CBT-I vs sleep medication: which works better?
Reviewed by the WeighedHealth Editorial Team against primary clinical sources — FDA labeling, peer-reviewed trials, and specialty-society guidelines.
Content current as of July 2026; updated when guidance or availability changes.
Cognitive behavioral therapy для insomnia (CBT-I) is the AASM-recommended first-line treatment для chronic insomnia, outperforming medications in durability (effects persist 6+ months after treatment ends) and lacking medication side effects. Sleep medications (zolpidem/Ambien, eszopiclone/Lunesta, doxepin, trazodone) work faster (week 1) but effects fade с tolerance, withdrawal causes rebound insomnia, and they pose fall risk (especially in older adults). CBT-I takes 6-8 weeks to show effect through structured programs (sleep restriction, stimulus control, cognitive restructuring). Digital CBT-I apps (Sleepio, Somryst) have RCT-grade evidence comparable к in-person CBT-I at lower cost ($300-600 vs $1,200-2,400). Best practice: CBT-I as primary treatment, short-term medication only as bridge.
Related questions
Is melatonin safe для long-term use?
Melatonin safe short-term (1-3 months) at LOW doses (0.3-1 mg). Long-term safety data sparse. Most retail products contain 3-10 mg — 10-30x physiologic dose. Higher doses don't improve sleep onset and worsen morning function. Avoid в children/teens.
Trazodone для sleep: does it work?
Trazodone (25-100 mg) is а sedating antidepressant prescribed off-label для insomnia. Preferred over Ambien due к no dependence and minimal abuse potential. Onset 30-60 min. Modest efficacy. Side effects: morning grogginess, dry mouth, mild orthostatic hypotension. Rare: priapism (men).