Is it time to get some SHUT-i?

There are four central things that are well known about insomnia which together highlight it as a serious public health concern: (I) it is a significant issue - over a third of the population will experience an acute episode (less than three months in duration) of insomnia every year (1) and between 10–20% of the population will report chronic insomnia (Insomnia Disorder) at any point in time (2); (II) once chronic, it is a persistent disorder with low natural remission rates and high recurrence rates (3,4), (III) it is costly both directly (in terms of healthcare costs) and indirectly (e.g., lost productivity and performance, accidents) (5) and (IV) it is a significant risk factor for the development and/or worsening of many physical or psychiatric disorders (6). Fortunately, as our understanding of insomnia has increased so has our armoury of management strategies. Most notably, at least from a non-pharmacological perspective, has been the introduction of a series of techniques aimed to increase the biological drive to sleep, stabilise the circadian rhythm and break negative, whilst reinforcing positive, associations between the bed/bedroom and sleep (addressing the behavioural aspects of insomnia) and help manage sleep related preoccupation, worry and anxiety, and address dysfunctional attitudes and beliefs about sleep and unwanted nocturnal ruminations (addressing the cognitive aspects of insomnia). Over time these techniques have been packaged together, under an umbrella term, of what is now considered Cognitive Behavioural Therapy for Insomnia (CBT-I).