News Release

Drug-free sleep solution: CBT effective for chronic insomnia

Embargoed news from Annals of Internal Medicine

Peer-Reviewed Publication

American College of Physicians

1. Drug-free sleep solution: Cognitive behavior therapy effective for chronic insomnia

Talk-based therapy addresses the root cause of insomnia, improves sleep without side effects

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An evidence review published in Annals of Internal Medicine finds that patients with chronic insomnia who undergo cognitive behavior therapy (CBT) can improve sleep without drugs and without adverse outcomes. According to the authors, CBT works because it addresses the process that drives insomnia - anxiety about time spent awake in bed.

Clinical chronic insomnia affects up to 15 percent of adults and is associated with health issues such as anxiety, depression, and type 2 diabetes. Pharmacological approaches to treating insomnia are associated with tolerance, dependence, and adverse side effects, which makes talk-based therapy an appealing option for appropriate patients.

Researchers reviewed 20 published randomized controlled trials assessing the efficacy of face-to-face, multi-component CBT on overnight sleep in adults with chronic insomnia and no underlying medical causes. They found that CBT helped patients enter sleep about 20 minutes faster, reduced the amount of time spent awake after falling asleep by nearly 30 minutes, and improved sleep efficiency by almost 10 percent. Study authors say that these findings are important because the psychological approach is safer and better tolerated than medication and teaches skills that can be maintained over time. They note that this approach takes significant effort from the patient compared to taking a pill.

CBT for insomnia includes five specific components that work together to change a patient's thoughts and activities around sleep and their sleep environment. Cognitive therapy aims to identify, challenge, and replace dysfunctional beliefs and attitudes about sleep; stimulus control helps strengthen the association between bed and sleep; sleep restriction limits time spent in bed; sleep hygiene recommendations address environmental factors, physiologic factors, behavior, and habits that promote sound sleep; and relaxation techniques help to limit cognitive arousal and reduce muscular tension to facilitate sleep.

The author of an accompanying editorial notes that CBT is unfamiliar and underused by medical practitioners. More research is needed to determine if CBT for insomnia can improve the negative health outcomes associated with chronic insomnia.

Notes: For an embargoed PDF, please contact Angela Collom at The lead authors of this study can be contacted directly via email or cell. Dr. David Cunnington can be reached at or +61 438 576 112. Dr. James Trauer can be reached at Both are located at the Melbourne Sleep Disorders Centre in East Melbourne, Australia. Dr. Cunnington will be in Seattle beginning on June 5 for SLEEP 2015. The editorialist, Dr. Charles Morin, can be reached directly via email at Dr. Morin is located at Laval University in Quebec City, Quebec.

2. Lyme disease not the only reason to avoid tick bites

Newly recognized tickborne illness becoming more common in northeastern U.S.

July and August may be particularly risky months for infection

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An emerging tickborne infection that causes severe illness may not be rare in the northeastern United States. Borrelia miyamotoi disease (BMD) was first reported in the region in 2013 and its prevalence in host-seeking deer ticks is enough that human exposure is likely. Since symptoms are nonspecific, the illness may not be differentiated from other tick-transmitted diseases.

The authors of a case series being published in Annals of Internal Medicine describe the clinical spectrum and laboratory findings for 51 case patients out of 97 identified has having active BMD infection. Symptoms varied, but physicians were struck by the severity of sickness frequently seen in these patients. Severe headache was common, as were high fever, chills, myalgia, and abnormal blood cell and platelet counts. The authors note that many cases presented in July and August, suggesting transmission by larval ticks, which have their peak activity during these months. They conclude that infection with BMD should be considered in areas where deer tick-transmitted infections are endemic.

Note: This article is accompanied by editorial comment For an embargoed PDF of the article or editorial, or to arrange an interview, please contact


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