Cognitive Behavioral Therapy for Treatment of Chronic Primary Insomnia

Edinger, Jack D.; Wohlgemuth, William K.; Radtke, Rodney A.; Marsh, Gail R.; Quillian, Ruth E.

doi:10.1001/jama.285.14.1856

Cited by 567 publications

(375 citation statements)

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“…24 Unfortunately, broader adoption of CBTi has been hindered by several factors, including the relatively limited number of clinicians trained to provide it and the fact that the length of traditional protocols (6-10 sessions) is not well-matched to the resources available in primary care settings where the majority of insomnia cases are seen. [25][26][27] However, Manber and colleagues have described the successful training of mental health clinicians without sleep specialization to deliver CBTi in the VA healthcare system. 28 In response to this, shortened protocols (i.e., ≤ 4 sessions) have been developed, and research has shown them to be efficacious and effective in treating insomnia in adults of all ages (see McCrae, 29 Buysse,30 or Edinger and Sampson, 31 for review).…”

Section: S C I E N T I F I C I N V E S T I G a T I O N Smentioning

confidence: 99%

Impact of Brief Cognitive Behavioral Treatment for Insomnia on Health Care Utilization and Costs

McCrae

Bramoweth

Williams

et al. 2014

Journal of Clinical Sleep Medicine

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Study Objectives: To examine health care utilization (HCU) and costs following brief cognitive behavioral treatment for insomnia (bCBTi). Methods: Reviewed medical records of 84 outpatients [mean age = 54.25 years (19.08); 58% women] treated in a behavioral sleep medicine clinic (2005)(2006)(2007)(2008)(2009)(2010) based in an accredited sleep disorders center. Six indicators of HCU and costs were obtained: estimated total and outpatient costs, estimated primary care visits, CPT costs, number of office visits, and number of medications. All patients completed ≥ 1 session of bCBTi. Those who attended ≥ 3 sessions were considered completers (n = 37), and completers with significant sleep improvements were considered responders (n = 32). Results: For completers and responders, all HCU and cost variables, except number of medications, signifi cantly decreased (ps < 0.05) or trended towards decrease at posttreatment. Completers had average decreases in CPT costs of $200 and estimated total costs of $75. Responders had average decreases in CPT costs of $210. No signifi cant decreases occurred for non-completers. Conclusions: bCBTi can reduce HCU and costs. Response to bCBTi resulted in greater reduction of HCU and costs. While limited by small sample size and non-normal data distribution, the fi ndings highlight the need for greater dissemination of bCBTi for several reasons: a high percentage of completers responded to treatment, as few as 3 sessions can result in signifi cant improvements in insomnia severity, bCBTi can be delivered by novice clinicians, and health care costs can reduce following treatment. Insomnia remains an undertreated disorder, and brief behavioral treatments can help to increase access to care and reduce the burden of insomnia. Keywords: Insomnia, health care utilization, costs, brief cognitive behavioral treatment, physician visits, medication Citation: McCrae CS; Bramoweth AD; Williams J; Roth A; Mosti C. Impact of brief cognitive behavioral treatment for insomnia on health care utilization and costs. J Clin Sleep Med 2014;10(2):127-135.http://dx.doi.org/10.5664/jcsm.3436 S C I E N T I F I C I N V E S T I G A T I O N SC hronic insomnia impacts approximately 8% to 10% of adults in the United States population 1 and carries substantial economic burden. Direct costs (i.e., costs directly related to treatment) have been estimated at $13.9 billion annually in the United States, with total treatment costs estimated at $77 to $92 billion. 2 When indirect costs (i.e., lost productivity, insomniarelated accidents, increased medical problems) are included, annual costs exceed $100 billion. 3 Evidence from outside the U.S. reveals a similar pattern. Specifi cally, a study in Quebec, Canada, found that the combined direct and indirect per-person costs of insomnia syndrome (insomnia complaint ≥ 3 nights/ week with > 1 month duration, dissatisfaction with sleep, and daytime impairment; prescription sleep medication ≥ 3 nights/ week) was approximately $5,010; with $293 attributed to direct costs and $4,717...

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Section: S C I E N T I F I C I N V E S T I G a T I O N Smentioning

confidence: 99%

Impact of Brief Cognitive Behavioral Treatment for Insomnia on Health Care Utilization and Costs

McCrae

Bramoweth

Williams

et al. 2014

Journal of Clinical Sleep Medicine

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“…Cognitive-behavior therapy for insomnia (CBT-I), a multi-component treatment package that includes stimulus control, sleep restriction, relaxation exercises, and cognitive restructuring techniques, has demonstrated efficacy for the treatment of insomnia (e.g., (2)(3)(4)(5)). Meta-analyses have reported large effect sizes for reducing sleep onset latency and improving sleep quality and medium effect sizes for reducing wake time after sleep onset and increasing total sleep time (6)(7)(8)(9).…”

Section: Introductionmentioning

confidence: 99%

“…Early treatment outcome studies were inconsistent in reporting attrition, thus making it difficult to estimate the rate of dropouts. The recommendations outlined in the CONSORT statement (11) have improved the reporting of patient flow in randomized clinical trials (RCTs) and more recent RCTs using individual or group CBT-I for primary insomnia have revealed very low rates of dropout for participants in the CBT-I condition, ranging from 0% to 8% (2)(3)(4)(5). However, RCTs typically recruit homogenous samples, most commonly limited to patients with primary insomnia.…”

Section: Introductionmentioning

confidence: 99%

Who is at risk for dropout from group cognitive-behavior therapy for insomnia?

Ong

Kuo

Manber

2008

Journal of Psychosomatic Research

137

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Objective-The aim of the present study was to identify characteristics of patients who are at risk for dropout from a 7-session group cognitive-behavior therapy for insomnia (CBT-I) in a clinic setting using the receiver operating characteristics curve (ROC) approach.Methods-Two separate ROC analyses were conducted using predictor variables taken from questionnaire packets and sleep diaries collected at baseline including age, gender, Beck Depression Inventory (BDI), Morningness-Eveningness Questionnaire, Beliefs and Attitudes about Sleep, use of sleep medication, sleep onset latency (SOL), wake time after sleep onset (WASO), and total sleep time (TST).Results-The first ROC analysis was conducted on the entire sample of 528 patients with treatment completion versus dropout (non-completion) as the outcome variable. No significant predictor variables were found in this analysis. The second ROC analysis was conducted on the 211 patients who did not complete treatment with early termination (prior to fourth session) versus late termination (at or after fourth session) as the outcome variable. The results revealed that patients who reported an average baseline TST < 3.65 hours were at greatest risk for early termination. Sixty percent of patients in this group terminated early compared to 9.3% of patients with TST ≥ 3.65 hours. Among patients with TST ≥ 3.65 hours, 22% of those with BDI scores ≥ 16 were early dropouts compared to 4.3% of those who reported BDI < 16.Conclusion-These findings indicate that short sleep duration and elevated symptoms of depression at baseline are associated with increased risk of early termination from CBT-I.

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“…El terapeuta se vale de una serie de téc-nicas dirigidas a lograr la relajación mental y física mediante relajación muscular progresiva, terapia de control de estímulos 15 , terapia de intención paradójica, biofeedback asistido por mecanismos auditivos o visuales, respiración diafragmática, imaginación guiada por sugerencias, parada del pensamiento, restricción del sueño, etc... 16 . El paciente debe modificar la conducta limitando el tiempo de permanencia en la cama, estableciendo horarios (levantarse y acostarse a la misma hora), evitando siestas y cuidando el entorno ambiental del sueño.…”

Section: La American Academy Of Sleep Medicineunclassified

El insomnio

Sarrais

Castro-Manglano

2007

Anales Sis San Navarra

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RESUMENEl insomnio es una patología muy frecuente en la población general. Se estima que de un 10 a un 15 % de la población adulta padece insomnio crónico y que un 25 a 35 % ha sufrido un insomnio ocasional o transitorio en situaciones estresantes. El objetivo de este trabajo es proporcionar información actualizada sobre el insomnio: clasificación, causas, diagnóstico diferencial, opciones terapéuticas. Para ello hemos realizado una búsqueda en Pubmed con las palabras clave "insomnio", "trastornos del sueño" y "terapia farmacológica". La evaluación del insomnio se basa en una cuidadosa historia clínica en la que se analiza el sueño, antecedentes psiquiátricos y orgánicos personales y familiares, la toma de medicamentos y otras sustancias. Los autores coinciden en afirmar que el tratamiento debe ser primeramente etiológi-co y secundariamente sintomático.Palabras clave. Insomnio. Trastornos del sueño. Terapia farmacológica. ABSTRACTInsomnia is a common pathology in the general population. It is estimated that 10 to 15 percent of the adult population has chronic insomnia and 25 to 35 percent have suffered occasional or transient insomnia due to stressful situations. The aim of this article is to provide a review of insomnia: causes, differential diagnosis, and different options of treatment. To that end we have made a search in Pubmed with the keywords "insomnia", "sleeplessness", "sleep disorders" and "pharmacological therapy". Insomnia evaluation includes a careful sleep history, personal and family history of mental and organic illness, and a registration of drug and medication intake. Authors agree that treatment should be based primarily on etiology, and secondarily on symptomatology.

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Cognitive Behavioral Therapy for Treatment of Chronic Primary Insomnia

Abstract: Our results suggest that CBT represents a viable intervention for primary sleep-maintenance insomnia. This treatment leads to clinically significant sleep improvements within 6 weeks and these improvements appear to endure through 6 months of follow-up.

Cited by 567 publications

References 37 publications

Impact of Brief Cognitive Behavioral Treatment for Insomnia on Health Care Utilization and Costs

Impact of Brief Cognitive Behavioral Treatment for Insomnia on Health Care Utilization and Costs

Who is at risk for dropout from group cognitive-behavior therapy for insomnia?

El insomnio

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