Brief Behavioral Treatment for Insomnia: A Newer Treatment Option

If you’ve been struggling with insomnia for a while, you’ve probably come across cognitive behavioral treatment for insomnia (CBTI) as a gold-standard treatment. But have you ever heard of brief behavioral treatment for insomnia (BBTI)?

Doctors have been developing and refining BBTI since 2006. A recent meta-analysis summarized what the research tells us about this newer treatment for insomnia and who is most likely to benefit.^1,2

What is brief behavioral treatment for insomnia?

BBTI is a non-drug treatment for chronic insomnia. It is short-term, generally lasting around 5 half-hour sessions. Some of those sessions can be delivered by phone rather than in-person or by video telehealth.

BBTI interventions are largely behavioral in nature. This means a doctor will help you make changes to behaviors that impact your sleep. This includes things like reducing how much time you spend in bed and keeping a set bed and wake time. You’ll be asked to track your sleep daily on a sleep log, and your doctor will make recommendations based on that data.

BBTI versus CBTI

If you’re familiar with CBTI, you will notice some overlap between it and BBTI. Both use the behavioral strategies of sleep restriction and stimulus control to improve your quality and quantity of sleep. These behavioral strategies have been found to be effective parts of CBTI in past research.³

The treatments differ in important ways, however:

• BBTI is shorter (average course of 5 half-hour sessions) than CBTI (5- to 8-hour-long sessions), and some appointments can be delivered over the phone.
• Sleep restriction is adapted in BBTI so that it is less constrictive. This allows for a longer initial sleep window or sleep prescription.
• BBTI does not include relaxation training or cognitive interventions like CBTI does.
• BBTI can be offered by a wide range of providers, including nurse practitioners and pharmacists. CBTI is typically provided by a mental health provider with advanced training in sleep disorders.

Does BBTI work and for whom?

The meta-analysis reviewed 10 high-quality studies of BBTI with adult patients in the United States. Patients ranged in age from 32 to 84 years of age, but the majority were aged over 50. Some patients were generally healthy people seen in a primary care setting, while others were receiving specialty care for conditions including lung cancer and heart failure. Some struggled with treatment-resistant insomnia.²

While patients varied in age and their health status, overall, BBTI was effective in addressing their insomnia. Patients saw improvements in how long it took them to fall asleep, how well they slept during the night, and how satisfied they were with their sleep. The authors concluded that "BBTI offers several advantages as compared to CBTI by requiring fewer sessions that are briefer." And while the BBTI research literature is still in its infancy, “Current evidence suggests that BBTI can be considered preliminarily efficacious and can be used for ... middle-aged and older adults."²

Where to find a BBTI provider

Since BBTI is a newer treatment, providers are just beginning to be trained to deliver it. Many providers who work with military-connected patients (in the VA healthcare system or at military treatment facilities) provide BBTI within primary care.

You can also inquire about BBTI at a local sleep medicine practice or search the American Association of Sleep Medicine’s directory of accredited sleep centers. As BBTI becomes more popular, I hope we’ll see it being offered in primary care and other medical practices around the world.