Insomnia 1991-2021 How treatment has changed.
V
iews on insomnia and "trouble sleeping" have undoubtedly changed throughout the past few decades. As it became more culturally acceptable to talk about insomnia, treatments began being requested. Three World Sleep Society sleep experts have watched the field grow, expand and change from the 90s to today.
From "Z Drugs" to CBT-I For 44 years, Clete A. Kushida, MD, PhD has been working in the field of sleep medicine and research. Currently acting as Associate Chair, Division Chief and Medical Director of Stanford Sleep Medicine, he began working in the realm of insomnia in 1991. “Starting in July of 1991, I was a neurology resident at the University of California San Diego,” Dr. Kushida recalls. “I was fortunate in being able to evaluate sleep medicine patients under the supervision of Dr. Sonia Ancoli-Israel. At that time, many of the patients I saw with Dr. Ancoli-Israel were managed for their insomnia with antidepressants and benzodiazepines, including triazolam (Halcion).” In 1992, the FDA 4 | July/August 2021
approved Zolpidem (Ambien) and it was the first of the "z drugs" (zolpidem, zopiclone, zaleplon) that rapidly became the first-line pharmacologic treatment for short-term insomnia. “Since that time,” Dr. Kushida explains, “there have been other pharmacologic treatments for short-term insomnia, including ramelteon and suvorexant. However, the most important treatment for insomnia that has grown during the last two decades is cognitive behavioral therapy for insomnia (CBT-I), which has helped countless individuals with chronic insomnia.”
WHAT IS CBT-I? Cognitive behavioral therapy for insomnia is a course of therapy that runs 6, 8 or 10 weeks in length. Around 70-80% of patients will benefit from CBT-I and up to 50% can experience a full remission of insomnia symptoms.
