Derek Loewy

Title : The utility of cognitive behavioral therapy for insomnia CBTI in reducing sleep medication usage

Abstract:

For many years, the most common medical treatment for chronic insomnia has been sedative hypnotic drugs. Chief among these have been benzodiazepines and the so called “non-benzodiazepine” drugs (i.e., zolpidem, eszopiclone) which act more selectively on GABA receptors. Other off-label sedating agents have also been employed (i.e., trazodone, amitriptyline). Studies have shown that GABA agonists are associated with adverse short to medium term adverse events such as side effects, tolerance and physical dependence, when used for an extended period. More recent findings suggest these drugs are also associated with longer term health consequences such as dementia, increased cancer risk, and decreased mortality. Moreover, the risk for unintentional opioid overdose increases significantly when used in combination with benzodiazepines. A safe and effective alternative treatment for chronic insomnia is cognitive behavioral therapy for insomnia (CBTI). CBTI is comprised of an array of techniques designed to enhance natural sleep propensity by increasing homeostatic sleep drive, modulating the sleep-wake circadian rhythm, and countering conditioned arousal and anxiety which often interfere with effective wake to sleep transitions. The efficacy of CBTI has been demonstrated in numerous randomized, controlled studies. CBTI has greater long term benefit than sedative hypnotics. In 2016, CBTI was recognized by the American College of Physicians as the preferred first line treatment for chronic insomnia. CBTI is a highly effective stand-alone treatment for insomnia and can also serve as a useful therapy to support the tapering and discontinuation of sleep medications. The process of sleep medication discontinuation can be challenging to physicians and unpleasant for patients, often leading to failure. Data will be presented showing the effectiveness of CBTI in reducing sleep medication usage in a complex clinical population.

Biography:

Dr. Loewy is a clinical psychologist with board certifications in Sleep Medicine and Behavioral Sleep Medicine. He received his doctorate in psychology at the University of Ottawa, Canada in 1996. He completed a post-doctoral research fellowship on the psychophysiology of insomnia at the University of Arizona in 1999. He completed his fellowship in Sleep Medicine at the Stanford Sleep Center in 2001, during which time he co-founded the Stanford Insomnia Program. He is presently the Director of Behavioral Sleep Medicine at the Scripps Clinic Sleep Center and Insomnia Specialist at BetterNight© Medical Group in San Diego, California.