Verified by 
It's well-established that the best treatment for chronic difficulty sleeping is cognitive behavioral therapy for insomnia (CBT-I). While some medications may be as effective in the short-term, CBT-I is superior in the longer term.
A recent study published in Sleep Medicine included the longest follow-up assessment to date of treatment outcomes for CBT-I—up to 10 years after treatment ended (the average was 7.8 years). Of the 258 patients who received treatment, 123 participated in the follow-up, making it a robust sample for examining the lasting effects of CBT-I.
The treatment in this study included seven sessions and was similar to previous trials of CBT-I. It included education about sleep and insomnia, relaxation training for calming the mind and body, as well as practicing thoughts and behaviors that promote sound sleep. (See this earlier post for a description of CBT-I: How to Fix Broken Sleep.)
The study authors reported that at the end of treatment, about 90% of participants no longer met criteria for clinical insomnia, with more than 30% having no significant insomnia. Symptom severity for the average participant fell by 43%. These findings are in line with many previous reports showing the effectiveness of CBT-I.
In their follow-up analyses, the research team found that treatment gains were maintained 4 to 10 years later; average insomnia severity scores between the two time points were virtually identical.
How did the effects of seven CBT-I sessions endure for up to a decade, especially when insomnia is often a recurrent condition? Indeed, 79% of individuals in this study reported at least one insomnia relapse during the follow-up period.
The most likely interpretation is that people learn skills in CBT-I that they can use at any point in the future to deal with acute insomnia. Data from this study support this interpretation.
The researchers asked participants what they did to address a return of sleep problems. Options included:
- Use CBT-I strategies
- Take sleep medication
- Use CBT-I strategies and take sleep medication
The lowest insomnia scores in the follow-up sample were found among individuals who relied on CBT-I strategies alone—30% lower than those who only took sleep medication.
Taken together, findings from this study reinforce the effectiveness of CBT-I, and underscore the lasting benefits from this treatment. Additionally they suggest that returning to the strategies learned in treatment is the best way to prevent an acute bout of insomnia from turning into a more chronic condition.
One additional factor is worth noting: The CBT-I in this study was administered to groups of 8 to 15 patients, which is a more efficient mode of treatment delivery than individual therapy. Accordingly, group CBT-I appears to be a cost-effective means to relieve insomnia and prevent its return.
References
Castronovo, V., Galbiati, A., Sforza, M., Poletti, M., Giarolli, L., Kuo, T., ... & Ferini-Strambi, L. (2018). Long-term clinical effect of group cognitive behavioral therapy for insomnia: A case series study. Sleep Medicine, 47, 54-59.
