What are the clinical benefits of cognitive behavioural therapy for insomnia

CBT-I is the preferred first-line treatment for adults with chronic insomnia because its benefits persist after treatment ends, whereas pharmacological therapy should be avoided for long-term management. NICE CKS

• Durable benefit: CBT-I produces benefits that persist after completion, unlike medication. NICE CKS
• Appropriate across adulthood: CBT-I is recommended for chronic insomnia in adults of any age, including via the NICE-recommended digital CBT-I programme Sleepio. NICE CKS
• Avoids long-term hypnotic exposure: NICE advises avoiding pharmacological therapy in long-term insomnia management, and hypnotics should be avoided where possible because of their potential for significant adverse effects. NICE CKS
• Addresses maintaining mechanisms: CBT-I is particularly relevant because maladaptive behaviours and cognitions are thought to contribute to chronic insomnia. NICE CKS
• Medication has a limited role: A short course of a non-benzodiazepine hypnotic may be considered only as adjunctive treatment in selected circumstances, rather than as the core long-term treatment for chronic insomnia. NICE CKS
• Consistent with product information: Zopiclone is indicated for short-term treatment, with long-term continuous use not recommended and the lowest effective dose advised. SmPC Zopiclone,SmPC Zopiclone

For primary-care practice, prioritise referral or access to CBT-I, including digital CBT-I where suitable, alongside assessment of comorbid physical or mental health conditions and other sleep disorders that may require targeted management. NICE CKS