Self Help Strategies: Expanding Insomnia Treatment Options

As I have written before, cognitive behavioral therapy for insomnia (CBTI) is the gold-standard treatment for insomnia disorder. I recommend it to anyone who is struggling with insomnia, including friends and family. But I know not everyone has access to CBTI. So, what can I recommend for those people?

Challenges to CBTI

There are several reasons why patients don't always get the "best" care. First, there is a known shortage of providers trained in CBTI. Second, it is sometimes difficult to find a trained provider who accepts the patient's insurance. And third, even if providers are available, patients may not be able to get to the clinic due to transportation issues or time constraints.¹

A more convenient option?

A recent study asked the question of whether CBTI could work with more of a "self-help" structure. Researchers at the Durham, North Carolina Veteran's Affair (VA) Medical Center offered 2 interventions to veterans with insomnia. Some patients received what the researchers call "Tele-Self CBTi." These patients were assigned weekly readings from a CBTI treatment manual. Patients also had 6 weekly telephone calls with a nurse who helped them put those readings into practice. The calls were each about 20 minutes-long. A second group of patients received health education. They also had 6 weekly calls with a nurse, but they discussed healthy lifestyle habits that did not include sleep habits.²

The "Tele-Self CBTi" model seems like a middle ground between in-person CBTI and self-help. Though patients read the material themselves and made decisions about how to apply it, they also had support from a nurse. Based on their results, this middle ground worked.

Thirty-six percent of patients who received Tele-Self CBTi had a significant improvement in symptoms, while another 30 percent completely recovered. Patients reported falling asleep faster, staying asleep longer, and less fatigue and depression after treatment. Those improvements were maintained at a 6-month follow-up.

Another option

A study that is in-progress is looking at another model of insomnia treatment within the VA. Providers who work in integrated primary care clinics are providing Brief Behavioral Treatment for Insomnia (BBTI) to patients. BBTI is a simplified, briefer version of CBTI that has very good outcomes. Some of the appointments take place in person or via video call, but other appointments just take place over the phone. Making treatment available within primary care allows some patients to get treatment faster and without additional cost and referrals.

I talked to a provider in the study who is a nurse in a primary care clinic. She describes how her patients have responded to BBTI, "I've seen significant improvements in veterans' sleep efficiency within just the first week. Witnessing veterans' progress is incredibly rewarding as it leads to broader positive changes, such as increased energy, improved mood, and better stress management."

Accessing the options

Clearly the VA is working hard to expand access to effective treatment to our veterans. But the results of their studies can apply to all of us. Self-help options and BBTI might be options for anyone with insomnia. 

Keep in mind the self-directed treatments seem best for people without other complications. For example, if you have insomnia disorder and you work night shifts that impact your sleep schedule, you might benefit more from in-person treatment.

If you receive care through the VA or the Department of Defense, ask if CBTi or BBTI are available. Many clinics are offering these treatments through primary care and by telehealth, as well as the self-directed option.

If you get care elsewhere and think an online self-help program could work for you, there are a couple of free options:

• The Insomnia Coach app teaches you basic CBTI techniques. You can track your sleep and get personalized recommendations from the app, as well as set reminders and learn relaxation skills.
• The Path to Better Sleep is a 4-part course you can access online. It also teaches the main parts of CBTI and helps you track and adjust your sleep.

Although both of these tools were created in partnership with the VA, they are free to use by everyone, even if you don't have a connection to the military.

Figure out what works for you

Everyone's insomnia is a little different. What works for one person might not work as well for another. It might take a little work and research, but with so many treatment options out there, you are likely to find one that works for you.