Cognitive Behavioral Therapy for Insomnia

The early bird gets the worm. Cognitive Behavioral Therapy for Insomnia

What does Insomnia look like?

Insomnia Disorder is defined by one or more symptoms below:

  • Difficulty initiating sleep
  • Difficulty maintaining sleep
  • Early morning awakening with inability to return to sleep
  • Causes distress or impairs important areas of functioning (socially, at work, at school)
  • Sleep difficulty occurs at least 3 nights per week
  • Has been present for at least 2 months
  • Occurs despite having opportunity for adequate sleep
  • Not better explained by another sleep disorder (such as narcolepsy, circadian rhythm disorder)
  • Not due to a substance (drug of abuse or side effect of prescribed medication)
  • Not explained by other mental disorders (like posttraumatic stress disorder) or medical conditions (sleep apnea)

Cognitive Behavioral Therapy (CBT) for Insomnia

  • CBT is a type of therapy that has been shown to be as effective as medication for insomnia
  • It helps you develop habits and a healthy pattern of sleep by changing your actions and thoughts
  • It can take time, dedication, and patience and working with a therapist can help you stay on track and hone your skills

Components of CBT

Stimulus control - Stimulus is anything that results in a response.

  • The goal is to have a positive response when you go to bed. If you have problems sleeping, if you toss and turn a bed or where you sleep can become associated with negativity and frustration.
  • Only use bed for sleep and sex. NO: Reading, tv, phone or anything else in bed!
  • YES: Go to bed only when you feel very sleepy. If you are not asleep in 20 minutes, get out of bed & do something relaxing. When you start feeling sleepy, head back to bed. This can take time, but gradually, you can start falling asleep quicker and you associate your bed with sleep.

Sleep restriction: Limit the time you spend in bed

ways to reduce insomnia
  • Goal: Reach the point where you get the amount of sleep you need without reducing the quality of your sleep
  • How: First use the same amount of sleep you typically get on a nightly basis (not how much time you currently spend in bed)
    •  This sleep loss will make you even more tired BUT you will be able to fall asleep faster and wake up fewer times a night
    • As sleep improves, you then gradually increase the limit on the time you spend in bed

Psychotherapy: Working with a therapist can help you pinpoint attitudes and belief that impact your sleep

  • Therapy can help you promote positive attitudes and overcome negative thoughts and worries that disrupt your sleep
  • Guided imagery and setting worry times earlier in the day are examples of behaviors that can be developed in therapy

Sleep hygiene education: Developing basic habits to develop healthy patterns of sleep

The AASM (American Academy of Sleep Medicine) has good advice on habits to hone in on, in order to have healthier, more consistent sleep- Healthy Sleep Habits - Sleep Education by the AASM

Examples of healthy sleep habits:

  • Exercise regularly and eat healthy, balanced diet
  • Set a bedtime that ensures you get at least 7 to 8 hours of sleep
  • Get up at same time every day, even on weekends and when on vacation
  • Do not go to bed unless you are sleepy

Get in the mindset for bed:

  • Establish a relaxing bedtime routine. Keep bedroom quiet and relaxing and comfortable temperature
  • Limit bright lights in the evenings
  • No electronic devices at least 30 min before bedtime
  • Don’t eat a large meal or drink alcohol before bed
  • Limit fluid intake prior to bedtime
  • Avoid consuming caffeine in the afternoon and after

If you don’t fall asleep after 20 min, get out of bed and do a quiet activity that does not require a lot of light and continue to avoid electronics

Relaxation Training: Relax body and mind

Relaxation is good for mind and body. It Helps Promote Better sleep
  • Goal: Reduce anxiety and tension that keeps you awake
  • Methods that are taught: Muscle relaxation, breathing and mental focusing
  • Biofeedback: teaches you how to control certain functions of your body by receiving feedback from the body such as: Muscle tension, blood pressure, brain waves, heart rate, body temperature How: you may wear a device that signals to you the level of muscle tension or brain wave frequency, you will then try to change that level and device will let you know how level is changing.
  • Box Breathing: 3 step breathing technique for relaxation - take a slow and deep breath in for a count of 4 seconds, holding it for a count of 4, and exhaling slowly for a count of 4, then waiting 4 seconds before repeating.

For more information on getting better sleep and how Cognitive Behavioral Therapy can help check out these resources:

Cognitive Behavioral Therapy - Sleep Education by AASM

Healthy Sleep Habits - Sleep Education by the AASM

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