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.
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.