Lecture – Combining Medications and CBT for Insomnia

Available with English captions.

Presented by Jared Minkel, PhD, Rhode Island Hospital – Visiting Scholar Series lecture

Cognitive behavior therapy (CBT) techniques combined with medications have been shown to be effective in treating individuals with chronic insomnia.

In this presentation, Minkel discusses various types of CBT and common medication approaches for addressing insomnia. He states that medications are the most common treatment for insomnia disorder, and they can be helpful for improving sleep. However, he states, these medications are most effective when used in combination with behavioral interventions.

Watch now to learn more about:

  • Cognitive behavioral therapy for insomnia (CBT-I) and cognitive therapy for insomnia (CT-I)
  • Advantages and disadvantages of using several common sleep medications
  • The 2-process model of sleep and how it informs use of sleep medications
  • Cognitive and emotional factors that make it difficult to stop taking medication
  • Several strategies for reducing patients’ anxiety about tapering sleep medications

Drawing on research findings and his own clinical experience, Minkel explains how CBT-based approaches and medications can work well together under a shared, psychobiological framework.

Minkel reports that clinicians have had success using CBT-I. He describes this approach as a set of instructions that help insomnia patients reassociate their bed or bedroom with sleep and re-establish a consistent sleep/wake schedule.

Clinicians have also found success with CT-I. Designed to help those who do not see improvements with CBT-I, CT-I takes a more cognitive approach. Minkel explains that CT-I uses interventions aimed at reducing worry about insomnia, testing faulty beliefs about sleep, and eliminating unhelpful behaviors.

In this talk, Minkel discusses ways to combine these CBT-based therapies with medications to get the best results for chronic insomnia patients. He cites studies showing how the addition of medication to CBT produced added benefits during acute therapy for patients with persistent insomnia.

Also, Minkel examines the challenges associated with tapering off sleep medication. He talks about these medications and how they affect the brain, making it difficult for many patients to “step down” and still enjoy the benefits.

Minkel describes the ways that most individuals who are dependent on sleep medications are “anxious, not addicted.” He says that stepping down from sleep medications should be looked at as a significant psychiatric intervention. Treating anxiety related to tapering, he states, can improve outcomes.