The Current State of Insomnia Care According to Neomi Shah, MD

Neomi Shah, MD, MPH, MSC

According to Neomi Shah, MD, MPH, MSC, System Vice Chair of Medicine for Faculty Affairs, Department of Medicine, Mount Sinai, the current state of care for insomnia is suboptimal. However, online tools for cognitive behavioral therapy (CBT) for patients with insomnia have advanced within the last year.

Cognitive behavioral therapy is a psychological treatment that's used for a wide spectrum of conditions. With the guidance from a mental health couneslor, CBT can help patients to become aware of their negative thinking patterns which allows them to view challenges more accurately.

In the written interview with HCPLive, Shah explained that CBT is the primary intervention for patients with insomnia, but there are barriers to implementing this approach.

"Most institutions do not have psychologists as part of a multidisciplinary sleep team primarily because payors do not cover for CBT-I," she wrote. "This remains the biggest barrier to provide evidence based care for our insomnia patients and it leads to increased use of medications for insomnia which is not the recommended primary monotherapy for insomnia."

In addition to improved access to behavioral treatment for insomnia, the impact of irregular and short sleep duration on mental health and cardiovascular outcomes warrants more attention in 2023, Shah stated.

A specific aspect of this that poses a major problem is the early school start times for adolescents.

One effective way for patients to improve insomnia symptoms, is to make some adjustments to their lifestyle based on recommendations from their physician. While these changes don't always come easily or quickly everyone, there are multiple benefits.

"Lifestyle changes are always more important than medications in sleep medicine, especially for long-term impact without side effects," Shah explained. "The overall receptiveness of the vast majority of patients for this is great. We just need to have time to explain this to the patient and then provide resources that can help the patient make the changes."

Sleep health impacts various aspects of an individual's well-being, and should be addressed more frequently in the primary care setting. Shah shared advice on how to improve screening practices for insomnia.

"Ask about sleep duration (most adults need 8 hours of sleep per night), ask about sleep timing (ensure they are sleeping in alignment with their circadian rhythm), and instead of prescribing sleeping aids, look for correctable etiologies that are usually related to behavioral and mental health."