Neurocognitive Benefits of PAP vs CBT-I in Chronic Insomnia

This recent study may prove seminal once the dust settles, because its early findings purport to demonstrate that physiological PAP therapy has greater benefits for neurocognitive function among chronic insomniacs compared to the gold standard psychological therapy known as cognitive behavioral therapy for insomnia (CBT-I).

The study is comparing 3 different sets of therapies in sequence or in combination. One group gets PAP + CBT-I concurrently. The other two groups get the sequence of PAP, then CBT-I or CBT-I, then PAP. The follow-up periods appear to range between 1 and 2 months.

The striking finding is the impact of PAP, apparently in whatever sequence or combination, more powerfully improves working memory, verbal memory, or overall executive functioning compared to the impact of CBT-I.

These results are not surprising to us as we learned more than 20 years ago that treating insomnia first with PAP and then with CBT-I was often a practical ideal, although in some cases we tried PAP and CBT-I simultaneously. The beauty of PAP first is it literally clears the cobwebs out of the patient’s mind. Then, with clearer mental functioning, the individual could more easily understand and implement CBI-I steps.

And, of course, it goes without saying for many patients, the physiological treatment of insomnia with PAP often cuts the sleeplessness problem in half or even more dramatically in the majority of cases. So, PAP is quite the 2-for-1 treatment for a condition conventionally presumed to be psychologically driven.