Sleep Physicians Trained in CBT-I May Help Patients Cut Sleeping Pill Use
SEATTLE, WA—Cognitive behavioral therapy for insomnia (CBT-I) is highly effective when administered by a trained sleep physician, and can be successfully integrated into standard clinical practice, according to data presented at SLEEP 2015 by Brandon R. Peters, MD, Stanford University Department of Psychiatry and Behavioral Sciences, Redwood City, CA.
At present, CBT-I is usually conducted by psychologists and few sleep physicians are formally trained and actively practice this intervention, so the effectiveness and merits of CBT-I as administered by a sleep physician in a community-based clinic is unknown, Dr. Peters explained.
For this reason, Dr. Peters performed a retrospective chart review of 110 patients presenting with chronic insomnia during a one-year period, who were enrolled in CBT-I with a formally trained sleep physician at a community-based clinic. The modified program, which consisted of 4–6 sessions lasting 30–60 minutes, emphasized sleep education, sleep consolidation, and relaxation training. Subjects had to complete at least four sessions and have adequately completed sleep logs. Subjects with sleep apnea that interfered with compliance were excluded. Outcomes measured included changes in sleep-onset latency, wakefulness after sleep onset, total sleep time, and sleep efficiency from baseline to conclusion of the program.
Of the 89 subjects who met criteria, 65% were women and 35% men, with mean age 60.69 years (ranging from 12– 90 years). At baseline, 66 subjects (74.2%) used sleep medication, and 58 subjects (65.2%) were identified as having obstructive sleep apnea (AHI>5).
Improvements were observed in all averaged measures from baseline to program end: sleep onset latency (55.5 to 22.5 minutes), wakefulness after sleep onset (45.17 to 25.21 minutes), total sleep time (6.22 to 6.25 hours), and sleep efficiency (74.0% to 85.5%).
Study findings revealed comparable outcomes to published CBT-I data administered by psychologists. Board-certified sleep physicians who administer CBT-I in standard clinical practice “may be better equipped to taper sleeping pills and to identify and treat comorbid sleep conditions,” Dr. Peters concluded.