Trained clinicians or mental health professionals can administer CBT-I. Various delivery methods are available, including in-person individual or group therapy, telephone- or Web-based modules, and self-help books. It consists of a combination of cognitive therapy, behavioral interventions (such as sleep restriction and stimulus control), and educational interventions (such as sleep hygiene). Cognitive behavioral therapy for insomnia is multimodal cognitive behavioral therapy targeted specifically to insomnia. Psychological therapy options include cognitive behavioral therapy for insomnia (CBT-I) multicomponent behavioral therapy or brief behavioral therapy (BBT) for insomnia and other interventions, such as stimulus control, relaxation strategies, and sleep restriction (see Appendix Table 1 for a description of these interventions).
Insomnia can be managed with psychological therapy, pharmacologic therapy, or a combination of both. The goal of treatment for insomnia is to improve sleep and alleviate distress or dysfunction caused by the disorder. Older adults are more likely to report problems with waking after sleep onset (difficulty maintaining sleep) than they are to report problems with sleep onset latency (time to fall asleep). Symptoms of insomnia differ between older adults and the younger population. These criteria specify that symptoms must cause clinically significant functional distress or impairment be present for at least 3 nights per week for at least 3 months and not be linked to other sleep, medical, or mental disorders ( 1).
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Insomnia also takes a toll on the economy in terms of loss of workplace productivity, estimated at $63.2 billion in the United States in 2009 ( 8).Ĭhronic insomnia, also referred to as “chronic insomnia disorder” in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), is diagnosed according to the DSM-5 ( 9) and the International Classification of Sleep Disorders ( 10), which have similar criteria for making the diagnosis. An estimated $30 billion to $107 billion is spent on insomnia in the United States each year ( 7). People with the disorder often experience fatigue, poor cognitive function, mood disturbance, and distress or interference with personal functioning ( 2, 4).
Insomnia is more common in women and older adults ( 5, 6) and can occur independently or be caused by another disease. Approximately 6% to 10% of adults have insomnia that meets diagnostic criteria ( 1–4). It is defined as dissatisfaction with sleep quantity or quality and is associated with difficulty initiating or maintaining sleep and early-morning waking with inability to return to sleep ( 1). Insomnia is a major health care problem in the United States.
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