Cognitive Behavioral Therapies for Insomnia and Hypnotic Medications

Cheung, Janet M Y; Ji, Xiaowen; Morin, Charles M.

doi:10.1016/j.jsmc.2019.01.006

Cited by 19 publications

(9 citation statements)

References 55 publications

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“…In qualitative analyses of insomnia patient's decision-making Cheung et al [12], for example, found that while patients acknowledge both the longer-term benefits of CBTI and the side-effects of hypnotics, they also emphasize the need for rapid symptom remission (with most of the 51 participants in this study reporting a history of using pharmacological sleep aids). At the point of choice, patient priorities are further influenced by illness beliefs (particular around the causes of insomnia), experience, and perceptions of need [13]. Such evidence suggests that, among an increasingly informed patient population, insomnia treatment decisions (where they can be exercised) will be influenced more by a personalized appraisal of therapeutic pros and cons, than by current clinical guidance.…”

Section: Psychological and Pharmacological Treatments For Insomnia: B...mentioning

confidence: 99%

Psychological and pharmacological treatments for insomnia: Blending for patient benefit

Morgan

2021

Sleep Medicine Reviews

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Section: Psychological and Pharmacological Treatments For Insomnia: B...mentioning

confidence: 99%

Psychological and pharmacological treatments for insomnia: Blending for patient benefit

Morgan

2021

Sleep Medicine Reviews

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“…However, research indicates that this may not be the most effective frontline treatment due to their negative impact on sleep and the negative side‐effects of some medications (van Liempt et al., 2006). The World Health Organization (WHO) have indicated that CBT or EMDR are the appropriate treatments for PTSD in adults and children, with pharmacological intervention being applied only when CBT is unavailable, or is deemed ineffective (Cheung et al., 2019; World Health Organization, 2013). Furthermore, following an acute stressor, pharmacological approaches are not supported by WHO to treat sleep disturbances, instead sleep hygiene and relaxation strategies are considered “best practice” for adults, adolescents, and children (World Health Organization, 2013).…”

Section: Introductionmentioning

confidence: 99%

A review of behavioral treatments for sleep disturbances in civilians who have experienced trauma

Roche

McLay

Sigafoos

et al. 2021

Behavioral Interventions

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Sleep disturbances have frequently been associated with trauma and post‐traumatic stress disorder (PTSD). Effective treatments for sleep disturbances are therefore likely to be indicated for individuals who have experienced trauma. With the aim of advancing evidence‐based practice in this area, this review focuses on studies evaluating behavioral treatments for sleep disturbances among civilians who have experienced trauma. Seventeen studies were identified that met inclusion criteria. Data were extracted from each study on (a) the type of sleep disturbance experienced, (b) assessments used, (c) treatment procedures, (d) outcome measures, and (e) main findings. Research quality was also evaluated. The results of these 17 treatment studies were generally positive, but ratings of the strength of the research varied from strong to weak. Overall, this review finds evidence to support the use of behavioral treatments for sleep disturbances resulting from experiences of trauma. The implications of these findings for clinical practice are discussed.

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Section: Introductionmentioning

confidence: 99%

“…18,25,31,32 Unfortunately, patient access to this service remains limited and the need to train more primary health workers to provide CBT-i has been discussed widely in the literature. 29,33,34 Pharmacists are well positioned to provide CBT-i due to their highly accessible position in the health systems of many countries. Historically, pharmacists have been commonly involved in providing education and follow-up care related to the use of hypnotics.…”

Section: Introductionmentioning

confidence: 99%

Impact of Pharmacist-Led Cognitive Behavioural Therapy for Chronic Insomnia

et al. 2020

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Background: Chronic insomnia is a common medical condition that negatively impacts quality of life and daytime function. Access to the first-line treatment for insomnia, cognitive behavioural therapy (CBT-i), is limited. Pharmacists are well positioned to provide this service, but evidence regarding pharmacist delivered CBT-i is sparse. The aim of this study was to evaluate the effectiveness of CBT-i delivered by pharmacists practicing in an outpatient clinic setting. Methods: This study was a retrospective chart audit of adult patients with chronic insomnia who received CBT-i from a pharmacist at one of two outpatient clinics in Canada. The primary endpoints were the differences between patient self-reported sleep diary parameters and utilization of hypnotic medications before and after CBT-i was delivered. The differences in patient reported sleep parameters were compared using Wilcoxon Signed Rank test and paired samples t-test and changes in hypnotic utilization was compared using McNemar Chi-square test. Results: 183 patients were referred for CBT-i and attended an initial appointment with a pharmacist. Of these, 105 did not receive the CBT-i. This resulted in 78 patients who met the inclusion criteria. Changes in sleep diary parameters were all statistically significantly improved after patients received CBT-i, except for total sleep time. Hypnotic medication use was also reduced. At baseline, 71.8% (n=56/78) of patients were taking one or more hypnotic medications compared to 52.6% (n=41/78) after CBT-i (p=0.0003). Discussion: The results of this study provide preliminary evidence that pharmacists working in an outpatient clinic setting may be able to effectively deliver CBT-i for patients with chronic insomnia. The external validity of these results is limited by the observational study design and the inclusion of pharmacists practicing in outpatient clinics, which is not the setting where most pharmacists currently practice. Conclusion: This observational study found improvements in sleep quality and efficiency, as well as, a reduction in hypnotic medication use, in patients who received CBT-i from pharmacists practicing in an outpatient clinic setting. Future randomized, controlled trials should evaluate the impact of CBT-i in a larger sample of patients, provided by pharmacists practicing in both outpatient clinics and community pharmacies. Original Research

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Cognitive Behavioral Therapies for Insomnia and Hypnotic Medications

Cited by 19 publications

References 55 publications

Psychological and pharmacological treatments for insomnia: Blending for patient benefit

Psychological and pharmacological treatments for insomnia: Blending for patient benefit

A review of behavioral treatments for sleep disturbances in civilians who have experienced trauma

Impact of Pharmacist-Led Cognitive Behavioural Therapy for Chronic Insomnia

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