Cognitive Behavioral Therapy for Insomnia

Cognitive Behavioral Therapy for Insomnia

The United States has a sleeping problem, and the numbers behind that fact can be daunting. About 97.2 million Americans, or roughly 30% of the population, report symptoms associated with one of the five major sleeping disorders; sleep apnea, restless leg syndrome, REM sleep behavior disorder, narcolepsy, and insomnia. Of these, insomnia is the most common, affecting approximately 60 million Americans. While many people report occasional bouts of sleeplessness, chronic insomnia is characterized by persistent difficulty falling or staying asleep. The causes of insomnia can be widely varied, and as such, so are the treatments. Many people have found success treating their sleeping issues through the use of CBT-i, or cognitive behavioral therapy for insomnia.

What is CBT-i?

Cognitive behavioral therapy is a type of “talk therapy” that aims to change obstructive behaviors and develop personal strategies that help cope with and solve issues that are interfering with one’s way of life. This type of therapy can help with sleeping problems, as insomnia can absolutely be influenced by one’s daily behaviors.

CBT-i is a method of treating insomnia that focuses on changing and improving the sleeping habits, or sleep hygiene, of afflicted individuals. It is a structured program performed under the guidance of a professional, usually a therapist, that is used to identify thoughts or behaviors that contribute to insomnia. Together, the patient and therapist work to replace those habits with those that promote good sleep hygiene. Sleep hygiene refers to the behavioral and scheduling practices of an individual in regards to how they sleep. Some recommendations for improving sleep hygiene can include establishing a regular sleep schedule, limiting stress, avoiding exercise too close to bedtime, and using the bed solely for sleep.

How does it work?

According to the MayoClinic, “The cognitive part of CBT-I teaches you to recognize and change beliefs that affect your ability to sleep… The behavioral part of CBT-I helps you develop good sleep habits and avoid behaviors that keep you from sleeping well.” Just as CBT has many methods for acquiring mental clarity, there are several different techniques used in CBT-i that encourage, and discourage, certain behaviors.

Sleep Restriction Therapy is typically one of the major components of CBT-i. The treatment consists of reducing and restricting the amount of time spent in bed, with the goal being partial sleep deprivation. This somewhat “reboots” the sleeping schedule, essentially forcing the patient to sleep through the night due to exhaustion. As sleep improves, more sleeping time is gradually added.

Sleep Issues

A therapist treating using CBT-i might set specific stimulus control instructions that either remove or modify factors that basically make your brain resist sleep. Things like setting a consistent sleep schedule, using the bed only for sleep and sex, and getting out of bed if you can’t sleep after a certain period of time may be part of those instructions.

In addition to this, you may be advised to change the setup of your bedroom in order to make it more appropriate for sleeping. Keeping the bedroom dark and quiet, removing your television, and keeping your phone in another room are examples of methods that make a bedroom better suited for sleep time. Before bed, you may be encouraged to practice relaxation training– meditation, imagery, and muscle relaxation are all common approaches.

Another aspect of CBT-i is Sleep Hygiene Education. Practicing these methods does nothing if you don’t understand what waking-habits you can practice or curb in order to improve your sleep at night. This can include avoiding caffeine and alcohol or getting regular exercise. Usually, the therapist will come up with a custom routine composed of behaviors meant to prepare the body for sleep in the couple of hours before bedtime.

Therapists may also take a Biofeedback approach, in which the patient’s biological signs during, before, and after sleep are observed and documented. They can monitor things such as heart rate and muscle tension. This can be done in a medical office, a sleep center, or at home with the aid of a biofeedback device to record daily patterns.

Relapse Prevention is one of the most important parts of CBT-i. According to the Sleep Foundation, “The patient needs to learn how to maintain what they’ve learned and prepare for the possibility of a future flare up.” Lots of things can set off those bad habits that contribute to insomnia, and it is important to make sure not to compensate for sleep loss in an attempt to “get back on schedule.” Additionally, adhering to the sleep schedule that has been custom made for the patient is vital to the process. Occasionally, bouts of insomnia may occur, and in that case, restarting the sleep-restriction process is often recommended.

Through the Psychology Department at Healthpointe and the Functional Restoration Program offered at Healthpointe, our trained staff of psychological and medical professionals will utilize CBT-i to address the root of your insomnia and help you treat it. For more information on whether or not CBT-i is right for you, you can call us at (888) 724-8153 or make an appointment at any one of our offices by clicking here.

Press Release: The New Functional Restoration Program Website

Healthpointe Releases New Website for its Functional Restoration Program


Healthpointe is glad to announce the release of its newest website endorsing its Functional Restoration Program, for those suffering from chronic pain.

Healthpointe Medical Group is pleased to announce the release of its new website,, dedicated to providing patients with key information and research in regards to integrated chronic pain treatment at Healthpointe.

Chronic pain affects over 100 million Americans and takes an enormous negative toll on patients, families, employers, and the healthcare system. The Functional Restoration Program (FRP) at Healthpointe is a program focused on helping patients with chronic pain. The Functional Restoration Program uses an integrated, bio-psycho-social approach to helping patients improve their overall quality of life. At Healthpointe, a medical doctor, physiotherapist, and psychologist work together as a treatment team to help patients achieve their treatment goals.

The goals of the Functional Restoration Program are to help patients increase activities of daily living, improve physical functioning, facilitate return to work, decrease emotional suffering, decrease pain, and decrease pain medication.

Functional Restoration Program New Website

Those suffering from chronic pain are often prescribed opioids—a drug effective in relieving pain. However, opioids can be dangerous when used for lengthy periods of time, and they can lead to overt negative effects such as opioid addiction, overdose, and death. The Functional Restoration Program is designed to steadily wean patients off of opioid medications, while improving chronic pain coping skills.

The Functional Restoration Program is perfect for injured workers and all other patients suffering from chronic pain. The program is led by Levon Margolin Ph.D. and Roman Shulze M.D. These doctors at Healthpointe work closely with every patient, modifying their personal treatment plan based on the type of injury, medication, and overall desired outcome—ensuring the best results.

“I’m excited to be expanding upon our clinic’s pain management program,” says Healthpointe’s Dr. Ismael Silva. “The Functional Restoration Program will provide a huge leap forward in patient recovery. I trust that under Dr. Margolin and his team’s caring hands, the lives of many patients will be greatly improved.”

For more information about Healthpointe’s services, please call 888-956-2663 or simply schedule an appointment by visiting their website at

Car Crashes: The Psychological Effects

Car Crashes: The Psychological Effects

You are likely to be involved in an automobile accident every 18 years. According to this article on Forbes, that means you will on average experience 3 to 4 car crashes in your lifetime. Among the general consequences of car crashes, some of the most debilitating effects end up being psychological in nature, as even after the physical injuries have healed, the psychological trauma will usually remain. Here are the psychological effects of car crashes, their implications, and the methods in which they are treated.

Potential Psychological Effects of Car Crashes

According to this study, car crashes that result in physiological conditions such as whiplash, spinal cord injury, and traumatic brain injury, show evidence of elevated levels of psychological distress. Further studies of MVC (motor vehicle crash) survivors concluded that:

• 21%-67% experience depressive mood.
• Up to 47% experience elevated anxiety and driving phobia.
• 20%-40% suffer post-traumatic stress disorder (PTSD).

Additionally, high levels of pain and fatigue have been found in people suffering from a traumatic brain injury (TBI) and spinal cord injury (SCI)—ultimately leading to a reduced quality of life. To make matters worse, it is found that “when MVC-related injury results in psychological distress, medical and rehabilitation costs have been found to double.”


In regards to experiencing depressive mood, any persistent feeling of sadness or lack of interest is usually characterized as major depressive disorder—leading to a wide range of behavioral and physical symptoms. Such symptoms may include:

Mood changes: such as hopelessness, loss of interest, general apathy, and sadness.
Physiological problems: like fatigue, loss of appetite, and/or excessive hunger.
Changes in behavior: irritability or social isolation for instance.
Changes in weight
Sleeping changes: insomnia, excess sleepiness, or restless sleep for example.
Suicidal thoughts

In general, treatment for depression usually consists of taking medication, or engaging in talk therapy—if not both. The most common medication for depression is a selective serotonin reuptake inhibitor (SSRI), an antidepressant. One of the most common therapies is cognitive behavioral therapy.

Car Crash and Psychological Impact


Anxiety disorder is usually presented through feelings of worry or fear that are strong enough to interfere with an individual’s daily activities. Usually self-diagnosable, anxiety symptoms include feelings of stress that are considered out of proportion to the triggering event, restlessness, and the inability to set aside one’s worries. Other symptoms may include:

Physiological experiences: such as sweating, fatigue, nausea, palpitations or trembling.
Behavioral changes: irritability and hypervigilance for instance.
Mood changes: like excessive fear, worry, and feelings of impending doom.
Cognitive changes: racing or unwarranted-thoughts, and a lack of concentration for example.

Most often, treatment for anxiety includes some form of counseling or medications, like antidepressants for instance. There are also paths for self-care that you can take, such as avoiding alcohol and reducing your caffeine intake. Engaging in physical exercise is also a great choice.

PTSD (Post-Traumatic Stress Disorder)

Post-Traumatic Stress Disorder, is a type of anxiety, presented through an individual’s inability or difficulty in recovering after witnessing or experiencing a terrifying or traumatic event. This experience may last for months or even years, and there are usually triggers that can bring forth unpleasant memories of the trauma, as well as the intense emotional and physical reactions associated with it. General symptoms can include unwanted memories of the trauma, avoidance of triggers, and anxiety. Other symptoms may include:

Mood changes: such as feelings of guilt or loneliness, as well as a loss of interest, and emotional detachment.
Sleep changes: like insomnia and nightmares.
Behavioral changes: hostility, self-destructive behavior, social isolation, hypervigilance, and irritability for instance.
Physiological experiences: such as flashbacks to the event, severe mistrust or anxiety, and fear.

For the most part, PTSD is treated through medications that manage symptoms as well as trauma-focused psychotherapy. The most common medication for PTSD is a selective serotonin reuptake inhibitor (SSRI), and one of the most common therapies is cognitive behavioral therapy.

At the end of the day, patients may experience any one or a combination of these forms of psychological distress. While not an extensive list, depression, anxiety, and PTSD are the most common instances found to arise from car crashes with their effects afflicting one long after the MVC itself. If at any time you find yourself experiencing one or more of these symptoms, please consider consulting your primary care physician and requesting a visit with a psychologist or psychiatrist.

Medically reviewed by Levon Margolin, Ph.D., MSCP, QME

For more questions in regards to the Functional Restoration Program or to schedule an appointment, please call us at (888) 724-8153.