Teacher:In this task, you are given a text of many news articles seperated by special token "|||||". Your task is to summarize them.
Teacher: Now, understand the problem? Solve this instance: Philadelphia, May 3, 2016 -- Cognitive behavioral therapy for insomnia (CBT-I) should be the first-line treatment for adults with chronic insomnia, the American College of Physicians (ACP) recommends in a new evidence-based clinical practice guideline published today in Annals of Internal Medicine. 
  
 "Cognitive behavioral therapy for insomnia is an effective treatment and can be initiated in a primary care setting," said ACP President Wayne J. Riley, MD, MPH, MBA, MACP. "Although we have insufficient evidence to directly compare CBT-I and drug treatment, CBT-I is likely to have fewer harms. Sleep medications can be associated with serious adverse effects." 
  
 CBT-I consists of a combination of treatments that include cognitive therapy around sleep, behavioral interventions such as sleep restriction and stimulus control, and education such as sleep hygiene (habits for a good night's sleep). Cognitive behavioral therapy can be conducted through individual or group therapy sessions, telephone or web-based modules, and/or self-help books. 
  
 If CBT-I alone is unsuccessful, ACP recommends that doctors use a shared-decision making approach with their patients to decide whether drug therapy should be added to treatment. This should include discussing the benefits, harms, and costs of medications. 
  
 The FDA has approved medications for short-term use (four to five weeks) and patients should not continue taking them for extended periods of time. FDA labeling also states that patients with insomnia that does not remit within seven to 10 days of treatment should be re-evaluated. 
  
 "Medications should ideally be used for no longer than four to five weeks while the skills learned in CBT-I can manage insomnia over the longer term," Dr. Riley said. "Before continuing drug therapy, doctors should consider treatable secondary causes of insomnia such as depression, pain, enlarged prostate, substance abuse disorders, and other sleep disorders like sleep apnea and restless legs syndrome." 
  
 Insomnia is a major health care problem in the United States. It can occur independently or can be caused by another disease. Approximately 6 to 10 percent of adults have insomnia that meets diagnostic criteria. Insomnia is more common in women and older adults. People with insomnia often experience fatigue, poor cognitive function, mood disturbance, and distress or interference with personal functioning. Chronic insomnia is diagnosed when symptoms cause clinically significant functional distress or impairment, are present for at least three nights per week for at least three months, and are not linked to other sleep, medical, or mental disorders. 
  
 ACP developed the guideline to present the evidence and provide clinical recommendations on the management of chronic insomnia disorder in adults. Evaluated outcomes included global outcomes assessed by questionnaire, patient-reported sleep outcomes, and harms. ACP's recommendations are based on two background evidence review papers and an evidence review sponsored by the Agency for Healthcare Research and Quality (AHRQ). 
  
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 About the American College of Physicians 
  
 The American College of Physicians is the largest medical specialty organization and the second-largest physician group in the United States. ACP members include 143,000 internal medicine physicians (internists), related subspecialists, and medical students. Internal medicine physicians are specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum from health to complex illness. ||||| "People with insomnia are more likely to have depression. They're more likely to have cognitive problems,” Owens told NBC News. 
  
 The first step is to change bad habits. 
  
 Related: Confessions of an Ambien Zombie 
  
 “Cognitive behavioral therapy will give you the tools and the techniques and little tricks to sort of say between 5 and 8 pm I’m going to have all my worries on the table here,” Riley said. 
  
 “I'm going to worry about my kids dental appointment tomorrow or the big project at work but at about 9 o'clock, I'm going to set that aside and I’m going to relax and release and think about a nice beach scene somewhere or something that will put me in the mood that will be more conducive for sleep.” 
  
 And a big part of it is putting away the electronics. Smart phones, tablet computers, televisions and computer screens all disrupt normal sleep patterns. 
  
 “So number one, it would teach you not to lie in bed for long periods of time being awake instead of asleep,” Owens said. 
  
 “So one strategy about that would be not to do anything in bed but sleep. So don't watch television, don't be on your iPad, don't do anything in particular that's going to wake you up,” she added. 
  
 Related: Sleeping Pills Raise Crash Risk 
  
 “Another strategy would be to get up out of bed if you haven't been able to fall asleep for about 20 minutes or so. We don't want you to watch the clock, but when you start getting annoyed about not being able to fall asleep, get out of bed, sit in a chair, read a boring book until you start feeling drowsy, and then get back into bed and attempt to sleep again. “ 
  
 Also – no naps. 
  
 “Many people with insomnia take naps during the day and that's actually counterproductive and can make the insomnia worse,” Owens said. 
  
 The guidelines, published in the Annals of Internal Medicine, encourage patients to see their doctors. 
  
 “Many patients suffer for many years without discussing this with their physician,” Owens said. 
  
 “Many people with insomnia take naps during the day and that's actually counterproductive and can make the insomnia worse." 
  
 The good thing about therapy is it gives people tools to help themselves, she said. 
  
 “Drugs are only effective as long as you take them, whereas the tools that you learn in cognitive behavioral therapy can last a lifetime.” 
  
 It can be hard finding a professional to help, and hard finding time to get there. Riley said help does not necessarily have to come in a one-on-one session. Group therapy also works. 
  
 “It would consist of several other individuals who have similar problems with sleep. They would be sharing experiences. More importantly, they will be sharing of techniques and exercises that some patients may have found very helpful that others in a group setting could adopt and get benefit out of it as well,” he said. 
  
 In an editorial, Dr. Roger Kathol of the University of Minnesota and colleagues wrote that some insurance plans don’t pay for this kind of help. 
  
 “It is frustrating that an intervention as effective as cognitive behavioral therapy for insomnia is difficult for many patients to access,” they wrote. 
  
 “Drugs are only effective as long as you take them, whereas the tools that you learn in cognitive behavioral therapy can last a lifetime.” 
  
 Insurers and policymakers need to work to make sure it’s as acceptable as medication. And doctors need to get on board, too. 
  
 “Some clinicians do not recognize insomnia as a health problem, often considering it merely a symptom secondary to another condition. Second, many clinicians and their patients harbor biases against and are reluctant to consider ‘psychological’ interventions ,” they wrote. 
  
 “Although cognitive behavioral therapy for insomnia requires substantial effort and can be uncomfortable for patients during the early stages, with persistence this nonpharmacologic treatment leads not only to better-quality sleep but also to improved daytime functioning." ||||| Tossing and turning night after night? Don't automatically reach for the pill bottle. New guidelines say the first choice to treat chronic insomnia should be cognitive behavioral therapy — a way to condition your body to slumber again. 
  
 It takes more time and effort than popping a pill, but the American College of Physicians said Monday the method known as CBT can be effective and doesn't carry the side effects of medication, a recommendation intended to spur primary care doctors to prescribe the step. If it doesn't work, then doctors could consider adding a drug. 
  
 "Prescribing a sleeping pill is not the desirable first step," said the group's Dr. Thomas Tape, chief of general internal medicine at the University of Nebraska Medical Center. Yet for many primary care physicians, the behavioral approach "wasn't really on our radar screens," he said. 
  
 There are challenges, including finding health workers who are trained to deliver CBT for insomnia. Nor is it always covered by insurance, notes an editorial published along with the recommendation in Annals of Internal Medicine. Here are some things to know: 
  
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 THE RIGHT SLEEP 
  
 Adults ages 18 to 60 are supposed to sleep at least seven hours a night for good health. Cheating sleep can increase the risk of health problems from high blood pressure to obesity to fatigue-caused car crashes. 
  
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 WHEN INSOMNIA LASTS 
  
 People often get too little sleep because of lifestyle or job circumstances. That's different than trying to sleep and failing. Many bouts of insomnia that last several weeks to a month or two come about because of stress or an illness. 
  
 But between 6 percent and 10 percent of adults meet the criteria for an insomnia disorder: They suffer daytime problems because of difficulty falling asleep or staying asleep at least three nights a week for three months or more, and it's not explained by some other disorder. It's more common among older adults and women. 
  
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 WHAT IS COGNITIVE BEHAVIORAL THERAPY FOR INSOMNIA? 
  
 It's far more than sleep hygiene, those common-sense tips to keep the bedroom dark and cool and avoid too much caffeine. It's all about reconditioning a brain and body away from now-habitual tossing and turning and back to normal sleep patterns, said Duke University clinical psychologist Meg Lineberger. A certified behavioral sleep medicine specialist, she wasn't involved with the new guidelines but hopes they increase patients' access to care. 
  
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 HOW DOES IT WORK? 
  
 The hardest step is so-called sleep restriction. Say you average 5.5 hours of sleep a night — better some nights, worse others. Tack on an extra half-hour, and then count back the resulting six hours from the time you have to wake up. If the alarm goes off at 6 a.m., then midnight is the prescribed bedtime. 
  
 Staying up that long builds the body's natural drive for sleep so that once in bed, patients slumber right away, Lineberger explained. Gradually, patients move to an earlier bedtime. 
  
 They also undergo a variety of other steps. For example, just as dieters might be told to eat only at the table and never in front of the TV, it's important to strengthen the brain's expectation that bed is for sleep. If you can't fall asleep, don't read in bed — get up and go to another room to read until you're drowsy and ready to try again. 
  
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 WHAT ABOUT MEDICATIONS? 
  
 A variety of prescription sleep medications are available but a scientific review published in Annals Monday concluded they're best used for shorter-term insomnia, as use beyond four to five weeks hasn't been well studied. 
  
 The new guidelines said when insomnia becomes chronic, there's not enough information to directly compare medications and CBT — but that starting with the behavioral approach avoids medication side effects, some of which can be serious. 
  
 Indeed, after reports of sleep-driving and other semi-awake activities, the Food and Drug Administration in recent years lowered recommended doses of Ambien, Lunesta and related drugs, saying they could linger in the bloodstream long enough to interfere with activities that require alertness after the person wakes up. 
  
 Still, the new guidelines say if CBT alone isn't working, doctors should discuss with patients the pros and cons of adding a medication to the continuing behavioral therapy. 
  
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 IT'S NOT A QUICK FIX 
  
 Typically, CBT involves four to six appointments several weeks apart. There also are some online options. 
  
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 FINDING CARE 
  
 The American Academy of Sleep Medicine is a source for sleep specialists. But Duke's Lineberger said other health professionals, such as nurse practitioners or social workers, can learn to perform CBT for primary care offices, freeing specialists for the toughest cases. |||||
Student:
The American College of Physicians is issuing new guidelines on how to treat insomnia based on evidence suggesting that the side effects of sleeping pills are "underestimated," while the success of cognitive behavioral therapy (CBT-I) is compelling. "The evidence is quite strong that cognitive behavioral therapy is effective," Dr. Wayne Riley, president of the ACP, tells NBC News. "It works. It's long-lasting, and it has the potential to decrease cost to the health care system." In a press release, he adds that even though there is "insufficient evidence" to allow for a direct comparison between CBT-I and drug treatment, CBT-I is at the very least safer. "Sleep medications can be associated with serious adverse effects," he says. The review further found that there isn't enough evidence that drugs like Valium and Xanax actually help people sleep, never mind alternative therapies some people try, such as herbal teas. "Prescribing a sleeping pill is not the desirable first step," another expert tells Fox News, but he adds that therapy isn't on the "radar screens" for primary care physicians. An initial challenge will be training health care workers in providing CBT-I, and also convincing insurance providers to cover it. But the therapy itself takes work, too. Fox notes that it goes well beyond sleep hygiene; one particularly challenging step involves sleep restriction, where insomniacs don't allow themselves to get into bed until a certain number of hours before their alarm is set so that they go to bed exhausted and begin to associate their bed with sleep instead of tossing and turning. (There may be something to that evening glass of milk.)