Prise en charge comportementale de l'insomnie chronique

Insomnia is a prevalent complaint in clinical practice. Whether its presentation is as a primary disorder or as a condition comorbid with another medical or psychological disorder, insomnia is often associated with negative consequences impairing quality of life. Although the first line treatment is usually pharmacological in nature, cognitive-behavior therapy (CBT) represents an efficacious and well accepted non pharmacological treatment alternative. This paper summarizes the current status of cognitive-behavior therapy for persistent insomnia. After reviewing key issues to address in the evaluation of insomnia complaints, a brief description of CB1isprovided, with its rationale and indications, followed by a summary of the evidence supporting this therapeutic approach. Clinical data indicate that CBT produces a treatment response in 70% to 80% of patients, with an average 50% to 60% reduction of insomnia symptoms. Although CBT is more time consuming and requires more efforts relative to pharmacotherapy, therapeutic benefits often persist much longer after treatment completion. CBT is indicated for chronic insomnia, both in its primary and comorbid subtypes. Practical recommendations are made to facilitate compliance with treatment and to optimize therapeutic outcomes.