[Insomnia: cognitive behavioral therapy better than pills]

Chronic insomnia is a common condition that significantly burdens patients and increases the risk of various comorbidities. Cognitive Behavioral Therapy for Insomnia (CBT-I) is the recommended first-line treatment and has shown strong, long-lasting effects with fewer side effects compared to medication. This article presents a representative case study of a woman with long-term insomnia,illustrating the core components and practical implementation of CBT-I, including the combination with medication tapering. CBT-I targets the maintaining factors of insomnia through behavioral techniques (e.g. sleep restriction) and cognitive interventions, and restoring daytime balance. Up to 80% of patients experience clinically relevant improvements, even with comorbid conditions. In contrast, sleep medications like temazepam or zolpidem should be used cautiously, for no longer than 2-4 weeks. CBT-I leads to more sustainable outcomes and supports patient autonomy. Wider implementation in clinical practice is hindered by limited awareness, access, and reimbursement, despite strong evidence for its effectiveness.