Primary Care Sleep Medicine

Part of the series Current Clinical Practice pp 37-45

Cognitive-Behavioral Therapy Approaches for Insomnia

  • Edward J. StepanskiAffiliated withSupportive Oncology Services, Inc. Accelerated Community Oncology Research Network

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There are many specific treatment approaches for insomnia that fall under the general category of cognitive-behavioral therapy (CBT). Therapies in this area have common elements: patients gain more control on sleep by modifying their sleep-wake schedules, learning relaxation skills, changing sleep-related habits, and/or learning to decrease worry about sleep. These skills can be taught in different ways. The specific CBT approach most likely to be effective in a particular patient presumably depends on the etiology of their insomnia. However, attempts to match patients to particular behavioral therapies have met with limited success. One study did show that patients with increased muscle tension benefited more from electromyograph (EMG) biofeedback, and patients without this tension did better with electroencephalograph (EEG)-based biofeedback (1). However, another study that attempted to match patients to treatment modalities, based on aspects of clinical history, actually found that patients did worse when receiving the predicted “correct” treatment than those receiving the “incorrect” treatment (2). The recent trend has been to provide a CBT program that combines different behavioral treatments and cognitive therapy. As all patients are receiving several different treatments, this approach does not require any matching of treatment types to patient’s characteristics.