CBT-i Evidence and further reading

There are so many treatments out there claiming to help people with insomnia sleep again. The problem is that not one (apart from sleeping pills and CBT-i) is backed by sound scientific evidence. You probably already know about sleeping pills. But what about CBT-i?

If you have watched any of our webinars, you’ll probably be aware of CBT-i. If you haven’t yet, then here is some information about CBT-i. Even though it does fall into the family of Cognitive Behavioural Therapies (CBT), it is actually very different to CBT as offered by many psychologists.

What does the science say?

Firstly, it is important to point out that when we talk about scientific proof, we mean a large body of evidence coming from multiple studies. For CBT-i, there are literally hundreds of studies, (including well over 100 Randomised Control Trials (RCT)) going back over 30 years demonstrating its efficacy.

What does the research say?

There is strong empirical evidence that CBT-i is an effective and long lasting treatment for 57% to 75% of patients suffering from insomnia. It has been demonstrated that although improvements take longer to be experienced, these improvements are permanent. Sleep latency, total sleep time, duration of wakefulness, and sleep quality have all been shown to improve significantly compared with control groups.

Links for further reading:

Cognitive-behavioral therapy for insomnia (CBT-I) has emerged as the first-line treatment for chronic insomnia but remains massively underused

CBTI is effective in specific and mixed comorbid samples

We conclude that CBTI is effective in the treatment of insomnia.

Significant effects of behavioral interventions for sleep latency, sleep quality, wakefulness after sleep onset and sleep efficiency 

Insomnia with Comorbidity

Insomnia has a high comorbidity rate with chronic medical and psychiatric conditions (illness, pain, psychiatric conditions, PTSD) ranging from 20 to 80%. CBT-i has been demonstrated to be effective in patients with cancer, chronic pain, depression and anxiety, PTSD. 

Links for further reading:

CBT is an effective treatment for insomnia that is secondary to chronically painful medical conditions

Robust evidence for patients with or without comorbid disease

Cognitive-behavioral therapy for insomnia is promising for individuals with MDD and comorbid insomnia 

Significant improvements were found in sleep as well as in the extent to which pain interfered with daily functioning

Significant improvements in sleep and daytime PTSD symptom severity

Internet Based CBT-i

Of course the biggest challenge with CBT-i is getting access to the right practitioner, especially in these times. Between 7% and 12% of the population suffer from an insomnia disorder, the biggest challenge is to make CBT-i available and accessible to meet those population needs. This is the main reason that online CBT-i or eCBT-i has grown so much in the past years. Studies show that internet based CBT-i can be just as effective at treating insomnia.

Links for further reading:

eCBT-I improved insomnia severity, sleep efficiency, subjective sleep quality, wake after sleep onset, sleep onset latency, total sleep time, and number of nocturnal awakenings

Participants who received the Internet intervention for insomnia significantly improved their sleep

What are the reasons CBT-i is unsuccessful?

When looking at the wide ranging results of CBT-i, one might wonder about the factors influencing possible success. Why have certain studies shown only a 50% success rate while the top specialist sleep physiologists experience over 90% of their patients ending their insomnia?

There are of course multiple factors…but surprisingly when looking at the research, it is never linked to the severity of the insomnia, nor to the amount of time people were suffering from the condition. There are a few extremely rare conditions needing to be referred to other specialists.

By far, the most reported reason for failure is adherence.

The course only works if you are consistent and really push yourself to stick with it. If you put the work in, you get results. Not instantly, but they are permanent.

Links for further reading:

Attrition and suboptimal adherence diminishes CBT-I Impact

Want to sign up to the Sleepyhead Program CBT-i course?

We partnered with one of the world’s leading specialist sleep physiologists, Stephanie Romiszewski MSc. Behavioural Sleep Medicine, to create our online CBT-i based course. She has over 15 years experience treating sleep disorders with the most complex comorbidities and has over 90% success treating over 10,000 patients!

It will be hard work but the reward is finally being rid of insomnia for good!