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SHUTi: An online insomnia treatment

Cognitive behavioral therapy is the gold standard for insomnia treatment. Now there's an app for it.

Insomnia can be one of the most frustrating experiences of adult life. On top of losing vital sleep, one can feel helpless about how to fall asleep. It leads many patients to our practice, on its own or in combination with other issues. Unfortunately, lasting sleep improvement rarely comes from a magical formula mixed into a pill or a few words bestowed by a provider. Immediate solutions rarely lead to overnight (pun intended) success stories. If this is bad news, don’t worry, there is good to follow. Better sleep is possible, and the odds may be in your favor. You might even reach full remission of symptoms without medications. I have seen this happen for a host of reasons and with a variety of different interventions.

If you have insomnia and are ready to work on it, I encourage you to loosen your current beliefs about sleep, roll up your sleeves, and begin the journey to more restful nights. The first steps start with an evidence-based treatment known as Cognitive Behavioral Therapy for insomnia, or “CBTi.” CBTi is recommended as a first-line intervention by the The American College of Physicians. It’s also endorsed by the American Academy of Sleep Medicine. I feel very comfortable recommending it as a great place to start. Our goal is to create a foundation that leads to healthy ways of thinking about sleep and better bedtime practices for you. CBTi will get you started in that direction!

Below are the five basic tenets of CBTi, with brief explanations:

Stimulus Control: Lying in bed worrying about falling asleep only makes things worse! Don’t keep associating anxiety with your bed! This module looks at different ways to fix this problem.

Sleep Restriction: There are simple rules of thumb that affect how efficiently we sleep. Sleep restriction techniques improve sleep efficiency by minimizing time spent lying around awake.

Sleep Hygiene: There are many amazingly helpful tips and tricks to help increase your likelihood of falling asleep. One example is no Starbucks lattes at bedtime!

Cognitive Restructuring: Feeling helpless and demoralized about sleep won’t help you. Don’t be scared by the idea of “restructuring” your behaviors. It’s just a fancy word to help you feel more confident about sleep!

Relapse Prevention: This wraps up the CBTi package by reviewing essential skills you have learned, all of which can be used again if your insomnia returns.

I will save a full blog explaining these tenets in more detail for some future post, but hopefully, these teasers give you an idea of the essential elements of CBTi. Now, let me introduce SHUTi, a well-studied online CBTi solution. Studies show that when compared to face-to-face CBTi, SHUTi reaps similar benefits. The latest review in the January 2017 issue of JAMA Psychiatry demonstrates durable, long-term results.

SHUTi is evidenced-based and efficient. It enables clients to address their sleep issues at home and integrate them into therapy with their providers.

SHUTi is available to anyone on the web for a reasonable cost and was introduced at Pondworks in the first quarter of 2018. It makes sense for our practice on several fronts. First, it has a well-studied positive effect on insomnia when used independently, without face-to-face CBTi treatment. Second, it will allow your Pondworks therapist to carve out a portion of your visit for sleep therapy. Remember, if your provider were to do this work in face-to-face sessions, he or she would need 6-to-12 sessions devoted entirely to sleep. My hope is SHUTi will free up vital time in each therapy session and allow pursuit of other aspects of psychotherapy.

Sleeping better is an integral part of our emotional well being. Whether insomnia is your primary reason for seeking treatment or just part of an overall treatment plan, SHUTi offers a convenient and efficient way to address it.

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