CBT-I: The Natural Treatment for Insomnia
Sleep disturbance is common in long-term care facilities and can be very dangerous if not treated properly.
A study that included 4,000 residents in 57 different long-term care facilities showed 24 percent of LTC residents suffer from Insomnia and 5 percent of older adults meet the criteria for clinically significant insomnia disorders. Another study of 334 nursing home residents found that 72.1 percent were classified as poor sleepers. This can lead to increased risk of falls and accidents, cognitive impairment, increased sensitivity to pain, altered mood, fatigue, decreased motivation, and worsened functional status and quality of life.
Insomnia is a sleep disorder in which a person has trouble falling asleep, and/or staying asleep. Insomnia can be acute (lasting from one night to a few weeks) or chronic (occurs at least three nights a week for three months or more).
One way to fight insomnia is with cognitive behavioral treatment for insomnia (CBT-I). CBT-I is a first-line treatment of chronic insomnia that doesn’t use drugs. It’s a short, structured, and evidence-based approach to combating the symptoms of insomnia. It focuses on exploring the connection between the way we think, the things we do, and how we sleep.
CBT-I combines several different approaches including cognitive, behavioral, and psychoeducational interventions.
Stimulus control techniques
Stimulus control aims to change associations with the bedroom. To successfully reassociate the bed with sleep, patients should avoid doing things in bed other than sleep, avoid sleeping out of bed, and go to bed only when tired. Patients unable to sleep should get out of bed (or sit up) after 15 to 20 minutes, lie down when sleepy, and repeat as needed.
Relaxation therapies
Relaxation techniques can help reduce racing thoughts and tension that accompany lying in bed awake. Relaxation therapies may include progressive muscle relaxation (PMR), breathing exercises, autogenic training, biofeedback, hypnosis, meditation, visual imagery, and scheduled “worry time.”
Cognitive strategies
Thoughts and feelings about sleep are examined and tested to see if they’re accurate, while behaviors are examined to determine if they promote sleep. A provider will then clarify or reframe misconceptions and challenges in a way that promotes better sleep.
Psychoeducation
Educating about the importance of good sleep hygiene is a core component of CBT-I. Good sleep hygiene involves increasing practices that support sleep, while decreasing or eliminating those that discourage sleep.
Some topics that may be covered are the effects that diet, exercise, and sleeping environment have on falling and staying asleep.
The order and flow of each component can vary based on the provider’s approach and the unique needs of each person.
CBT-I is a more gradual treatment response than hypnotics, but it is better in the long term and is typically safer for patients with multiple psychiatric and more than one medical condition.
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