[Skip to Navigation]
Invited Commentary
May 23, 2011

Time to Disseminate Cognitive Behavioral Treatment of Insomnia: Comment on “Efficacy of Brief Behavioral Treatment for Chronic Insomnia in Older Adults”

Arch Intern Med. 2011;171(10):895-896. doi:10.1001/archinternmed.2010.526

The efficacy of cognitive behavioral treatment for insomnia (CBTI) is supported by over 3 decades of research.1,2 Evidence is accumulating that it is effective not only for primary insomnia but also for patients with insomnia and complex comorbidities including psychiatric disorders, chronic pain, and cancer.3-5 Despite a wealth of data showing efficacy, CBTI has not been available in most practice settings, including many specialized sleep centers whose focus is on the assessment and treatment of sleep apnea. CBTI may be misperceived as being analogous to weight-loss treatment for obesity-related sleep apnea; that is, it is theoretically superior to all alternatives, but the obstacles to implementation seem overwhelming. CBTI involves initial demands for substantial behavioral changes that seem difficult to address in the context of most primary care settings. How does one help patients make changes in their sleep-wake activities that often are entrenched by years of habit? How does one refer patients for effective behavioral treatment? Unfortunately, CBTI remains limited to specialized sleep centers with trained behavioral sleep medicine specialists. Most primary care settings lack access to these resources, and there are concerns about stigma related to referrals to mental health treatment.