We all know that cognitive-behavioral therapy for insomnia is effective. But exactly who is it for? And what does it involve?
In my experience, patients who seek therapy for depression or anxiety often report problems with sleep. These problems usually fall into one (or more) of three categories: 1) difficulties falling asleep, 2) difficulties staying asleep, or 3) waking up earlier than intended. Any of these can have a real impact on one’s quality of life.
When is the right time to get help?
If insomnia is brought on by recent life stress like trouble at work or in a romantic relationship, it is called acute insomnia. Usually, this kind of short-term insomnia resolves itself and sleep patterns return to normal. However, if insomnia persists past a few weeks (chronic insomnia), it can exacerbate other problems. It can then evolve into a vicious cycle of a) sleeplessness and b) anxious thoughts about sleeplessness. When this is the case, insomnia treatment can be helpful.
Sleep medication are often used for insomnia treatment, and they can be effective. However, many people find the side effects of such medications difficult to tolerate. Others are concerned about the habit-forming nature of some of these medications.
Cognitive-behavioral therapy for insomnia
Cognitive-behavioral therapy for insomnia (CBT-I) is a good option for people who do not want to rely on medication. CBT-I centers on on several key components, each of which which are described below.
The first is learning sleep hygiene principles. This involves guidelines such as going to bed and waking up at the same time every day, keeping your bedroom at a comfortable temperature, decreasing caffeine and alcohol intake, and avoiding naps during the day.
Another element involves stimulus control procedures. For example, it might be tempting to watch TV or use your phone in bed. However, studies have shown that this may interrupt sleep patterns over time as you come to associate non-sleep activities with being in bed. Limiting your activity in bed to sleep may help to ‘re-train’ your brain to pair the bedroom with sleep (rather than “TV time” or “internet time”).
Changes to your daytime and bedtime habits may also be helpful in getting a good night’s rest. Incorporating more physical activity in your day, practicing relaxation techniques before bed, and creating a pre-sleep routine have all proven to be beneficial. Studies have shown that up to 80% of patients who implemented behavioral techniques reported sleep improvements in as little as a month.
A more rigorous behavioral intervention is known as sleep restriction training. Sleep restriction is a treatment option for those with more severe chronic symptoms. It involves spending less time in bed, which is counter-intuitive. However, it is very effective, and a central part of cognitive-behavioral therapy for insomnia.
If you have worries about your sleep, cognitive techniques may also be warranted. Cognitive techniques teach you to identify and challenge any distorted thoughts about sleep. This, in turn, frees you from the grip of insomnia.
For example, some patients think that not getting a good night’s rest is going to “completely ruin” the next day. We all know how the thought of not functioning at work can bring on feelings of helplessness and increased anxiety. However, reminding yourself that you have in fact functioned before on very little sleep can help a lot. Similarly, remembering that in the past you’ve eventually caught up on your sleep helps alleviate some anxiety.
Similarly, one of the most important things to remember is to NOT bring your problems to bed. If you find yourself replaying the day’s events or concocting ‘what-if’ scenarios, get out of bed, write your problems down on a piece of paper. Attend to them in the morning when your brain is fully functioning.
The big picture
You will need some patience to succeed with cognitive-behavioral therapy for insomnia, as these techniques can take time to take effect. However, they can lead to improved and long-lasting sleep quality. Given that we spend a third of our lives sleeping, CBT-I can be a critical step in improving alertness, energy, and quality of life.
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