ABSTRACT
Insomnia is the complaint of an inability to fall or stay asleep, or unrefreshing sleep. After pain, it represents the second most commonly expressed complaint in clinical settings (Mahowald, Kader, & Schenck, 1997). It is also one of the most commonly encountered and challenging complaints by psychiatric practice. Although a vast array of treatment modalities is available for this malady, individual treatments do not confer absolute benefit for insomnia in all patients. Treatment resistance is noted in more than one third of insomnia patients following the application of standard pharmacological therapies (Mini, Wang-Weigand, & Zhang, 2008). Additionally, insomnia represents a persistent symptom following the management of its comorbidities; for example, nearly half of responders in the pharmacological management of major depression in one study had persistent sleep disturbances (Nierenberg et al., 1999). The persistence of insomnia represents a treatment complication, as it introduces the possibility of polypharmacy and a wider array of side effects, enhances the risk of daytime cognitive and functional impairment, and is associated with a higher risk of relapse, especially in the context of mood disorders. Cognitive behavioral therapies (CBT) have long been known to be effective in the management of insomnia (Morin et al., 2006). This chapter will explore the role of integration of CBT and pharmacotherapy in optimizing the management of insomnia.
