Cognitive behavioral therapy — a type of psychotherapy that explores patterns of thinking that lead to self-destructive actions — requires a person to monitor and challenge their automatic negative thoughts. Scientific studies have demonstrated the effectiveness of this treatment in helping patients with substance abuse issues, mood disorders, eating disorders, and even mental illnesses that cause psychosis. But can it also help people who have trouble sleeping?

The most current research emphatically says “yes.” In a recent study, 86 percent of insomnia patients who completed at least three sessions of cognitive behavioral therapy found their sleep improved. Even better, in the six months following their treatment, each patient saw their health-care-related expenses plummet by more than $200 on average. "Each year in the U.S. millions of prescriptions are filled and billions of dollars are spent to treat insomnia," Dr. Michael T. Smith, president of the Society of Behavioral Sleep Medicine, said in a press release. "This study reaffirms that cognitive behavioral therapy is clinically effective, and it provides promising new evidence that even brief treatment … may reduce health care utilization costs." A summary of the new research appears in the Journal of Clinical Sleep Medicine.

Cognitive Behavioral Therapy … for Insomnia

Chronic insomnia impacts up to one out of every 10 American adults. Behavioral Sleep Medicine treats sleep disorders by addressing behavioral, psychological, and physiological factors that interfere with sleep. Many Behavioral Sleep Medicine interventions are based on cognitive behavioral therapy that helps people eliminate habits, behaviors, and environmental disruptions that erode quality rest-time. In addition to subtracting behaviors, cognitive behavioral therapy for insomnia (CBTi) also introduces positive steps that can be taken to improve sleep, such as changing a sleep schedule. Most CBTi interventions are brief and involve only an evaluation and a limited number of treatment visits. This goal-oriented psychotherapy usually requires a patient to practice outside of sessions and does not involve medication.

Seeking to better understand the use and costs of CBTi, Dr. Christina McCrae, associate professor of clinical and health psychology at the University of Florida, and colleagues from both the VA Pittsburgh Healthcare System and Drexel University reviewed the medical records of 84 outpatients treated in a behavioral sleep medicine clinic. Next, they estimated total costs, including outpatients costs and expenses associated with office visits, while also calculating the number of primary care visits, number of CBTi office visits, and number of medications over a six-month period prior to and following treatment. The treatment itself included sessions, led by clinical psychology graduate students and pre-doctoral interns, who focused on sleep education, sleep hygiene, stimulus control, relaxation exercises, and cognitive therapy.

After analyzing the data and crunching all the numbers, what did the researchers discover? The majority of those who completed treatment (86 percent) achieved improved sleep. As if this alone were not impressive enough, the researchers also highlighted the financial impact. “Of the six [health care utilization] and cost variables examined, all but total number of medications either significantly decreased or trended toward a decrease from pre- to post-treatment,” the authors wrote. Although the cost of CBTi — about $460 in the study — might have negated short-term savings in the first six months after treatment, the main advantage of CBTi treatment is that the effects are long-lasting, which means there are no ongoing treatment costs as is often the case with other types of therapy. Finally, because so many people suffer from insomnia, the researchers added, cognitive behavioral therapy for insomnia has the potential to produce substantial long-term savings for the entire health care system.

Source: McCrae CS, Bramoweth AD, Williams J, Roth A, Mosti C. Impact of Brief cognitive behavioral treatment for insomnia on health care utilization and costs. Journal of Clinical Sleep Medicine. 2014.