How CBT-I compares to sleep medication for better sleep 

To begin, it would be helpful to define insomnia, since prescriptions for sleep medication are often provided to people experiencing this condition. Insomnia is generally characterized as a sleep disturbance manifested as difficulty falling asleep, staying asleep, or waking up earlier than intended. These sleep disturbances are further associated with significant distress and daytime impairments like fatigue or irritability. Insomnia can be acute (i.e., short-term, or lasting a few days or weeks), or chronic (i.e., lasting three months or longer, and sometimes for several years).

For the most part, we tend to tolerate acute episodes of insomnia. Most of the population will experience these short-term sleep disturbances at some point in their lives. However, when insomnia becomes chronic, worries about one’s health can begin to emerge, leading to heightened distress that can end up making sleep worse. Further, symptoms like daytime fatigue and irritability can be linked to insomnia, which can start to affect our social and occupational functioning in negative ways. At this point, most people will reach out to their family doctor, who may prescribe sleep medications.

Sleep medications that are prescribed for insomnia are often sedative in nature and focus on targeting symptoms. Potential benefits include quick symptom relief, reduced anxiety about sleep, and the utility for transient periods of sleep disruption, such as when experiencing jet lag or going through stressful life events. Drawbacks for their prolonged use include increased tolerance, dependence, and side effects like daytime drowsiness or cognitive impairment. Sleep medications also don’t address the underlying causes of insomnia, so sleep often worsens once the medication is stopped.

On the other hand, Cognitive Behavioural Therapy for Insomnia (CBT-I), is a structured and evidence-based approach that is considered the gold-standard and first-line treatment for insomnia due to the likelihood of long-term improvements to sleep, no side effects, and addressing of the underlying causes of insomnia. The primary aims of CBT-I are to target thoughts and behaviours that maintain insomnia, promoting behaviour change strategies and reducing the struggle to fall asleep. Commonly cited drawbacks can include the increased time, effort, and commitment required for treatment, and difficulties with accessing trained providers.

Research shows that CBT-I is equally or more effective than medications in the short-term, and more effective over the long-term due to durable and lasting treatment effects. While medications can provide immediate relief, CBT-I leads to more sustainable improvements in sleep with fewer risks and no side effects. Further, medications can lose their effectiveness over time, whereas CBT-I tends to build sustainable skills.

Choosing the right approach must take into consideration factors like the severity of one’s insomnia, access to treatment, co-occurring conditions (e.g., depression, anxiety, PTSD), and personal preference. Short-term medication may be appropriate in certain cases, such as when experiencing acute stress or travelling. Some may even benefit from the combined use of short-term medications and CBT-I. Many people can gradually taper off sleep medications while progressing through CBT-I, often with support from their prescribing physician and CBT-I trained therapist.

If sleep difficulties persist for more than a few weeks, begin affecting your mood, energy, or daily functioning, it may be time to seek support. Chronic insomnia rarely resolves on its own, but effective, evidence-based treatments like CBT-I can help you regain restful, consistent sleep. Whether you’re currently using sleep aids or just starting to explore your options, reaching out for help is a meaningful first step toward better sleep and improved wellbeing.