CBT for Insomnia - Insurers

2.5% of health plan members fill at least one hypnotic prescription annually. Since non-hypnotics (Trazodone, Xanax, Ativan, Klonopin) are prescribed 2 to 1 to recognized hypnotics, a total of 7.5% of plan members use a prescription medication for insomnia annually. Many sleep medications are used nightly and, since 2/3 of patients use them for more than a year and 1/3 use them for more than 5 years, annual insomnia medications costs are significant. At an average price of $1/pill, insomniacs who take sleeping pills nightly cost an insurer $500/year including one PCP visit excluding specialists, lab tests, and psychology/psychiatry visits.

Cognitive behavioral therapy for insomnia (CBT-I) is now recommended as the first line treatment for chronic insomnia. In all three studies that directly compared CBT-I to sleeping pills, CBT-I was more effective. Meta-analyses show that CBT-I helps people fall asleep faster than sleeping pills and that 75% of patients derive significant clinical benefit from CBT-I. CBT-I also eliminates sleep medication use in 60% of long-term nightly users (Morin et al., Am. J. of Psychiatry, 2004) and reduces or eliminates sleep medication in 90% of patients (Jacobs et al., Am. J. of Med.,1996). Most sleeping pills are no longer considered a safe or appropriate treatment for chronic insomnia because they can have significant side effects that far outweigh their benefits, are only moderately effective for insomnia subjectively, and objectively are no more effective than a placebo.

Despite the superiority of CBT-I to sleeping pills, and its efficacy in reducing or eliminating sleeping pills, CBT-I -I has not been widely available as a first-line treatment for chronic insomnia for numerous reasons. These include lack of availability in sleep clinics; lack of clinicians trained in CBT-I; lack of awareness by physicians and patients; and, cost, time, and inconvenience. As a result, a major paper in the journal Sleep recently suggested that self-help and online CBT-I should be the first-line treatment for insomnia. Recent randomized published clinical trials demonstrate that online CBT-I is highly effective and may be as/more effective than face-to-face CBT-I. One study showed that 81% of insomnia patients improved with online CBT-I. (Sleep, 2009). A second study funded by the National Institutes of Health showed that 75% of patients eliminated insomnia altogether, and increased total sleep time by an hour, with online CBT-I. (Archives of General Psychiatry, 2009). A third study showed that CBT-I delivered via PDF treatment sessions is effective for insomnia. (Sleep, 2011). Additionally, recent studies demonstrate that CBT can be delivered inexpensively and effectively in self-help (book, DVD, CD) formats.

Dr. Gregg D. Jacobs’s gold-standard Conquering Insomnia program makes CBT-I available in online, self-help formats. It is based on 20 years of research and clinical practice at the Harvard and U. of Massachusetts Medical Schools involving 10,000 insomnia patients and a study at Harvard, funded by the National Institutes of Health, demonstrating that this CBT-I insomnia program is more effective than Ambien. The Conquering Insomnia program, which includes PDF and MP3 versions and QA with Dr. Jacobs, is a five week, five session CBT-I treatment program including sleep medication reduction techniques. It includes individualized weekly email feedback to the user from Dr. Jacobs on an optional weekly and weekly CBT-I goals/guidelines. Resources include an MP3 relaxation file and a library of insomnia focus articles and study reviews.

75% of those using the Conquering Insomnia program report significant improvement in sleep, total sleep time increases from under 6 hours per night to almost 7 hours per night, and 66% reduce their medication by at least 50%. Because many patients take insomnia medications for more than five years, these significant reductions in sleep medications and improvements in sleep result in substantial short-term and long-term savings on sleep medications expenses as well as reduced expenses for psychology visits, lab tests, and specialists.

The Conquering Insomnia program is a standardized, proven CBT-I treatment in a convenient, usable format. It includes objective assessment of positive outcomes and efficacy on sleep parameters and sleep medications, and objective assessment/demonstration of ROI. In comparison, the majority of behavioral health treatments provide none of the preceding advantages and, as a result, often result in no ROI.

Introductory annual license rates for the Conquering Insomnia program start at $3900 for health plans. Contact Dr. Jacobs at info@cbtforinsomnia.com for more information.

1. Jacobs G.D., et al., Arch Intern Med, 2004; 2.Morin, C. et al., Am. J. of Psychiatry, 2004; 3.Jacobs, GD., et al., Am. J. of Med. , 1996; 4. Espie, C. , Sleep, 2009.; 5. Van Straetn, A., and Cuijpers, P., Sleep Med Rev, 2009.; 6.Ritterband, L.M., et al. Arch Gen Psychiatry. 2009.