Cognitive Behavioral Therapy for Insomnia

Cognitive Behavioral Therapy (CBT) is a form of psychotherapy in which people learn to challenge their beliefs, thoughts, and actions that cause problems in life. CBT is rooted in the idea that life’s problems and challenges are made worse by our distorted beliefs about them. In other words, our malformed thinking about insomnia generates unhelpful behaviors that interact and make insomnia even worse.

Treatment Options For Insomnia

Before we go into the details of Cognitive Behavioral Therapy (CBT) and insomnia, I would like to give you a brief overview of the different treatments that can help you improve your sleep habits.

  • Sleep routine – having a healthy sleep routine is the first step to getting a great sleep.
  • Relaxation – yoga, meditation or simple deep breathing. Any of these techniques can help you maintain mindfulness and purge stresses from your body. It’s a great way to relieve anxiety before you slip under the comforter.
  • Sleep restriction – this is a method that is designed to improve your sleep efficiency. So, it simply aims to restrict how much time you spend in your bed awake. So, if you spend 7 hours in bed, but you only sleep for five of those you should only spend five hours in bed. You can increase this as you sleep through the night. There are no naps, or early nights involved. It’s a strict process. It’s based on your sleep patterns and habits, though, so this is generally something that is done with a practitioner.
  • Herbal remedies – your body naturally produces melatonin, sadly, sometimes it just isn’t enough. You can purchase this from your local pharmacy or try another herbal remedy like valerian root. It may be that this is your first stop before you see your doctor for a more intense medication. Generally speaking, three nights of good sleep should help you form your sleep routine.
  • Medication – for serious sleep problems, your doctor may want to prescribe a medication that will promote sleep. You don’t want to become reliant on these drugs. However, short-term use of these may help you get your sleep routine back on track. Typically, doctors do not want you to take these types of medications any longer than a couple of weeks.
  • Exercise – regular exercise can promote an improvement in sleep quality.
  • Light therapy – this is often used to help people with delayed sleep phase syndrome. This is when someone struggles to get to sleep within the conventional bedtime, with a delay of two hours or more. This, of course, makes it difficult to rise at the desired time as well.
  • CBT – cognitive behavioral therapy is effective in helping you eliminate, or at least control, any negative thoughts or worries that may be keeping you up.

What is CBT-I

CBT-I uses the techniques and methods of Cognitive Behavioral Therapy to treat primary insomnia. Primary insomnia means that the sleep disorder is not related to any other mental or physical illness or environmental condition. CBT-I is a solution-oriented therapy. It doesn’t delve into a person’s past to find deep-seated referents. Instead, CBT-I aims to reduce insomnia and increase positive sleep behaviors by identifying and changing thoughts and behaviors that conflicting with getting a good night’s sleep.

Like all behavioral therapies, CBT-I starts with an inventory of the person and environment. People come into therapy with a set of problems and their ideas about those issues, but they don’t exist in a void. With CBT-I, starting with the basics is essential.

What is the process of CBT-I

First, the patient visits a physician to rule out any physical condition or illness that’s contributing to or causing insomnia. CBT-I only works with primary insomnia. Primary insomnia is non-biogenic; that is, it doesn’t result from a purely physical disorder or illness.

Next, the patient keeps a sleep journal for several days. The longer the journal, the more troublesome issues can be rooted out. A patient’s sleep journal helps the therapist identify patterns of thoughts and behaviors surrounding sleep over a brief period.

Once the general pattern of insomnia is identified, therapists have several techniques available to treat insomnia, including:

Sleep hygiene

The environment in which the patient sleeps must be conducive to restful sleep—cool, clean, and quiet works best. Sleep-harming activities like vigorous exercise, physical labor, or emotionally charged mental activity must be eliminated. It’s important to refrain from drinking alcohol or caffeine for at least four hours before bed. Nothing more than a light snack should be eaten within three hours of bedtime.

Stimulus control

Stimulus control re-associates the patient’s bed with nothing but sleep. The patient is to

  • Use the bed only for sleep and sex. No watching tv in bed, no reading in bed, and so forth.
  • Go to bed only when tired and
  • Get out of the bed at the same time every morning.
  • If sleep doesn’t happen within 20 minutes of going to bed, the patient is to get out of bed and move to another room.

Relaxation training

Relaxation training involves teaching the patient methods to increase their feelings of calmness and reduce feels of stress. Stress and anxiety often manifest themselves in the body as tense, tired, and aching muscles. Everyone relaxes differently. Thus it’s a big benefit to have a therapist provide support, encouragement, and training in different techniques. A few of these include:

  • Progressive muscle relaxation
  • Meditation
  • Deep breathing
  • Biofeedback

Why Cognitive Therapy?

Cognitive therapy takes time but can be accomplished while the other treatments are in place and ongoing. Cognitive involves understanding and breaking down the psychological determinants of the patient’s insomnia. Often, people with insomnia catastrophize their sleeplessness (e.g., “If I don’t go to sleep, tomorrow will be an absolute disaster! I’ll make lots of mistakes at work and lose my job.”).

Learning how our behaviors and thoughts interact to make sleep easier and more restful is the heart of CBT-I. It can sound mechanistic, but it’s a faster route to relief from insomnia than any other variant of psychotherapy.

The Importance of Treatment

So, why is it so important to treat insomnia? Well, it could be indicative of a mental health problem. The treatment should be targeted, especially if the initial treatment of a certain disorder hasn’t improved your sleep.

Just 20 years ago, experts would have told you that insomnia was simply a symptom of a more significant problem. While that can still be true, it isn’t as easy as that now. We know that it is recognized as its own issue. It doesn’t always mean there is an underlying mental health problem. The real question is whether it’s a symptom or a risk factor for mental illness. The evidence is strong that insomnia can serve as a risk factor for the development of substance abuse issues as well as anxiety and depression.

If you have experienced insomnia for more than 14 days, then this is considered acute. You have two options here. The first is to do nothing at all. You can choose to tough it out, or you can opt for the second, which is that you visit your doctor for assistance, whether it be medication or advice.

If your insomnia persists and lasts for four weeks, then seeking treatment is wise. It’s always smarter to seek treatment earlier, this will help protect your overall health and wellness. Why go through the pain when you can deal with it immediately?

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