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Comment by snikeris | Hacker News Reader

The first line of treatment is CBT-I.

CBT-I is psychotherapy targeted at treating one specific cause of insomnia. It does not address any of the physical ailments that may also lead to sleep disorders.

If you aren't careful, you'll lose your internet medical license with such bold medically unsound claims.

I think our friendly internet medical doctor was trying to say that there are some useful principles in CBT-I that could be helpful for a lot of people, which is probably true.

As someone who took way too long fussing with sleep hygiene and the like before finally getting a proper sleep test though, I see the potential danger of telling people what to do first. (Though in my defense, I did get a sleep test a while back and it ended up the sleep tech was trash and I should have gotten a second opinion)

CBTi is generally effective, and "physical ailments" are not generally suspect in the case of insomnia. You can get checked for ailments such as sleep apnea anyhow and CBTi doesn't somehow jeopardize that. It's not like it has to be either or.

I wouldn't start CBT-I without first getting a sleep test, particulary for sleep apnea which can be present without obvious symptoms beyond insomnia or a delayed sleep phase. It's also much more common in young fit people than is often thought.

I would by virtue that CBTi isn't just sleep restriction, the most important component is CBT. At any rate restriction need not be very severe.

My point is that CBTi isn't what you need if you have sleep apnea or some other treatable disorder as the root of your sleeping issues.

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