Brief Behavioral Treatment of Insomnia

https://doi.org/10.1016/j.jsmc.2019.02.003Get rights and content

Section snippets

Key points

  • Cognitive behavioral treatment for insomnia (CBTI) is an effective treatment of insomnia; however, there are insufficient CBTI providers for the 10% to 25% of the population who have insomnia.

  • Brief behavioral treatment for insomnia (BBTI) is a 4-session manualized treatment paradigm administrable in medical settings by nonpsychologist health professionals.

  • BBTI is effective in reducing symptoms of insomnia, such as sleep onset latency, wake after sleep onset, and sleep efficiency. In some cases,

Brief behavioral treatment for insomnia overview

BBTI was developed to be brief, acceptable to patients taking medications and with other comorbidities, and efficacious in a short time period. It is deliverable by professionals with minimal specialty training (the initial efficacy trial was delivered by a nurse practitioner with no prior sleep medicine or behavioral interventions). The design targets 2 physiologic processes that regulate sleep: Homeostatic drive that increases sleep propensity as duration of wakefulness increases, and

Update on brief behavioral treatment for insomnia efficacy

The goals of BBTI are similar to other insomnia treatment modalities: (1) improve sleep quality and quantity and (2) reduce daytime impairment.1 Improvements in these domains are generally assessed using questionnaires addressing sleep quality (eg, Pittsburgh sleep quality index; PSQI),12 insomnia severity (eg, insomnia severity index; ISI),13 and daily sleep diaries in which patients estimate and record their bedtime, sleep onset latency (SOL), wake after sleep onset (WASO), wake time, and

Other implications of brief behavioral treatment for insomnia

Improving or resolving insomnia has a positive impact on other medical and psychological domains. For example, individuals who underwent CBTI had reduced pain ratings after treatment even though pain management was not a part of the treatment protocol.20 Similarly, Manber and colleagues21 found that individuals with major depression and insomnia had better depression remission rates when they were offered CBTI in addition to pharmaceutical treatment of depression. Buysse and colleagues9 found

Limitations and future directions of brief behavioral treatment for insomnia

Much of what is known about BBTI’s efficacy has been observed in older adult populations. Insomnia with comorbidities is common in older adults,26 who are also at increased risk for side effects from medications.27 Thus, results of BBTI trials demonstrate positive outcomes for a population most likely to benefit from a brief behavioral intervention for insomnia that is deliverable by health practitioners in a medical setting. However, evaluation on generalizability of BBTI efficacy is currently

First page preview

First page preview
Click to open first page preview

References (38)

  • S. Schutte-Rodin et al.

    Clinical guideline for the evaluation and management of chronic insomnia in adults

    J Clin Sleep Med

    (2008)
  • M.R. Rosekind et al.

    Insomnia risks and costs: health, safety, and quality of life

    Am J Manag Care

    (2010)
  • D.F. Kripke et al.

    Hypnotics' association with mortality or cancer: a matched cohort study

    BMJ Open

    (2012)
  • A. Qaseem et al.

    Management of chronic insomnia disorder in adults: a clinical practice guideline from the American College of Physicians

    Ann Intern Med

    (2016)
  • J.M. Trauer et al.

    Cognitive behavioral therapy for chronic insomnia: a systematic review and meta-analysis

    Ann Intern Med

    (2015)
  • W.M. Troxel et al.

    Clinical management of insomnia with brief behavioral treatment (BBTI)

    Behav Sleep Med

    (2012)
  • D.J. Buysse et al.

    Efficacy of brief behavioral treatment for chronic insomnia in older adults

    Arch Intern Med

    (2011)
  • R.R. Bootzin et al.

    Stimulus control instructions

  • A.J. Spielman et al.

    Treatment of chronic insomnia by restriction of time in bed

    Sleep

    (1987)
  • Cited by (34)

    • Call to action: Addressing sleep disturbances, a hallmark symptom of PTSD, for refugees, asylum seekers, and internally displaced persons

      2022, Sleep Health
      Citation Excerpt :

      Similar to IRT, exposure, relaxation, and rescripting therapy (ERRT) consisting of 3-5 60-90-minute sessions of cognitive behavioral treatment, has demonstrated efficacy in trauma-related nightmares but also has shown mixed findings.46,49 For a more thorough review on sleep disorders treatment efficacy and combined treatment efficacy in non-refugee patients with PTSD, please refer to.29,46,50-57 Unfortunately, there is a paucity of data on the applicability and efficacy of IRT among refugee populations.

    • Management of Sleep and Fatigue in Gastrointestinal Patients

      2022, Gastroenterology Clinics of North America
      Citation Excerpt :

      Remission rates are typically ∼60% and CBT-I delivered via telehealth is as effective as in-person treatment.69,78 Further, Brief Behavioral Treatment for Insomnia, 2 to 4 session insomnia treatment that excludes the cognitive components of CBT-I, is also quite effective and may be delivered by non-specialists.79,80 Not only is CBT-I highly effective for insomnia, it also may impact other comorbid or insomnia-maintaining processes such as pain, depression, and inflammation.

    • The platform development, adherence and efficacy to a digital Brief therapy for insomnia (dBTI) during the COVID-19 pandemic

      2022, Methods
      Citation Excerpt :

      In this context, digital behavioral therapy technology came into being. Brief therapy for insomnia (BTI) is a short-term cognitive behavioral therapy, which takes only 1–2 weeks [5]. The basic principle of BTI is to regulate sleep by changing behaviors when awake, thereby directly affecting homeostasis and circadian clock driving.

    • How sleep can help maximize human potential: The role of leaders

      2021, Journal of Science and Medicine in Sport
      Citation Excerpt :

      Leaders should be aware that the US Department of Veteran's Affairs hosts a free online resource called “Path to Better Sleep” which implements cognitive-behavioral therapy concepts to help improve sleep without medications.83 Cognitive-behavioral therapy is a well-established84 and effective85 non-pharmacologic treatment for insomnia and sleep problems and can be delivered online86 or in brief coaching sessions.87 The US Army's Performance Triad initiative and resources provide a structured and tailored way for leaders to deliver operationally-relevant coaching and instruction on sleep as well as activity and nutrition to improve military readiness and performance.88

    View all citing articles on Scopus

    Disclosure Statement: H.E. Gunn and J. Tutek have no financial disclosures to report. D.J. Buysse has served as a paid consultant to BeHealth Solutions, Emmi Solutions, and Bayer HealthCare (last 3 years).

    View full text