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Forget about counting sheep and drinking hot milk, an effective way to combat chronic insomnia is cognitive-behavioral therapy, researchers confirmed.
The authors of a new study say that even if the therapy is effective, it is not used enough, doctors have limited knowledge and patients can not access it.
"There is a very effective treatment that does not involve drugs that should be available in your primary care setting. If not, it should be, "said Dr. Judith Davidson, co-author of a new study on CBT for insomnia at Queen's University in Ontario, Canada.
Chronic insomnia, in which individuals have difficulty falling or staying asleep at least three nights a week for three months or more, would affect about 10 to 15% of adults. The disease is linked to health problems, including depression, operational difficulties and sometimes accidents.
Sleeping pills are not recommended for long-term use and may have side effects as well as a risk of dependence. The main treatment for chronic insomnia is rather CBT – a program of changes in the way a person approaches and thinks about sleep. This includes staying away from bed when awake, questioning attitudes to sleep loss and limiting the number of hours spent in bed.
In the British Journal of General Practice, Davidson and his collaborators report how they examined the results of 13 previously conducted studies on providing a CBT for insomnia through primary care. In some studies, participants also took medication to help them sleep.
The results showed that CBT for insomnia was effective and led to improvements in sleep that lasted for a follow-up many months later.
Examining the results of four randomized controlled trials, involving between 66 and 201 participants of varying age, the team found that participants fell asleep an average of nine to 30 minutes earlier after receiving TCC treatment for insomnia and experienced a reduction of 22 to 36 minutes. minutes in the time spent waking up after bedtime. On the other hand, those who were just on a waiting list or who were following treatment as usual only experienced an improvement of up to four minutes within the time limit. of removal and a maximum improvement of eight minutes in the time spent awake after being asleep.
The team reported that it took between four to eight CBT sessions to achieve such improvements, and that an additional trial offered little benefit when only two CBT sessions were offered to insomniacs. .
Davidson said the new study supported the idea that CBT for insomnia could and should be offered by general practitioners – the usual first point of contact for patients – although, as in most studies, treatment it can be administered by other workers or other primary care services.
In the UK, she added, opportunities include increased access to IAPT services (improved access to psychological therapies), health visitors or even specialized apps and websites such as Sleepio, currently available for free in the NHS in parts of South East England.
Professor Helen Stokes-Lampard, President of the Royal College of GPs, welcomed the study. "CBT adapted for insomnia has been a first-line treatment option for some time, and we know that many patients have found it beneficial. It is therefore very positive that its effectiveness has been demonstrated by this research, "she said. But, she added, access to CBT through the NHS could be extremely difficult to find in the community and varied widely across the country.
"This situation must be remedied, first and foremost by implementing the commitment made in the NHS England" Forward View "publication, which states that all GPs' offices in the country will have access to the information provided by the NHS England. one of 3,000 new mental health therapists by 2020-2021 and providing many additional psychologists. trained to provide formal CBT, "she said.
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