Editing Insomnia (section)

==== Cognitive behavioral therapy ====

{{main|Cognitive behavioral therapy for insomnia}}
There is some evidence that cognitive behavioral therapy for insomnia (CBT-I) is superior in the long-term to [[benzodiazepine]]s and the [[nonbenzodiazepine]]s in the treatment and management of insomnia.<ref name="Mitchell-2012">{{cite journal | vauthors = Mitchell MD, Gehrman P, Perlis M, Umscheid CA | title = Comparative effectiveness of cognitive behavioral therapy for insomnia: a systematic review | journal = BMC Family Practice | volume = 13 | pages = 40 | date = May 2012 | pmid = 22631616 | pmc = 3481424 | doi = 10.1186/1471-2296-13-40 | doi-access = free }}</ref> In this therapy, patients are taught improved sleep habits and relieved of counter-productive assumptions about sleep. Common misconceptions and expectations that can be modified include:{{Cn|date=November 2024}}
* Unrealistic sleep expectations.
* Misconceptions about insomnia causes.
* Amplifying the consequences of insomnia.
* Performance anxiety after trying for so long to have a good night's sleep by controlling the sleep process.

Numerous studies have reported positive outcomes of combining cognitive behavioral therapy for insomnia treatment with treatments such as stimulus control and relaxation therapies. [[Hypnotic]] medications are equally effective in the short-term treatment of insomnia, but their effects wear off over time due to [[drug tolerance|tolerance]]. The effects of [[CBT-I]] have sustained and lasting effects on treating insomnia long after therapy has been discontinued.<ref name="JacobsG2004Cognitive">{{cite journal | vauthors = Jacobs GD, Pace-Schott EF, Stickgold R, Otto MW | title = Cognitive behavior therapy and pharmacotherapy for insomnia: a randomized controlled trial and direct comparison | journal = Archives of Internal Medicine | volume = 164 | issue = 17 | pages = 1888–96 | date = September 2004 | pmid = 15451764 | doi = 10.1001/archinte.164.17.1888 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Morin CM, Colecchi C, Stone J, Sood R, Brink D | title = Behavioral and pharmacological therapies for late-life insomnia: a randomized controlled trial | journal = JAMA | volume = 281 | issue = 11 | pages = 991–99 | date = March 1999 | pmid = 10086433 | doi = 10.1001/jama.281.11.991 | doi-access = free }}</ref> The addition of hypnotic medications with CBT-I adds no benefit in insomnia. The long-lasting benefits of a course of CBT-I shows superiority over pharmacological hypnotic drugs. Even in the short term, when compared to short-term hypnotic medication such as zolpidem, CBT-I still shows significant superiority. Thus, CBT-I is recommended as a first-line treatment for insomnia.<ref>{{Cite journal | vauthors = Miller KE |title=Cognitive Behavior Therapy vs. Pharmacotherapy for Insomnia |journal=American Family Physician |volume=72 |issue=2 |pages=330 |year=2005 |url=http://www.aafp.org/afp/2005/0715/p330.html |archive-url=https://web.archive.org/web/20110606060237/http://www.aafp.org/afp/2005/0715/p330.html |archive-date=6 June 2011}}</ref>

Common forms of CBT-I treatments include stimulus control therapy, sleep restriction, sleep hygiene, improved sleeping environments, relaxation training, paradoxical intention, and biofeedback.<ref>{{cite journal | vauthors = Ramakrishnan K, Scheid DC | title = Treatment options for insomnia | language = en-US | journal = American Family Physician | volume = 76 | issue = 4 | pages = 517–526 | date = August 2007 | pmid = 17853625 | url = https://www.aafp.org/pubs/afp/issues/2007/0815/p517.html | access-date = 2022-07-15 | archive-date = 2022-07-27 | archive-url = https://web.archive.org/web/20220727045819/https://www.aafp.org/pubs/afp/issues/2007/0815/p517.html | url-status = live }}</ref>

CBT is the well-accepted form of therapy for insomnia since it has no known adverse effects, whereas taking medications to alleviate insomnia symptoms has been shown to have adverse side effects.<ref>{{cite journal | vauthors = Krystal AD | title = A compendium of placebo-controlled trials of the risks/benefits of pharmacological treatments for insomnia: the empirical basis for U.S. clinical practice | journal = Sleep Medicine Reviews | volume = 13 | issue = 4 | pages = 265–74 | date = August 2009 | pmid = 19153052 | doi = 10.1016/j.smrv.2008.08.001 }}</ref> Nevertheless, the downside of CBT is that it may take a lot of time and motivation.<ref>{{cite journal | vauthors = Matthews EE, Arnedt JT, McCarthy MS, Cuddihy LJ, Aloia MS | title = Adherence to cognitive behavioral therapy for insomnia: a systematic review | journal = Sleep Medicine Reviews | volume = 17 | issue = 6 | pages = 453–64 | date = December 2013 | pmid = 23602124 | pmc = 3720832 | doi = 10.1016/j.smrv.2013.01.001 }}</ref>