Medically reviewed by
Dacelin St Martin, MD
Triple board-certified in Sleep Medicine,
Internal Medicine, and Pediatrics.
Insomnia can be a complex issue often with ties to mental disorders and stress. Studies show that insomniacs may be at risk of dying earlier than individuals who don’t suffer from this sleep disorder.
Sleeping pills also contribute to mortality risk factors for insomniacs. Turning to cognitive behavioral therapy for insomnia (CBT-I) may lead to better results and a healthier outcome.
Insomnia is a sleep disorder that makes it hard for you to fall asleep, stay asleep or get quality restorative sleep. Sometimes, the condition can cause you to consistently wake up earlier than desired.
If you have insomnia, you may be dealing with symptoms for months at a time (chronic), or symptoms can be present for just a few weeks (acute). With Insomnia, even though you’re extremely tired, falling and maintaining sleep can be difficult.
Sleeping pills can be perceived as the most efficient remedy for sleeplessness; however, they can have crippling side effects, including daytime drowsiness, addiction, suppressed breathing, and even death.
It’s clear that sleeping pills are not a solution for sleeplessness as they can mask an underlying condition, sabotage long-term health, and eventually become ineffective as your body builds up a tolerance.
Studies show that over 5 million people visit the doctor annually for insomnia-related symptoms and are prescribed and/or use sleep medications frequently:
- About 4% of U.S. adults aged 20 and overused prescription sleep aids in the past month.
- The percentage of adults using a prescription sleep aid increased with age and education. More adult women (5.0%) used prescription sleep aids than adult men (3.1%).
- Non-Hispanic white adults were more likely to use sleep aids (4.7%) than non-Hispanic blacks (2.5%) and Mexican-American (2.0%) adults.
- Prescription sleep aid use varied by sleep duration and was highest among adults who sleep less than 5 hours (6.0%) or sleep 9 or more hours (5.3%).
- One in six adults with a diagnosed sleep disorder and one in eight adults with trouble sleeping reported using sleep aids.
Any number of factors can cause insomnia, from emotional and medical issues to daytime routine and sleeping habits. Some of the known and leading causes of insomnia include:
- Emotional or psychological problems such as anxiety, stress, anger, depression, worry, grief, trauma, and bipolar and schizophrenia disorders.
- Medical conditions or diseases, like asthma, allergies, acid reflux, cancer, kidney disease, hyperthyroidism, endocrine problems, and chronic pain at night. Also, urinary, respiratory, cardiac, and neurologic problems can have insomnia as one of their symptoms.
- Prescription drugs such as high blood pressure medications, contraceptives, antidepressants, thyroid hormones, corticosteroids for asthma, and stimulants for ADHD.
- Over-the-counter medications, like diet pills, diuretics, cold and flu medications containing alcohol, and pain-relieving drugs that contain caffeine (e.g., Midol, Anacin, Excedrin). 
- Use of hard drugs.
- Poor sleep hygiene, like chronic napping, irregular sleep/wake schedules, or an uncomfortable sleeping environment.
- Caffeine, alcohol, or tobacco use.
- Advanced age.
- Undiagnosed or poorly treated sleep disorders, like restless legs syndrome, sleep apnea, or shift work sleep disorder.
There are multiple factors that can predispose you to insomnia. These can be classified into three main categories.
1) Predisposing Factors
Factors that increase the risk of experiencing insomnia:
- History of childhood or interpersonal trauma
- Chronic mental health conditions, depression, or anxiety
- History of shift work or erratic sleep-wake patterns
- Chronic pain conditions
2) Precipitating Factors
Certain events that lead to sleep disturbance:
- A severe accident leading to physical injury
- Divorce or death of a spouse or close family member
- Change in an occupation such as loss of a job or transition to a new job
3) Perpetuating Factors
Behavioral and cognitive drivers that sustain poor sleep over time:
- Watching television in bed while trying to fall asleep
- Staying in bed for extended periods of time in an effort to obtain more sleep or taking long naps during the day
- Anxiety and worry about sleep loss
- Excess caffeine intake
Sleeping pills are commonly prescribed as a treatment for insomnia, whether it’s experienced independently or as a symptom of another disorder; however, they’re not effective for long-term use, and result in serious short- and long-term side effects.
Evidence suggests that the longer sleeping drugs are taken, the less effective they become. This happens because the human body can build up tolerance in as little as a few weeks. Sleeping pills can only help you fall asleep 10 minutes faster and increase your snooze time by a maximum of one hour.
Effects of Sleeping Pills
While sleeping pills can work for a short duration of time, long-term use can interfere with the quality of your sleep. Secondly, they won’t cure your insomnia, and they’ve been linked to undesirable side effects, such as residual morning drowsiness, forgetfulness, and confusion.
Taking sleeping pills for an extended period can worsen your symptoms and lead to adverse effects like higher death risk. An extensive study involving a total of 34,205 participants found that frequent users of sleeping medications have a 4.6 times higher mortality rate and a significant increase of developing cancer than the control group.
The addictive potential of sleeping aids is another unpleasant side effect that comes with the regular use of these drugs. It’s another reason why doctors recommend using them as little as possible to avoid an over-dependence on them.
What is CBT-I?
Studies have shown that cognitive-behavioral therapy for insomnia (CBT-I) is the best long-term treatment that can help break the cycle of sleeplessness.
CBT-I is a type of therapy that aims to identify and change negative thoughts, feelings, and behaviors preventing you from getting a good night’s sleep.
Unlike sleeping pills, CBT-I is a drug-free method and is usually the preferred first line of treatment recommended for insomnia. Though it requires a greater investment in time and effort, CBT-I remains the best remedy because it’s a healthier way to manage chronic lack of sleep. Furthermore, it works well for short- and long-term use and has none of the side effects and dependency issues of sleeping pills.
To undergo CBT-I treatment, you’ll meet with a sleep or CBT-I therapist who will work with you to uncover the underlying factors causing your sleep problems. The next step after that is to help you find coping strategies that would make you respond or tackle those issues more effectively so your sleep quality can improve.
Why is CBT-I Effective?
On its own, the CBT-I is the best psychological treatment currently available in the medical field. Pointing to all available evidence, this treatment is considered the gold standard of psychotherapy.
According to the study, a treatment method only gets conferred with the gold-standard status if it is evidence-based or has been tested with the most stringent criteria (e.g., randomized controlled trials) similar to those used in pharmacotherapy.
Many insomniacs struggle with worries and negative thoughts are at the root of their sleeplessness, the CBT method was tailored into CBT-I to address insomnia.
A systematic review and meta-analysis done in 2015 on the efficacy of the CBT-I method showed that on average, people who had their insomnia treated with this method fell asleep 20 minutes faster while spending 30 fewer minutes awake at night as compared to people who did not undergo CBT-I.
CBT-I for Children
Just like how CBT-I is effective for adult insomnia, the therapy also works well in children. In fact, health care professionals are more likely to prescribe cognitive behavioral therapy treatment over sleeping pills for a child or teenager who has trouble sleeping well.
CBT-I is readily available through online consultations, group therapy, or face-to-face sessions, but for minors, a parent has to be present. The CBT-I approach involves helping the child replace an unhealthy bedtime regime with more sleep-friendly hygiene practices.
Benefits of CBT-I
CBT-I doesn’t have health risks associated with it; however, it requires more effort than just taking a pill. It’s drug-free and delivers higher sleep satisfaction that can be sustained up to 6 months after treatment. CBT-I therapy may be repeated if insomnia recurs. Additional benefits you can gain from CBT-I are
- No Residual Symptoms
- More Sustained Sleep Improvement
- Higher Rate of Remission
CBT-I gives you the tools to overcome insomnia while avoiding the health risks associated with taking sleeping pills. Studies of CBT for treating Insomnia show that it is a healthier option and can be used both for adults and children.
If you’re interested in using this approach to overcome your insomnia, make an appointment with your doctor. Before you go, it will be helpful to keep a 2- to 3-week personal record or diary of your sleep pattern for your doctor to evaluate.
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