Counting Sheep

Psychiatric TimesVol 38, Issue 12 Sleep Supplement

How can cognitive behavioral therapy improve outcomes for individuals with insomnia?

Marc/Adobe Stock

Marc/Adobe Stock

Jade Wu, PhD, of Duke University School of Medicine, presented on the impact of sleep-wake disorders on mental health at the 2021 Neuroscience Education Institute Congress.

In “Counting Sheep: Improving the Recognition and Management of Insomnia,” she discussed the neurobiology of sleep and its importance; evidence-based strategies for improving the diagnosis of sleep-wake disorders such as insomnia; and how these strategies can be applied to help promote healthy sleep.

First-line treatment, said Wu, is cognitive behavioral therapy for insomnia focused on encouraging behavioral changes (eg, controlling stimuli, maintaining a consistent sleep-wake schedule); cognitive changes (eg, challenging unhelpful thoughts, correcting misconceptions about sleep); and other practices such as self-monitoring and mindfulness. She also recommended common US FDA-approved pharmacological agents that are indicated specifically for insomnia, including estazolam, quazepam, eszopiclone, and zaleplon.1

Improving recognition and management of insomnia is important because the problem is so widespread. According to Wu, about 5% to 15% of adults meet the diagnostic criteria for insomnia, but between 35% and 50% of adults have significant insomnia symptoms. In addition, individuals with insomnia are at increased risk of suicide, drug use, posttraumatic stress disorder, depression, anxiety, and other psychiatric disorders, and physical symptoms like pain may also be exacerbated in individuals with insomnia.1

“When we improve insomnia symptoms, we’re also improving depression and anxiety,” Wu said during her presentation. “We’re reducing inflammation, and just across the board, we’re improving a lot of other psychiatric medical and quality-of-life outcomes like chronic pain, functioning, quality of life—you name it. So, in a way, treating insomnia is like raising the water for all boats.”

A board-certified behavioral sleep medication specialist and researcher at Duke University School of Medicine, Wu’s current research focus is the treatment of sleep disorders in individuals with chronic illness.


1. Wu JQ. Counting sheep: improving the recognition and management of insomnia. Presented at: 2021 Neuroscience Education Institute Congress; November 4, 2021; Colorado Springs, CO.

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