Drug-Free Sleep Therapy Better Than Sleeping Pills to Treat Insomnia, Experts Say

Insomnia is a common sleep disorder caused by autonomic dysfunction. Albina Gavrilovic/Shutterstock

Researchers from Flinders University and the Sax Institute are calling for improved access to Cognitive Behavioural Therapy for insomnia (CBTi), a non-drug treatment method, following findings from a five-year study.

Alexander Sweetman, primary author of the study that was published in the Journal of Clinical Sleep Medicine, said that while it is becoming more accessible, CBTi is utilised by only 1 percent of insomniacs.

Sweetman said it treats the underlying causes of long-term insomnia without drugs and has been rated the most effective long-term solution.

Yet, sleeping pills are still the mainstay management option for insomnia.

Insomnia and CBTi Treatment

About one in 10 people have experienced at least mild insomnia and Sweetman said sleep issues are among the most common reasons patients present to the doctor in Australia.

Symptoms of insomnia include difficulty falling asleep, waking up a lot during sleep, waking up too early, and waking up tired. Insomnia can also lead to several day symptoms such as fatigue, irritability, and concentration difficulties.

Untreated insomnia can cause various health issues, including an increased risk of cardiovascular problems and mood disorders.

In an email to The Epoch Times, Sweetman said CBTi can generally be completed over four to eight sessions.

“Most people start experiencing improvements in sleep and daytime functioning after three to four weeks.”

“In the long-term, treating insomnia symptoms with CBTi can also gradually reduce symptoms of depression, anxiety, and reduce reliance on sleeping pills.”

Research studies have shown that the approach improves sleep for many months or years into the future. In comparison, sleeping pills are only effective when people are using them, and are recommended for a maximum of four weeks.

Some patients and healthcare providers think that “sleep hygiene” recommendations and CBTi are the same thing, but they are different.

Sleep hygiene information includes general recommendations about sleep environment, routine, and night behaviours.

This sleep treatment program, on the other hand, includes several cognitive and behavioural approaches to identify and gradually treat underlying factors causing insomnia.

Costs of Treatment

Sweetman said CBTi is effective when delivered in several different formats or modalities, including individualised sessions, weekly or fortnightly sessions, or even tele-health consultations.

There is often a cost and/or long waiting list to see a psychologist with relevant training.

But, Australian GPs can refer patients with insomnia to a psychologist with an MBS Mental Health Treatment Plan, which subsidises a portion of the cost.

CBTi can also be accessed for free through research study or some evidence-based digital programs that can be completed with or without guidance from a clinician.

“A GP can help patients decide which treatment options will be most suitable,” Sweetman said.

Senior respiratory and sleep physician Professor Robert Adams said new education and training opportunities will help turn the tide. He encourages patients and their partners to ask GPs about CBTi.

Sweetman added that improved access in the Australian health system will relieve the difficulties faced by people with this common debilitating sleep disorder.

Risks of Long-term Sleeping Pill Use

Sleep expert Jenny Haycock said most GPs interviewed were aware of the risks of long-term sleeping pill use, but had limited knowledge of CBTi and how patients could access it.

Sleeping pills are an effective short-term solution to insomnia symptoms. However, they are not recommended as a first-line treatment, and long-term use is inadvisable.

Sweetman said that over time the therapeutic effects of sleeping pills can gradually become replaced by patterns of dependence and withdrawal difficulties in some patients.

“They are also associated with some unwanted side effects that can differ from person-to-person,” he said.

Non-drug CBTi is recommended as the first line treatment, leading to long-lasting improvements in most patients, with less risks of side-effects.

She is optimistic that greater awareness will enable many more insomnia patients to access this type of care.

Rolling Out Treatment Training

The study produced six major recommendations mainly focused on improving awareness of CBTi and its funding options amongst GPs and psychologists.

“GPs play a central role in Australia’s universal health care system,” co-author Emeritus Professor Doug McEvoy said.

“As a result, GPs were at the centre of our insomnia translation program to improve access to CBTi,” McEvoy said.

Most clinicians have limited training in sleep health, insomnia, and CBTi and few GPs have specific training in its delivery.

McEvoy said GPs are often the first point of contact for patient engagement with the health system. They screen and deliver care for many health conditions, and operate as “gatekeepers” for referral to specialist medical services.

“We are urging more GPs and psychologists to access CBTi training resources, and offer evidence-based CBTi to people with insomnia symptoms—rather than drugs,” he said.

The study recommended programs to improve awareness, funding, training, and resources for the treatment method.

There are current training programs that have been running for some time and a publicly-accessible CBTi provider directory is also available for clinicians to opt into.

However, while a handful of interactive digital CBTi programs with scientific evidence are emerging and being made available in research studies, access is still limited in Australia.