Sleep is associated with physical and mental health as well as overall well-being, making it a crucial factor in maintaining good health. Insomnia is highly prevalent among patients experiencing pain. A bidirectional relationship exists between insomnia symptoms and pain intensity. Interestingly, recent findings suggest that insomnia predicts next-day pain intensity, and that this relationship is stronger than the effect of pain intensity on predicting insomnia. Psychological factors also contribute to insomnia in patients with pain symptoms. Internationally, cognitive behavioral therapy for insomnia (CBT-I) is recommended as the first-line treatment for insomnia. This paper introduces research findings demonstrating the effectiveness of CBT-I within the field of psychosomatic medicine for improving both insomnia and primary symptoms in patients. Based on these findings, I provide suggestions for the application of CBT-I, including personal insights.

Cognitive behavioral therapy (CBT) is useful for treating psychosomatic diseases and has been effective in treating various psychosomatic diseases. In this article, we focused on chronic pain, one of the most common psychosomatic diseases, and discussed the techniques and procedures of CBT used for chronic pain as well as the considerations and innovations necessary to implement effective CBT in patients with psychosomatic diseases. It has also been reported that one out of two patients with chronic pain experiences insomnia, strong pain symptoms affect sleep disorders, sleep disorders affect strong pain symptoms, and chronic pain and insomnia are interrelated. CBT for chronic pain may also include approaches to improve sleep. Therefore, we report how sleep problems can be treated using CBT for chronic pain.

Sleep disturbances have a considerable impact on the exacerbation of both psychological and physical symptoms. Although cognitive behavioral therapy for insomnia has been shown to improve sleep and reduce symptoms, the mechanisms underlying these effects remain insufficiently understood. In this article, we introduce two specific aspects of these mechanisms : (1) the relationship between sleep problems and pain ; and (2) the association between sleep disturbances and food-related impulsivity. First, both acute sleep deprivation and sleep debt can lower pain thresholds. Second, insomnia and chronotype may be associated with increased tendencies toward overeating and food-related impulsivity. These findings highlight the importance of a comprehensive approach aimed at improving insomnia and regulating sleep-wake rhythms to address the related psychological and physical health issues.

A large proportion of patients with psychiatric and certain medical conditions experience comorbid insomnia, characterized by difficulty sleeping at night and daytime functional impairment. Owing to the adverse impact insomnia has on the symptoms of coexisting conditions, it should be regarded as a critical therapeutic target. Cognitive behavioral therapy for insomnia (CBT-I) has been shown to be effective not only for primary insomnia but also for insomnia comorbid with psychiatric and other medical conditions. Furthermore, CBT-I has been demonstrated to lead to reduction in psychiatric symptoms, such as depression and anxiety, and physical symptoms, including pain and fatigue, associated with medical conditions. Therefore, integrating CBT-I with standard treatments for the primary condition may offer major benefits in reducing symptoms related to the primary disorder, enhancing the patients’ quality of life (QOL), and improving long-term treatment outcomes. When implementing CBT-I for comorbid insomnia, it is crucial to assess the underlying factors of insomnia, ensure the stability of the primary condition symptoms, and monitor changes during the intervention.

In recent years, the importance of treatment strategies that consider the “exit” or long-term outcomes has been increasingly emphasized in the management of insomnia. The Japanese clinical practice guidelines recommend sleep hygiene education as a basic intervention, primarily to prevent overreliance on pharmacotherapy. Cognitive behavioral therapy for insomnia (CBT-I) is internationally acknowledged to be safe and effective. Unfortunately, it is not currently covered by the national health insurance system in Japan, which makes full implementation impractical. Nevertheless, key components of CBT-I, including stimulus control and sleep restriction, can be readily integrated into routine clinical practice. Furthermore, in terms of pharmacotherapy, it is important to adopt an individualized approach and choose drugs based on patient characteristics. In this regard, the recent introduction of novel agents, including orexin receptor antagonists, has expanded the range of safe and effective treatment options. This article outlines practical approaches for integrating pharmacological and non-pharmacological strategies to optimize the management of insomnia in everyday clinical settings.

Background and Objectives : A previous study stated that cognitive behavioral therapy (CBT) is not sufficiently disseminated and that Japan exhibits considerable regional disparities in this regard. Thus, in the present study, we aimed to determine the current status of CBT in Japan.

Methods : We used CBT data from the National Database of Health Insurance Claims and Specific Health Checkups from the fiscal year (FY) 2014 (FY2014) to FY2022. We analyzed the number of CBT sessions stratified by year, month, sex, five-year age group, 47 prefectures, and eight regions. Additionally, we calculated the standardized claim ratio (SCR) for the number of sessions to account for age variations among prefectures.

Results : The number of annual CBT sessions decreased from 44,999 in FY2014 to 35,231 in FY2022. In FY2022, the vast majority of CBT sessions were administered by physicians, with only 239 sessions being co-provided by nurses in collaboration with physicians. In FY2022, 63％ of CBT sessions were conducted for female patients, with the therapy being provided more frequently for women than for men in the age groups ≥15 years. Additionally, 64％ of the CBT sessions were administered to patients aged 20-49 years. CBT sessions for patients aged ＜20 and ≥65 years accounted for 13％ and 7％ of sessions, respectively. The highest number of CBT sessions per million members of the general population was observed among women aged 20-24 years (n＝864) and men aged 25-29 years (n＝490). In 14 prefectures, Aomori, Akita, Yamagata, Niigata, Toyama, Fukui, Nara, Yamaguchi, Kagawa, Kochi, Saga, Nagasaki, Oita, and Okinawa, ＜10 CBT sessions were conducted. In FY2022, the highest number of CBT sessions per million individuals of the general population was observed in Okayama (n＝2,834). Among the eight regions, the highest CBT sessions per million of the general population was observed in Chugoku (n＝595) and Hokkaido (n＝37), respectively. The SCR for Tokyo, Osaka, and Miyagi were close to the national average. The SCR was the highest in Okayama (1,029). During FY2020, the number of sessions was the lowest in May (n＝2,509) and highest in March (n＝3,263). Notably, the coronavirus disease 2019 pandemic led to a decrease in the number of monthly CBT sessions.

Conclusions : Although various health policies promoting CBT, including broadening the spectrum of diseases covered by health insurance and delegating CBT to nurses, have been implemented, concerns raised by previous studies persist. Improving the environment and providing physicians and nurses with adequate training are crucial for the widespread dissemination of CBT.