepines," antidepressants, or a combination of the above. In 1999, the FDA approved a new prescription drug, zolpidem, for the short-term relief of insomnia in adults.

A recent small study investigated the role of behavioral therapy versus conventional treatment in the treatment of insomnia. This placebo-controlled study involved 63 young to middle-aged participants suffering from sleep onset insomnia. These participants received cognitive behavioral therapy (CBT), sleep medications or a combination compared to placebo. The researchers measured progress by sleep diaries, sleep efficiency, total sleep time, as well as daytime functioning. In most of these measurements, the therapy showed the most promising results. It helped improve sleep onset as well as sleep efficiency. In addition, this therapy also showed the greatest long-term results. Administering the drugs along with this therapy did not illustrate any greater effects. The authors concluded that, “These findings suggest that young and middle-age patients with sleep-onset insomnia can derive significantly greater benefit from CBT than pharmacotherapy and that CBT should be considered a first-line intervention for chronic insomnia.”2


1. Leger D, Stal V, Guilleminault C, Raffray T, Dib M, Paillard M. Diurnal consequence of insomnia: impact on quality of life. Rev Neurol (Paris). Oct2001;157(10):1270-8.
2. Jacobs GD, et al. Cognitive Behavior Therapy and Pharmacotherapy for Insomnia. Arch Inter Med. Sept 2004. 164(17):1888-1896.