Insomnia Therapy in NYC (CBT-I & Evidence-Based Treatment)
What Is Insomnia?
Someone has insomnia if they have trouble falling asleep, staying asleep, or have early-morning awakening on a consistent basis. For example, you might find yourself lying in bed for hours tossing and turning. Or, you might fall asleep quickly but wake up quite a few times in the middle of the night and then have trouble falling back asleep. And lastly, you might consistently wake up before your morning alarm. In all those cases, symptoms of insomnia can lead to irritability, difficulty with attention and concentration, relationship difficulties, and sometimes even impaired work performance.
Signs You Might Benefit From Treatment
It’s normal to have occasional trouble sleeping, especially during periods of stress or major life changes. However, persistent sleep difficulties can begin to take a significant toll on mood, concentration, health, and daily functioning.
You may benefit from seeing a sleep therapist for insomnia treatment if:
You regularly have trouble falling asleep, staying asleep, or waking too early
Sleep problems occur multiple nights per week
You dread bedtime or feel anxious about sleep
You spend long periods awake in bed trying to fall asleep
Fatigue, irritability, or poor concentration are affecting your work, relationships, or quality of life
You rely heavily on naps, sleep aids, alcohol, or other substances to help you sleep
Your sleep difficulties have persisted for several months or keep returning
Many people assume insomnia is something they simply have to “push through,” but chronic insomnia often becomes self-perpetuating over time. CBT-I and other evidence-based approaches can help address the behavioral and psychological factors that commonly maintain insomnia.
Acute Insomnia
Sometimes we have trouble sleeping for a few nights in a row. There can be many reasons for this. Often the problem will improve on its own, and treatment is not necessary. Acute insomnia can become chronic, and should be treated if it does.
Chronic Insomnia
When sleep problems persist for more than three months, they are considered chronic. Chronic insomnia can have significant effects on our quality of life, and can affect our health.
What Does an Insomnia Therapist Do?
If you see a therapist for insomnia, you can expect them to do any or all of the following:
- Assess sleep patterns and factors contributing to insomnia
- Help adjust sleep and wake routines
- Address thoughts and worries that interfere with sleep
- Tailor treatment strategies to fit your life and goals
CBT-I: Evidence-Based Treatment for Insomnia
Cognitive-behavioral therapy for insomnia (CBT-I) is a form of CBT that is specifically tailored to help people suffering from chronic insomnia. It is more effective than medication in improving sleep. Additionally, CBT-I’s effects are typically longer lasting than those of medication.
The foremost authority on sleep problems is the American Academy of Sleep Medicine. In their 2017 guidelines, they recommended CBT-I as the first-line treatment for insomnia. This means that CBT-I’s effectiveness and lack of side effects make it the best first option for insomnia treatment.
“The worst thing in the world is to try to sleep and not to.”
F. Scott Fitzgerald
What’s Involved with Doing CBT-I?
CBT-I typically involves up to 10 sessions with a CBT therapist trained in CBT-I. The sessions focus on the following steps:
- Learning about the physiology of sleep and circadian rhythms
- Learning how your environment and behavior affect sleep
- Making helpful changes to your environment and behavior
- Making changes to the times you get in bed and wake up
- Monitoring your progress
Your CBT-I therapist may recommend changes that seem counterintuitive. For example, sometimes you may be asked to set an alarm to wake up before you get what feels like enough sleep. Changes like this one are part of what it takes to establish good sleep habits. Having healthy sleep habits is often the most important part of addressing insomnia. (If you’re looking to improve your sleep habits on your own, read our recommended sleep hacks.)
How CBT-I Treats Insomnia
CBT-I focuses on identifying and changing behavioral and psychological patterns that commonly maintain insomnia. Treatment may involve:
Improving sleep scheduling and consistency
The therapist will recommend that you strive to maintain consistent wake times in the mornings on weekdays (and no more than an hour later on the weekends).
CBT-I may encourage greater daytime activity and more consistent routines to help strengthen natural sleep drive.
Reducing behaviors that unintentionally maintain insomnia
You’ll be asked to avoid excessive physical activity, caffeine, strong light exposure, and heavy meals close to bedtime.
It’s also recommended to limit alcoholic beverages since alcohol tends to disrupt the quality of sleep (even if you fall asleep more quickly when under the influence).
It’s also recommended for people with chronic insomnia to generally avoid daytime naps.
Addressing sleep-related worry and anxiety
Remember that a healthy sleep range is between 6-8 hours on average for healthy adults. If you believe you need 8-10 hours, it’s possible you need less sleep than you think.
Strengthening the association between bed and sleep
If you find yourself lying in bed awake at night for more than 15-30 minutes, your therapist may suggest you get up and go to another room until you’re feeling sleepy.
You’ll also be asked to keep your bedroom environment cool and comfortable – and pay attention to whether disruptive pets, snoring partners, or blue light stimulation from your bedroom TV is keeping you up at night.
One oft-used CBT-I technique is called stimulus control. For example, if someone lies awake in bed for a prolonged period of time, they may be encouraged to get out of bed briefly and return only when sleepy. The goal is to help the bed become associated with sleep rather than frustration or alertness.
CBT-I may also address “sleep effort” — the tendency to try too hard to force sleep to happen. In many cases, becoming preoccupied with sleep can actually increase anxiety and make sleep more difficult. Treatment helps people develop healthier and more flexible responses to normal fluctuations in sleep.
CBT-I and Sleep Medication
CBT-I can be used whether or not you take sleep medication, and many people use it to reduce long-term reliance on medications if appropriate.
Doctors will sometimes prescribe sedatives and hypnotics to help with sleep. Remember, these medications are typically not recommended for long term use. Some of these medications can be habit-forming. In the short term they may be helpful, but over time they can erode our natural abilities to fall asleep. This can actually make insomnia worse. These medications are best used rarely, and only for short-term purposes. Most people with insomnia can benefit from changes to their habits and from addressing any anxiety problems that affect their ability to get to sleep.
Frequently Asked Questions
How long does it take for a person to fall asleep?
On average, it should take someone twenty to forty minutes to fall asleep. If you still can’t sleep after forty minutes, try doing a relaxing activity out of bed and then return to bed when you get sleepy.
Who is most likely to get insomnia?
You are more likely to suffer from insomnia if you focus too much on the number of hours of sleep you’re getting or if you dread sleep. If you stay in bed for a long time when you can’t sleep, you’re more likely to get insomnia. If you are inactive during the day, your risk for insomnia goes up. These are some of the most common risk factors.
What triggers insomnia?
Normal life events can trigger brief difficulty in falling asleep – sleep disruption from jet lag, conflict with a loved one, worry about job performance. Not every night or nights of poor sleep is insomnia or can lead to insomnia.
How long does CBT for insomnia take to work?
CBT-I has been shown to improve ability to fall asleep, stay asleep, and improve sleep quality in a few weeks.
Contact Us
Please contact us if you would like help with insomnia or other sleep-related difficulties. Our CBT therapists are doctoral-level psychologists trained in evidence-based treatment approaches, including CBT-I.
Our offices are in midtown Manhattan, and we also offer teletherapy services throughout New York State, New Jersey, Massachusetts, Virginia, North Carolina, and Florida.
If you have questions about treatment or would like to schedule an appointment, we’re happy to help.