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Physicians recommended cognitive behavioral therapy before drugs for insomnia

Physicians recommended cognitive behavioral therapy before drugs for insomniaPeople with long-term sleep troubles should turn to a form of psychotherapy to reboot normal sleeping patterns before trying sleeping pills, the American College of Physicians recommends.

Specifically, people with chronic insomnia should try cognitive behavioral therapy (CBT), the experts said. This treatment combines talk therapy, behavioral interventions and education. If CBT doesn't work, patients and their doctors should then decide together whether to add drug therapy, the new guidelines said.

"We know chronic insomnia is a real problem that patients present within our [doctors'] offices," said Dr. Wayne Riley, president of the American College of Physicians (ACP). "We want to get away from the overtendency to prescribe sleep medications, and clearly CBT can be a very nice tool in the toolkit."

Up to 10 percent of adults are affected by insomnia, defined as having trouble falling or staying asleep, the guideline authors said. More common in women and older adults, the condition can produce fatigue, poor thinking and mood disturbance, and takes a toll on workplace productivity, according to the college.

In issuing its first practice guideline on chronic insomnia treatment, the ACP didn't find enough evidence to directly compare behavioral therapy and drug treatment. But the group incorporated a review of published research indicating behavioral therapy is effective and can be initiated in a primary care setting.

Before recommending behavioral therapy to patients, doctors should rule out medical conditions that can cause insomnia -- including obstructive sleep apnea, restless legs syndrome and prostate gland enlargement -- and counsel patients on behavioral factors that can contribute to poor sleep, such as heavy alcohol use, Riley said.

Source: Medline Plus
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