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“I’ve tried everything!” Why CBTi (Cognitive Behavioral Therapy) should be first line therapy for insomnia.

By August 19, 2019 No Comments
I use Google alerts to send me a daily list of insomnia headlines. A few weeks ago I came across this story by a novelist named Roisin Meaney. She is telling us about how she developed and tried to overcome insomnia. Her story is so very typical, I hear similar accounts every week. I hope by sharing it with you here, we can talk about some very important lessons.

You can read the article here: https://www.independent.ie/life/health-wellbeing/i-so-envy-those-of-you-who-go-to-bed-each-night-and-fall-asleep-writer-roisin-meaney-on-her-battle-with-insomnia-37067802.html

In summary she was sleeping well into her mid therties. At that point she started having intermittent insomnia problems that became more and more frequent. She eventually saw her general practitioner (what we would call primary care provider in the US) who “prescribed daily exercise, no caffeine after midday, a telly and computer embargo in the evenings, a bath and some warm milk before bedtime”. This did not work and she was prescribed a 1 week course of a sleep medication which helped but as soon as she stopped taking it her insomnia recurred. She then went on to try a number of sleep remedies without success until she found a sleeping pill in Spain that helped. Eleven years later, she ends up with a routine that has her taking Benadryl a few times per week and lives with her insomnia the other days.

In her own words “I tried everything” and she never found a solution. The article ends by saying that those readers that sleep well should “count their blessings” with a sense of resignation.

Let’s take a look at the things she tried and what “everything” means to her:

1. Sleep hygiene (including limiting screen time and caffeine)
2. Sleep aids (helped but did not resolve her insomnia problems)
3. Alternative remedies in my local heath store (likely including Melatonin)
4. Yoga and meditation
5. Lavender drops on pillow
6. Sleep spray (not heard of this one before)
7. Listening to rainfall and waves and whale noises and other sounds
8. A yantra mat .                                                                                                                                                                                                                 

Now on this list of all the things she has tried in order to sleep better, there is missing a treatment that has a success rate often in the 80-90% range, has no side effects and helps for years. She has tried everything except the best treatment for insomnia which you know by now is CBTi. I want to double down on this because it is so common:

People with long standing insomnia almost always have tried every sleep remedy out there except the one treatment that is most likely to cure them.

It is impossible to know if Roisin would have been free of insomnia if she had started CBTi 11 years ago but it is more likely than not. But if she had, imagine the amount of frustration it would have saved her. Even if she had not, there are millions of people world wide with similar stories and literally millions of people could sleep better if CBTi was available to them.

And not only should CBTi be available: CBTi should be first line therapy for all insomniacs.

Most importantly, if CBTi was the first therapy insomniacs tried most would benefit quickly. Equally important is that for every day, week, month and year that someone lives with insomnia and goes through trial after trial of sleep remedies without sleeping better the more entrenched the insomnia becomes. The more entrenched, the harder to treat. And in someone with decades of insomnia, the assocation of the bed, the bedroom or even night time with difficulties sleeping becomes stronger and harder to reverse even with CBTi.

I will share this post with Roisin. Maybe there is still hope for her if she tries CBTi. I will let you know if she replies and what she says.

In the meantime, please share your thoughs and experiences with insomnia here. And please please tell people you know that have insomia about CBTi.