CBT-I works for '70% of patients' — the Headspace Sleep Advisor on therapy for insomnia
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According to the American Academy of Sleep Medicine, 12% of US adults are diagnosed with chronic insomnia, a disorder that makes falling asleep and staying asleep difficult.
While treatment for insomnia can include medication, more and more people are turning to CBT-I (Cognitive Behavioral Therapy for Insomnia). This form of therapy is designed to address the root factors contributing to insomnia, rather than just medicating symptoms.
But how effective is it? We spoke to Dr Aric Prather, Sleep Advisor to wellness app Headspace, and the Director of the Behavioral Sleep Medicine Research Program at the University of California at San Francisco, to find out more following the launch of Headspace's new CBT-I sleep programme Finding Your Best Sleep. Here's what he told us...
"Cognitive Behavioral Therapy for Insomnia (CBT-I) is the gold-standard empirically supported treatment for insomnia, and should be the first line treatment for individuals with insomnia before embarking on pharmacologic treatment," says Dr Aric.
CBT-I also addresses the anxiety that develops with unpredictable sleep
"Unlike hypnotic medication, CBT-I addresses the perpetuating factors that drive insomnia, and provides the patient with science-backed strategies to improve sleep by consolidating sleep and entraining their circadian rhythm.
"CBT-I also addresses the anxiety that develops with unpredictable sleep by incorporating relaxation techniques and psychological strategies like cognitive restructuring.
"The goal is to help patients better regulate their sleep, find some success in sleeping, and build confidence and resilience."
"CBT-I focuses specifically on sleep and insomnia symptoms. Unlike other CBT therapies, CBT-I is heavily behavioral. We know quite a bit about what regulates our sleep biologically, so that's where we start.
"Focusing on standardizing someone's wake up time, implementing stimulus control to reduce cognitive arousal in bed, and tracking sleep behavior via a sleep diary followed by restricting their time in bed to increase sleep consolidation can go a long way towards increasing the predictability at nighttime and reducing anxiety prior to and during the night."
"CBT-I can certainly improve anxiety symptoms. In fact, several clinical trials demonstrate that individuals randomized to CBT-I show significant reductions in anxiety symptoms compared to those randomized to control conditions.
"This isn't surprising given that poor sleep often leaves people more 'on edge' and anxious. Headspace also offers a guided program specifically for anxiety and depression, the CBT for Anxiety & Depression program, which incorporates CBT techniques specific to improving anxiety and depression symptoms.
"The course has been shown to decrease anxiety & depression symptoms, improve sleep quality and positively impact mental health and wellbeing (results currently being prepared for peer review)."
"Some people tend to benefit more from CBT-I than others, though much more research is needed to clarify these differences.
There is little downside [to CBT-I], and it's likely to provide you with a greater sense of control over your sleep
"There is some evidence that shorter sleepers with insomnia- those sleeping less than six hours, for example- may struggle with CBT-I more than longer sleepers.
"This is likely because one of the active mechanisms for why CBT-I is effective is through time in bed restriction, which may not be as powerful in those already getting little sleep.
"In my clinical experience, CBT-I may also be less effective in individuals with complex psychiatric or medical presentations.
"In some cases there may be conditions or medications that are impacting sleep where CBT-I may not completely resolve the sleep concern."
"While CBT-I remains the gold standard for treating insomnia, it isn't always accessible. Headspace's sleep course 'Finding Your Best Sleep' was created to expand low-cost access to effective sleep support.
Unlike sleep medications, CBT-I does not carry any long term risk
"The course expands access to proven sleep support by offering expert-led, self-guided sessions that can be completed anytime, anywhere. Included with a Headspace membership, it offers flexibility and affordability—removing common barriers to care.
"The course has been clinically proven to improve insomnia after practicing just 10 minutes a day over the course of 18 days.
"I hope that anyone who is struggling with insomnia will consider a trial of CBT-I in any way that is accessible to them. There is little downside, and is likely to provide you with a greater sense of control over your sleep experience.
"Unlike sleep medications, CBT-I does not carry any long term risk. Moreover, the strategies learned through CBT-I can be useful well into the future and sleep changes as our lives unfold."
"My suspicion is that stress and feelings of uncertainty are the most likely culprits of insomnia. For so many- too many- we feel like we are in a state of hypervigilance, and this results in nights of disturbed sleep.
In turn, we often lack the emotional resources to deal with the stressors the following day, leading to yet another night of poor sleep.
Thankfully, programs like CBT-I can help provide a roadmap to better regulate our sleep, and when coupled with stress management strategies, can help us cope with this stressful world."
"First, I would say that they are not alone. In fact at least 30% of adults, if not more, are not getting adequate sleep. The second piece of advice is to take stock of your sleep life. Is it that you are getting sleep but don't feel refreshed?
At least 30% of adults, if not more, are not getting adequate sleep
"Is something disrupting your sleep? Are you so pressed for time that you are not giving yourself enough opportunity? The answer to these questions will lead to different solutions.
"If you are worried about your sleep, the first step could be to talk to your doctor to make sure that you don't have a sleep disorder, like sleep apnea, disrupting your sleep.
"If not and you're looking for a personalised approach, consider trying CBT-I through a sleep specialist, I always suggest that people explore the Society for Behavioral Sleep Medicine directory to find someone in their region."
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CBT-I works for '70% of patients' — the Headspace Sleep Advisor on therapy for insomnia
When you buy through links on our articles, Future and its syndication partners may earn a commission. According to the American Academy of Sleep Medicine, 12% of US adults are diagnosed with chronic insomnia, a disorder that makes falling asleep and staying asleep difficult. While treatment for insomnia can include medication, more and more people are turning to CBT-I (Cognitive Behavioral Therapy for Insomnia). This form of therapy is designed to address the root factors contributing to insomnia, rather than just medicating symptoms. But how effective is it? We spoke to Dr Aric Prather, Sleep Advisor to wellness app Headspace, and the Director of the Behavioral Sleep Medicine Research Program at the University of California at San Francisco, to find out more following the launch of Headspace's new CBT-I sleep programme Finding Your Best Sleep. Here's what he told us... "Cognitive Behavioral Therapy for Insomnia (CBT-I) is the gold-standard empirically supported treatment for insomnia, and should be the first line treatment for individuals with insomnia before embarking on pharmacologic treatment," says Dr Aric. CBT-I also addresses the anxiety that develops with unpredictable sleep "Unlike hypnotic medication, CBT-I addresses the perpetuating factors that drive insomnia, and provides the patient with science-backed strategies to improve sleep by consolidating sleep and entraining their circadian rhythm. "CBT-I also addresses the anxiety that develops with unpredictable sleep by incorporating relaxation techniques and psychological strategies like cognitive restructuring. "The goal is to help patients better regulate their sleep, find some success in sleeping, and build confidence and resilience." "CBT-I focuses specifically on sleep and insomnia symptoms. Unlike other CBT therapies, CBT-I is heavily behavioral. We know quite a bit about what regulates our sleep biologically, so that's where we start. "Focusing on standardizing someone's wake up time, implementing stimulus control to reduce cognitive arousal in bed, and tracking sleep behavior via a sleep diary followed by restricting their time in bed to increase sleep consolidation can go a long way towards increasing the predictability at nighttime and reducing anxiety prior to and during the night." "CBT-I can certainly improve anxiety symptoms. In fact, several clinical trials demonstrate that individuals randomized to CBT-I show significant reductions in anxiety symptoms compared to those randomized to control conditions. "This isn't surprising given that poor sleep often leaves people more 'on edge' and anxious. Headspace also offers a guided program specifically for anxiety and depression, the CBT for Anxiety & Depression program, which incorporates CBT techniques specific to improving anxiety and depression symptoms. "The course has been shown to decrease anxiety & depression symptoms, improve sleep quality and positively impact mental health and wellbeing (results currently being prepared for peer review)." "Some people tend to benefit more from CBT-I than others, though much more research is needed to clarify these differences. There is little downside [to CBT-I], and it's likely to provide you with a greater sense of control over your sleep "There is some evidence that shorter sleepers with insomnia- those sleeping less than six hours, for example- may struggle with CBT-I more than longer sleepers. "This is likely because one of the active mechanisms for why CBT-I is effective is through time in bed restriction, which may not be as powerful in those already getting little sleep. "In my clinical experience, CBT-I may also be less effective in individuals with complex psychiatric or medical presentations. "In some cases there may be conditions or medications that are impacting sleep where CBT-I may not completely resolve the sleep concern." "While CBT-I remains the gold standard for treating insomnia, it isn't always accessible. Headspace's sleep course 'Finding Your Best Sleep' was created to expand low-cost access to effective sleep support. Unlike sleep medications, CBT-I does not carry any long term risk "The course expands access to proven sleep support by offering expert-led, self-guided sessions that can be completed anytime, anywhere. Included with a Headspace membership, it offers flexibility and affordability—removing common barriers to care. "The course has been clinically proven to improve insomnia after practicing just 10 minutes a day over the course of 18 days. "I hope that anyone who is struggling with insomnia will consider a trial of CBT-I in any way that is accessible to them. There is little downside, and is likely to provide you with a greater sense of control over your sleep experience. "Unlike sleep medications, CBT-I does not carry any long term risk. Moreover, the strategies learned through CBT-I can be useful well into the future and sleep changes as our lives unfold." "My suspicion is that stress and feelings of uncertainty are the most likely culprits of insomnia. For so many- too many- we feel like we are in a state of hypervigilance, and this results in nights of disturbed sleep. In turn, we often lack the emotional resources to deal with the stressors the following day, leading to yet another night of poor sleep. Thankfully, programs like CBT-I can help provide a roadmap to better regulate our sleep, and when coupled with stress management strategies, can help us cope with this stressful world." "First, I would say that they are not alone. In fact at least 30% of adults, if not more, are not getting adequate sleep. The second piece of advice is to take stock of your sleep life. Is it that you are getting sleep but don't feel refreshed? At least 30% of adults, if not more, are not getting adequate sleep "Is something disrupting your sleep? Are you so pressed for time that you are not giving yourself enough opportunity? The answer to these questions will lead to different solutions. "If you are worried about your sleep, the first step could be to talk to your doctor to make sure that you don't have a sleep disorder, like sleep apnea, disrupting your sleep. "If not and you're looking for a personalised approach, consider trying CBT-I through a sleep specialist, I always suggest that people explore the Society for Behavioral Sleep Medicine directory to find someone in their region."
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HIV/AIDS: Facts about the viral infection that attacks the immune system
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This loss of immune protection leaves the person vulnerable to deadly infections and cancers. Although an HIV diagnosis was once a death sentence, scientists have developed treatments that suppress the virus and enable people to live long lives without transmitting the disease to others. Additionally, there are now effective preventive medications that can dramatically reduce the risk of getting HIV in the first place. There is not yet a widespread cure for HIV/AIDS, although a handful of people have been cured of the infection or are in long-term remission thanks to special stem-cell transplants, specially cell transplants from people who have genes that make them resistant to the virus. Scientists are exploring potential avenues for a cure, which could someday mean that people who contract HIV could be rid of the infection rather than having to take medication for life to manage the disease. HIV/AIDS remains a major public health threat worldwide, with an estimated 39.9 million people living with the disease at the end of 2023. Around 630,000 people died from illnesses related to AIDS the same year; by weakening the immune system, AIDS opens the door to these fatal diseases. HIV can spread through contact with an infected person's bodily fluids, although it's important to note that not all bodily fluids can transmit the virus. Bodily fluids that can spread HIV include blood, semen, preseminal fluid, vaginal secretions, breastmilk and rectal discharge (liquid from the anus that's not blood or stool). HIV is not transmitted through saliva, sweat or tears. It's also not spread through the air or through casual contact, such as hugging, shaking hands or sharing food. For transmission to occur, the bodily fluids containing HIV must come into contact with mucous membranes — tissues that line cavities in the body, like the vagina, anus or mouth. 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The symptoms of HIV vary depending on how far the disease has progressed. The virus can spread from one person to another at any stage of the infection, unless the infected person is taking ART and has reached "viral suppression" (see glossary). The initial stage is called "acute HIV infection." Within two to four weeks of contracting the virus, many people develop a flu-like illness involving symptoms like fever, headache, rash and sore throat. These symptoms can last from a few days to a few weeks. Some people have no symptoms at this stage, however. The viral load, or amount of HIV in the blood, at this stage is very high. The second stage of the disease is "chronic HIV infection," during which the virus continues to multiply but at a slower speed than during acute infection. This stage is also called "clinical latency" or "asymptomatic HIV infection," as many people don't feel sick during it. 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Different ART drugs work in different ways to keep the amount of virus, or viral load, in check. They are available as daily pills or as shots given periodically throughout the year, depending on the person's treatment plan. It's key for patients to take their medication as prescribed, because missing pills or shots can open the door for the virus to multiply, as well as develop drug resistance, which causes the medication to work less well. ART medications can also interact with other drugs and carry some risk of serious side effects, so patients work with their medical providers to figure out which drug combination is best for them. The goal of ART is "viral suppression," which describes when a person's viral load falls low enough that there are 200 or fewer copies of the virus's genetic material per milliliter (mL) of blood. Historically, tests weren't sensitive enough to detect levels of HIV below that threshold, so doctors called this level "undetectable." Studies also found that people who reach viral suppression can't transmit the virus via sex; have a lower chance of spreading the virus through pregnancy, childbirth or breastfeeding; and likely have a lower chance of spreading it through needle sharing. This is why the slogan "undetectable equals untransmittable," or "U = U," was coined. Nowadays, some tests for HIV are extremely sensitive, so they can detect viral loads significantly below 200 copies/mL. However, experts emphasize that 200 copies/mL is still the critical threshold at which transmission risk becomes extremely low. If a person with HIV/AIDS develops another medical condition, such as an AIDS-defining illness, the individual would receive treatment for that condition in addition to their ART regimen. There is no widespread cure for HIV/AIDS. However, a handful of people have been cured of their HIV infections through stem cell transplants, and a few more are considered "potentially" cured via the same process. Stem cells can develop into different types of cells in the body. In certain cancers that affect blood cells, stem cell transplants can be used to replace the cells lost in the course of cancer treatments such as chemotherapy. Each individual who has been cured of HIV also had one of these cancers, so their doctors searched for stem cell donors who carry a rare gene that makes them resistant to HIV infection. By swapping in cells from an HIV-resistant individual, the procedure essentially locks the virus out of the patient's CD4 cells. There is one exception to this rule: A person known as the "Geneva patient" was potentially cured of HIV after a stem cell transplant, but the donor didn't have this special genetic resistance. It's unclear exactly why the man entered long-term remission from the infection after this procedure, but scientists are investigating. There have also been a couple of cases in which people's own immune systems somehow rallied against the virus and controlled it without treatment; these people are known as "elite controllers." Scientists hope to learn from both the stem cell recipients and from elite controllers to discover cures that could reach far more people with HIV/AIDS. Meanwhile, some researchers are exploring the use of gene-editing tools like CRISPR to cure the infection, while others are investigating the use of drugs and modified immune cells. Antiretroviral therapy (ART) – Combinations of medications that lower the amount of HIV in a person's blood. These drugs, given as pills or shots, prevent the viral infection from progressing to AIDS and dramatically lower a person's risk of complications and of transmitting the virus to others. Pre-exposure prophylaxis (PrEP) – Medicines that people at risk of being exposed to HIV take to prevent the infection. Viral load – The amount of HIV in a person's blood. This is measured in terms of the number of HIV RNA molecules — the virus's genetic material — found in a milliliter of blood. It's an important way to measure how well ART is working. Viral suppression – When a person's viral load falls to 200 copies/mL or lower. Viral suppression is the goal of ART, as it both lowers a person's likelihood of spreading the virus and extends their lifespan by preventing the infection from progressing to AIDS. CD4 T lymphocyte – A type of white blood cell that helps coordinate the actions of other immune cells to fight infections. HIV infects CD4 cells and uses them to multiply while the virus depletes the number of CD4 cells in the body. Image 1 of 4 In the 1980s and 1990s, groups organized "die-ins" to protest the lack of U.S. government attention to the ongoing HIV/AIDS crisis. Die-ins were also conducted to push for support for research to uncover effective treatments and, once treatments were discovered, to demand that those drugs be released to the public. The AIDS Coalition to Unleash Power — known as ACT UP — was a major force behind such protests and remains an active organization today. Image 2 of 4 Kaposi's sarcoma, an example of an AIDS-defining illness, characteristically causes big, purple patches or nodules to appear on the skin and mucous membranes. Image 3 of 4 The public health slogan "U = U," depicted on this sign, refers to the fact that people living with HIV who have undetectable viral loads cannot transmit the virus to others via sex. It stands for "undetectable = untransmittable." Image 4 of 4 The "Berlin patient," pictured here, was the first person cured of HIV via a stem cell transplant. His name was later revealed to be Timothy Ray Brown. Brown went on to launch a foundation under his name that was dedicated to fighting HIV/AIDS. 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Major new study reveals jobs with the highest depression rate in the US
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