Natural Insomnia Treatment with CBT-I
Cognitive behavioral therapy for insomnia (CBT-I), is an evidence based lifestyle treatment for optimizing sleep. Multiple studies show that CBT-I protocols are more effective than medication management (PMID: 15451764, 19201632). Optimal sleep without the use of medication is important because lack of sleep and sleep medication are both linked with many negative health outcomes. This topic is relevant because insomnia is the most common sleep disorder and up to 10-30% of Americans report living with chronic insomnia (PMID: 25083008).
Evidence for the importance of sleep:
Cardiovascular health: consistently getting less than 6 hours of sleep increases your risk of experiencing a stroke, heart attack, pulmonary embolism or clot formation by 200% (PMID: 20009370)
Cognitive health: poor sleep linked to Alzheimer's disease (PMID: 30781802)
Metabolic health: lack of sleep increases hunger hormones leading weight gain (PMID: 26612385, 15583226, 23922121, 25462194)
Reproductive health: less than 6 hours per night linked to increased fertility issues in both men and women (PMID: 32256630, 25458772)
What is cognitive behavioral therapy for insomnia:
Cognitive behavioral therapy is comprised of 5 categories:
Sleep restriction: goal is to increase homeostatic sleep drive. No naps and waking up at the same time each day and going to bed at the same time each night.
Stimulus control: bed is only for sex and sleep. Go to bed only when drowsy, based off of your symptoms not what time it is. Leave bed if not able to sleep after 20 min, do something that is relaxing and try again when you feel tired again. Avoid all screens 2 hours before bed.
Hygiene: no caffeine, nicotine, or alcohol 4-6 hours before bed; avoid all fluids 2 hours before bed, get daytime light exposure and exercise, but not 2-4 hours before bed, bedroom should be dark, quiet, cool, create a bedtime routine that is a cue to the body.
Relaxation techniques: implement daily stress management ie meditation, progressive muscle relaxation, diaphragmatic breathing, guided imagery, journaling.
Cognitive therapy: identify and challenge and replace dysfunctional beliefs.
Evidence for improvement in sleep
After 4 weeks of CBT-I implementation patients had significant improvement of sleep and patients continued to do well 2 years after the intervention; whereas those managed with medication almost immediately reverted back once medication was discontinued (PMID: 15451764). Not only does sleep medication minimally improve speed of falling asleep it has shown to reduce memory solidification, and increase risk for mortality and cancer; those who who used less than 13 sleeping pills per year still had an increased mortality risk.
MEDICAL DISCLAIMER: the information in this blog post is for informational and educational purposes only. The information and education provided is not intended or implied to supplement or replace professional medical treatment, advice, and/or diagnosis
