What is Cognitive Behavioral Therapy – for Insomnia
Cognitive Behavioral Therapy for Insomnia, also known as CBT-I, is a technique commonly used for treating insomnia that incorporates behavioral approaches, either without medication or in conjunction with medication.
What Is Insomnia?
Insomnia is a sleep disorder experienced by millions of people worldwide. People suffering with insomnia find it difficult to either fall asleep, stay asleep, or to get sufficient good-quality sleep. Insomnia typically leads to lethargy, daytime sleepiness, and a general feeling of being both physically and mentally unwell.
The aim of CBT-I is to improve behaviors and sleep habits by firstly identifying, and then changing the thought patterns and behaviors that affect a person’s ability to sleep or to sleep well.
Identifying the Causes of Insomnia
Before a patient’s insomnia can be treated with CBT-I, however, the underlying causes of the insomnia must be identified. People unfortunate enough to experience insomnia should have their sleep patterns evaluated in order to determine all possible factors that could be affecting their ability to sleep. This can be done privately at home, and would involve keeping a journal or sleep diary for at least two weeks. Maintaining a regular journal can be very helpful in identifying the stress, habits, thoughts, or behavior that may be contributing to the person’s insomnia.
Once the underlying causes and factors contributing to the insomnia have been identified, then the person can start taking positive steps towards achieving better sleep. In CBT-I these steps include the control of stimulus, sleep restriction, sleep hygiene, cognitive therapy, and relaxation training. In addition, some sleep specialists also recommend biofeedback. It’s been found that CBT-I is an effective form of treatment for insomnia, including insomnia caused by or related to mood disorders. Interestingly, people suffering with Post Traumatic Stress Disorder have also shown improvement.
See blog on Cognitive Behavioral Therapy- Insomnia (CBTI)
Behavioral Practices for Treating Insomnia
1: Practice Sleep Hygiene by Maintaining a Positive Sleeping Environment –
- Keep the sleeping space quiet and dark;
- Remove distractions such as computers, televisions, and other engaging activities;
- Have a good quality, comfortable bed;
- Commit to a consistent bedtime and to a consistent wake up time;
- Avoid staying in bed while awake for a long period of time: it’s recommended that you relax elsewhere, then return to your bed when you feel ready for sleep.
2: Control and Limit Stimulation before Going to Bed
- Complete your evening meal three hours before bedtime, particularly for those people prone to heartburn or indigestion;
- Avoid caffeinated or alcoholic beverages before sleeping;
- Avoid smoking for at least three hours before going to bed;
- Unless your physician has directed otherwise, choose to take your medications far in advance of sleeping times, because most medications can disrupt or delay sleep;
- Don’t engage in physical exercise within four hours of going to sleep;
- Avoid napping too close to bedtime; and
- Try to avoid stressful situations before going to bed.
The aim of stimulus control is to associate our bed with sleeping only, and to limit its association with stimulating activities. People who suffer from insomnia are advised to follow the following tips –
- Only go to bed when you’re tired;
- Limit bedroom activities to sleep and sex;
- If sleep onset doesn’t occur within 10 minutes, get up and move to another room;
- Ensure that you get out of bed at the same time every day.
‘Sleep Hygiene’ is a term used for controlling a person’s behaviors and environment that precede sleep. This process means limiting substances within 4 to 6 hours of going to bed – substances such as alcohol, nicotine, and caffeine, that are known to interfere with proper sleep. It may be that a light bedtime snack of peanut butter or milk is recommended.
Very important also for the person suffering from insomnia is the environment in which they sleep, and this includes the environment that directly precedes sleep. It’s important that insomniacs engage in relaxing activities prior to going to sleep, such as listening to calming music, reading, taking a bath, writing, and so on. Stimulating activity, such as being around bright lights, using a computer, and watching television, should be avoided at all costs.
When it comes to CBT-I, sleep restriction is a fairly controversial step because it initially involves restricting sleep. Restricting sleep sounds counterintuitive, but it is, in fact, an effective and significant component of CBT-I. Sleep restriction as a treatment for insomnia revolves around controlling time in bed (TIB): it’s based on the person’s sleep efficiency so that the homeostatic drive can be restored to their sleep. Depending on the person’s initial sleep efficiency this process could take several weeks or months to complete. During the first week or two daytime sleepiness will be a side-effect, so people who cannot be sleep deprived for various reasons, such as operating heavy machinery, should not undergo this process.