Medication Considerations

Abstract

Despite the general efficacy of CBT for insomnia, this form of therapy is generally not the first intervention chosen for the majority of treatment seeking insomnia sufferers. Most are seen in primary care settings where they usually are treated with some form of hypnotic medication. Many of those who eventually present for a trial of CBT do so while continuing hypnotic medications prescribed for their sleep difficulties. Additionally, many people with insomnia may continue using medications to manage their sleep problems for long periods of time despite less than optimal benefits and their ongoing desires to become medication free. Also, many insomnia sufferers use combinations of sedating anxiolytics and prescription hypnotics in an effort to reduce their sleep-related anxiety and sleep difficulties in general. These observations spawn a number of important questions in regard to the use of CBT with such individuals. First, it is important to consider whether these people derive similar benefits from CBT, as do those who enter treatment medication free. It also seems useful to question if there is an optimal treatment protocol for people who wish to combine CBT with pharmacotherapy for insomnia. Finally, it seems useful to ascertain if CBT and other psychological techniques are useful to those who exhibit hypnotic-dependence and ultimately wish to discontinue their sleep medication use.