Using CBT-I Instead of Medication

Dr. Colleen Ehrnstrom's profile picture
Dr. Colleen Ehrnstrom, PhD
May 3, 20225 min read
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If you have problems falling asleep, staying asleep, or waking up too early, you may have insomnia — a common sleep disorder. Insomnia may make you feel like you barely sleep at night and it may cause you to feel really tired during the day. While occasional sleeplessness is common, you may have chronic insomnia if your sleep troubles have been ongoing for at least a month.1

There are several options for insomnia treatment. If your sleeping problems are caused by an underlying medical disorder, addressing that condition is always a good first step. Additionally, certain medications and lifestyle changes can help you get a better night’s sleep. The most well-known and effective option is cognitive behavioral therapy for insomnia (CBT-I),2 CBT-I is a personalized program that addresses your relationship with sleep and how best to support and promote healthy sleep patterns.

Popular Medications for Insomnia

Several types of medications may help you sleep better. Some sleeping aids can be bought over-the-counter. Some of the most popular options include:3

  • Melatonin, a hormone supplement
  • Diphenhydramine, which goes by brand names like Aleve PM, Benadryl, and ZzzQuil
  • Unisom SleepTabs (doxylamine succinate)

Other medications are sedatives that are prescribed by a doctor. Prescription sleeping aids include:4

  • Lunesta (eszopiclone)
  • Restoril (temazepam)
  • Sonata (zaleplon)
  • Ambien (zolpidem)
  • Silenor (doxepin)

When going through a severe episode of insomnia, it is typical to reach for these types of aids. Medications for insomnia may help you get a full night’s sleep when nothing else will, and higher-quality sleep can help protect your health.3

Unfortunately, sleep medications can also have drawbacks. It is a good idea to talk to your doctor to find out whether these drugs may be helpful for your personal needs.

Sleep Aids: A Short-Term Treatment

Experts recommend using sleeping aids only as a temporary fix. They are not a good long-term solution, for several reasons:

  • The hangover effect — These drugs make some people feel “hungover.” You may feel extra groggy the day after using sleep aids.3
  • You can build up tolerance to over-the-counter drugs — These medications typically work well at first. However, your body quickly gets used to them, making these aids increasingly less effective the longer you use them.3
  • You may become addicted to prescription drugs — If you use sleep aids too often, you may develop a dependence on them and be unable to fall asleep without them.2
  • Side effects — Different types of sleeping pills can lead to different health issues, including headaches, dizziness, tiredness, nausea, diarrhea, and memory and thinking problems.4

It is also quite popular to treat insomnia with antidepressants. These medications may alter levels of certain brain chemicals that affect sleep. However, symptom relief can take several months to achieve and is not also sustainable if you stop taking antidepressants. Also, paradoxically, some antidepressants can negatively impact sleep quality. To learn more about using antidepressants to manage insomnia, read our primer here.

How Can CBT-I Help With Insomnia?

CBT-I is a program that can help you develop better habits and attitudes surrounding sleep. It can be understood as a therapy that creates a bond between your behavior, your thoughts, and your emotions to reprogram your sleep patterns. CBT-I can provide a long-term solution to sleeping problems.5 To learn more about cognitive behavioral therapy for sleep and check out an in-depth explanation of the “CBT-I triangle,” read our CBT-I blog post.

CBT-I also gives you the tools you need to change unhelpful thought and behavioral patterns.6 Purposely working to build up beneficial attitudes and behaviors through CBT-I can help you develop more positive emotions toward sleeping and feel more motivated to stick to new sleep habits.

Benefits of CBT-I Treatment

CBT-I is the gold standard treatment for insomnia, recommended by both the American Academy of Sleep Medicine and the American College of Physicians.7 There are a few reasons why experts recommend CBT-I over medication:57

  • CBT-I tackles the underlying factors that initially lead to insomnia. Sleep aids, on the other hand, merely address surface-level insomnia symptoms.
  • Because CBT-I more directly taps into the causes of insomnia, it provides longer-lasting relief for sleep problems.
  • Medications aren’t always effective at treating insomnia. CBT-I has a high success rate and is especially helpful for people who have mental health issues that may be contributing to insomnia, such as anxiety.
  • You don’t have to worry about tolerance, dependence, or addiction when using CBT-I.
  • CBT-I doesn’t lead to any uncomfortable or harmful side effects.

Choosing CBT-I Instead of Medications

CBT-I is one of the best treatments for insomnia. It may work better and be better for your health as compared with sleeping pills. If you want to learn more about CBT-I and gain tools for better sleep, check out Dawn’s many resources and articles. Here, you can learn more about how it’s possible to relieve sleeplessness with the right treatment and effort.

If you’re interested in trying cognitive behavioral therapy for sleep, fill out our questionnaire to see if it may be a good fit for you.

References

  1. MedlinePlus. (2022, March 29). Insomnia. https://medlineplus.gov/insomnia.html

  2. MedlinePlus Medical Encyclopedia. (2022, April 1). Insomnia. https://medlineplus.gov/ency/article/000805.htm

  3. Mayo Clinic. (2019, October 16). Sleep Aids: Understand Over-the-Counter Options. https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/sleep-aids/art-20047860

  4. Mayo Clinic. (2018, January 30). Prescription Sleeping Pills: What’s Right for You? https://www.mayoclinic.org/diseases-conditions/insomnia/in-depth/sleeping-pills/art-20043959

  5. Mayo Clinic. (2016, September 28). Insomnia Treatment: Cognitive Behavioral Therapy Instead of Sleeping Pills. https://www.mayoclinic.org/diseases-conditions/insomnia/in-depth/insomnia-treatment/art-20046677

  6. InformedHealth.org. (2016, September 8). Cognitive Behavioral Therapy. https://www.ncbi.nlm.nih.gov/books/NBK279297/

  7. Feuerstein, S., Hodges, S. E., Keenaghan, B., Bessette, A., Forselius, E., & Morgan, P. T. (2017). Computerized Cognitive Behavioral Therapy for Insomnia in a Community Health Setting. Journal of clinical sleep medicine, 13(2), 267–274. https://doi.org/10.5664/jcsm.6460


Dr. Colleen Ehrnstrom's profile picture
Dr. Colleen Ehrnstrom, PhD

Dr. Colleen Ehrnstrom is a licensed clinical psychologist with a specialty practice in Acceptance and Commitment Therapy (ACT). Areas of expertise include insomnia and other sleep disorders, anxiety, and depression.

Dr. Ehrnstrom is not a medical provider and is not providing any recommendations regarding medications. Rather, she is sharing and reviewing the research as it relates to education when learning how best to treat insomnia.

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