Cognitive Behavioral Therapy for Insomnia

For so many individuals, sleep seems like one of the most elusive needs of our time. With an ever-increasing degree of time-efficient demands, continuous connectivity to the world, and an internet-driven pace, insomnia has become much more prevalent world-wide. This is evidenced further by the huge increase in both over-the-counter sales and prescription sales of sleep hypnotics in the last two decades. Unfortunately, almost all of the remedies have significant side effects, a limited time of effectiveness, or more importantly, a high risk for dependency for sleep. While medications may be the best for short term insomnia difficulties, long term insomnia is best addressed by behavioral interventions. This is where Cognitive Behavioral Therapy, or CBT, has made a tremendous impact in providing lasting relief for may sleep loss sufferers.

CBT basically addresses a person’s behavior through providing education and establishing better sleep habits. Usually, this is provided to an individuals through several sessions (varying from 4 to 12) usually lasting about 30 minutes by a qualified sleep professional. Most commonly this is a psychologist with special interest in insomnia, but nurse practitioners, physicians, psychiatrists, and others that direct patient care can also provide CBT if specially trained. In the process, misconceptions and misinformation about sleep in general are eliminated, and better sleep hygiene is developed.

Whether poor sleep ideas are developed intuitively or through other sources of incorrect information, detrimental beliefs about sleep can promote and perpetuate insomnia. For instance, some people may believe that if they go to bed earlier, they have a better chance of getting more sleep. In actuality, however, this has the opposite effect as going to bed earlier only decreases the chance of falling to sleep. This is because the body’s circadian rhythm, or daily bio-rhythm, has a window of time that is optimal for sleep onset and trying to fall asleep outside of this window only creates frustration and anxiety further worsening insomnia. Another example is that many people may hold a belief that they need at least 8 hours of sleep to feel rested. While the majority of us need 7.5-8 hours of sleep each evening, the range is from 4 hours to 10 hours for various individuals. If someone that requires only 5 hours of sleep continues to try and obtain 8 hours, there can be unnecessary stress associated with this perceived sleep loss.

CBT first targets accurate information about an individual’s sleep and sleep needs and educates them on factual aspects about sleep in general. After a detailed sleep history is obtained, some of these discrepancies are brought to light and corrected through discussion and examples. Then at each subsequent session, these areas are again discussed to reinforce adherence to the newly learned concepts.

Secondly, CBT also looks at general sleep habits, which are usually referred to as sleep hygiene. Sleep hygiene describes beneficial behaviors and negative routines that can affect one’s sleep ability. Areas covered include the sleep environment, sleep schedules at night, daytime napping, amounts of stimulating foods and beverages consumed, overly rigid bedtime routines, general health behaviors, timing of exercise, and many others. A common example of this is that many sufferers try and fall asleep, but despite being unable to do so, continue to lie in bed hour after hour watching the clock. Positive sleep hygiene encourages you to get out of bed after 20 minutes or so if sleep is not obtained, and then participating in a sleep-promoting behavior like reading. Once you are feeling drowsy again, another attempt to fall asleep is tried. By continuing to lie in bed, anxiety builds thus making sleep even less likely to occur. Once again, educating an insomniac about positive and negative effects of behaviors on sleep provides an understanding upon which to change the behavior, thus establishing a long lasting therapy for their insomnia.

Insomnia is a condition that indeed becomes more common with age as the brain’s mechanisms for falling asleep and staying asleep become less robust. In addition, many people have a genetic tendency to be “hyper-alert”, and have greater difficulty sleeping regardless. Even in some insomniacs who do require supplemental medication for sleep, CBT can provide the best template upon which these can be effective. Cognitive Behavioral Therapy also can identify concurrent problems with depression, anxiety, and other physical problems that may need separate attention through other measures. If other conditions do exist, these will need to be addressed concurrently. In this regard, CBT offers the most comprehensive approach to date for addressing insomnia long term by providing a foundation of knowledge and direction for behavior that enables the insomniac to maintain good quality sleep.

Sleep Disorders

Dyssomnias

Parsomnias

"It’s been a hard day’s night
I’ve been workin´ like a dog
It’s been a hard day’s night
And I’ll be sleepin´ like a log…. "

(John Lennon and Paul McCartney)