Treating the cause of Insomnia: Behavioral Treatment works best

Many people have trouble sleeping. But when one or two nights of restless sleep turn into a long-term problem of sleepless nights, you might be experiencing Insomnia Disorder.

Insomnia Disorder is a widespread sleep problem among Veterans. In fact, rates of Insomnia Disorder are 30 to 40 percent higher among Veterans than the general population. If you’ve talked with your healthcare provider about your insomnia, or have looked for information on the internet, you might have received a list of “dos and don’ts” or “easy tips to cure insomnia.” Usually those lists and tips are just sleep hygiene education. Sleep hygiene tips can be very helpful for people who are usually good sleepers, but they probably won’t help someone with Insomnia Disorder.

In our last VAntage Point blog about sleep we discussed how long term insomnia is complicated. Healthcare providers are beginning to learn about the most effective approach to insomnia treatment. Although medications can help you fall asleep, they only mask the symptoms of insomnia. A different treatment, called Cognitive Behavioral Therapy for Insomnia, or CBT-i, actually treats the root cause of insomnia.

Sleep experts recommend CBT-i as the best treatment for Insomnia Disorder. Veterans who have completed CBT-i report less severe insomnia symptoms, less depression, and fewer thoughts of suicide. Even Veterans experiencing Post Traumatic Stress Disorder (PTSD) had improved sleep after CBT-i, including better overall sleep, fewer trauma-related sleep issues, fewer nightmares, and less depression.

CBT-i is much more than just a list of strategies to improve your sleep hygiene. It targets the behaviors, thoughts and emotions that keep you stuck in the insomnia cycle. Think of the difference between sleep hygiene education and CBT-i like the difference between a dental hygienist and a dentist. Like a dental hygienist, sleep hygiene education helps healthy people stay healthy. Like a dentist, CBT-i treats a health condition.

CBT-i uses the body’s own natural processes to improve sleep. It helps people with insomnia schedule sleep and improve sleep quality. Without realizing it, people with insomnia have trained themselves to sleep poorly. CBT-i helps people to “un-train” poor sleep habits. CBT-i also helps people with insomnia to challenge unhelpful thoughts and beliefs about sleep.

VA has trained more than 800 healthcare providers to deliver CBT-i. If you are diagnosed with Insomnia Disorder, there’s a good chance you’ll be able to find a CBT-i trained provider at your VA facility. Face-to-face treatment can be delivered in either one-on-one or group therapy formats. Your therapist will recommend the best approach for you based upon your specific situation.

Our last blog in this series will tell you more about VA’s Path to Better Sleep, a course that offers Veterans free access to online CBT-i. Be sure to check back soon!

This blog post is the second in a series about understanding sleep disorders in Veterans and options for treatment. To learn about common sleep disorders, read the first blog in the series here. 

Christi S. Ulmer, PhD, DBSM, and Carolyn Greene, Ph.D., work at VA Durham.