Insomnia is a sleep disorder characterised by persistent difficulty falling and staying asleep. Living with insomnia can wreak havoc on a person’s daily life, affecting relationships and work, as well as contributing to long-term health issues.
There are many ways to treat and manage the symptoms of insomnia, with many people attempting to combat symptoms with over-the-counter or prescription medication. Yet, while sleeping pills can provide effective relief in some situations, there are many other safe and effective treatment options that can make a significant difference in the lives of people who suffer from persistent and ongoing sleep difficulties.
Cognitive behavioral therapy for insomnia (CBTI) is a scientifically proven, highly effective way to treat insomnia and the symptoms associated with it. This article takes a closer look at CBTI as an effective treatment and some of the techniques and approaches that are used in CBTI to assist people living with insomnia.
Cognitive behavioural therapy for insomnia (CBTI) is an evidence-based approach to managing the symptoms of insomnia that explores the connection between how people think, feel, and behave when it comes to sleep.
In sessions with a qualified sleep psychologist, patients receiving CBTI are taught skills, ways of thinking, and habits that they can use to help against their struggle. CBTI therapists use cognitive, behavioural, and psychoeducational techniques to reframe misconceptions and beliefs about sleep and change habits and behavioural patterns that disrupt sleep.
The approaches used by providers of CBTI can vary between patients, depending on their symptoms and unique needs.
Through cognitive restructuring, patients work with their therapist or sleep coach to interrogate and reframe unhelpful thoughts and beliefs they may have about sleep.
There are many commonly held beliefs about sleep that are inaccurate and could be exacerbating symptoms of insomnia. By clarifying or reframing these beliefs, CBTI therapists can help patients develop and change their thoughts around sleep in a way that is healthier and more helpful for their recovery.
CBTI providers also help patients to identify and challenge unhelpful thoughts and concerns, such as worry or anxiety associated with past experiences of insomnia. For example, someone plagued by worry that they won’t get enough sleep will often be kept awake by the stress of their concerns, feeding into a negative cycle. CBTI helps to break that cycle.
A behavioral approach to CBTI focuses on helping people suffering from insomnia to develop healthy sleep habits. Behavioral interventions, such as relaxation techniques, stimulus control, and sleep restriction are often introduced by therapists.
Aimed at reducing the intensity of stress and a racing mind that people with insomnia often experience when trying to fall asleep, relaxation techniques may include breathing exercises, meditation, body scanning, progressive muscle relaxation (PMR), which involves tensing and relaxing different muscle groups or parts of the body, and biofeedback, which uses technology to monitor breathing, brainwaves, heart rate, and body temperature.
Stimulus control is centred around building positive associations and responses to their sleeping environment. People suffering from insomnia tend to develop negative associations to their bedroom and their bed, such as wakefulness, frustration, or worry. Some people even associate their bed with habits and activities that make sleep more difficult, such as watching TV, using a phone or laptop, or eating.
Stimulus control attempts to change these associations, reestablishing the bedroom as a place for relaxation and sleep. To achieve this, various guidelines are introduced, such as restricting the bedroom to specific activities, usually sleep or sex, and getting out of bed after lying awake for more than 10 minutes at night.
Sleep restriction is a technique that may be used by CBTI therapists that sets limits on the amount of time spent in bed. The purpose of this is to reduce the amount of time spent lying awake in bed, and to establish a consistent sleeping pattern or routine.
A psychoeducational approach to CBTI teaches patients about the connection between their thoughts, feelings, behaviours, and the quality or amount of sleep they get. Therapists introduce education about sleep hygiene, and the ways in which a person’s diet, exercise, and sleeping environment can impact upon their sleep. This helps patients correct habits or lifestyle factors that may be disturbing their ability to sleep well.
As an example, a therapist may provide education about how the amount of light, the types of light a person is exposed to at different times of the day can impact their sleep.
Research has proven that when various CBTI approaches and techniques are applied together according to a person’s unique needs, lifestyle, and symptoms, people living with insomnia experience improvements and benefits, such as taking less time to fall asleep, staying asleep longer at night, and waking up less throughout the night.
It’s important to note that while the benefits are often felt long-term, changes can be gradual. Some of the techniques used in CBTI take practice and discipline, and some require significant lifestyle changes or fundamental changes to a person’s thoughts and feelings around sleep. Some CBTI techniques, such as sleep restrictions, may even initially cause a person to feel even more tired before eventually reestablishing new patterns and habits that work to relieve symptoms. So, in order to discover whether CBTI is right for you, you’ll need to be prepared to invest time and effort into learning and applying the techniques.
CBTI is often recommended as a first-response strategy to relieving or managing symptoms of insomnia, ahead of sleep medication. Unlike some medications, CBTI has no significant risks or negative side effects.
CBTI can benefit not only those suffering from chronic, ongoing insomnia, but those with short-term or acute insomnia, or even people without a diagnosis of insomnia who experience sleep difficulties.
People qualified to provide CBTI can include doctors, counselors, therapists, sleep psychologists, or psychiatrists. If you suffer from difficulty falling or staying asleep and are interested in finding out if CBTI could help you, book a call to speak to our sleep coach.