So many Americans, myself included, struggle to get a good night’s sleep.
Sometimes sleep problems are transient. Illness, a new baby, shift work, anxiety, grief, or many other life events can cause us to lose sleep.
But if the occasional night of wakefulness turns into weeks or months of sleepless misery, that’s insomnia. Insomnia is a physical condition that should be taken seriously and treated with the help of a professional.
What causes insomnia?
Sleep seems like it should be the easiest thing to do, doesn’t it? At least until you can’t.
It’s a complex process that’s also very sensitive to disruption. Sleep craves routine, and our lifestyles often aren’t conducive to getting a good night’s sleep.
Irregular sleep schedules, electronics, light, noise, stress, alcohol, and caffeine all play a part in wrecking our sleep.
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For many, insomnia is a self-perpetuated problem.
For example, if we don’t sleep well at night, we may nap the next day or go to bed an hour or two earlier. Although this sounds sensible, messing with sleep routines is actually counterproductive.
Or perhaps we have an anxious personality, and toss and turn all night worrying about what will or won’t happen to us the next day. Frequently we insomniacs just fret about not sleeping 😟
What eventually happens, however, is that we associate our beds or bedrooms with feelings of anxiety, frustration, and misery. We start to dread the upcoming night, which creates a truly vicious cycle of nighttime sleeplessness and daytime sleepiness.
For these people, CBT-I can help.
What is Cognitive Behavioral Therapy for Insomnia?
Cognitive Behavioral Therapy for Insomnia, or CBT-I, is one of the most effective tools in the sleep medicine doctor’s toolbox.
It’s typically a 6-8 week program that changes the poor sleep habits and thoughts that perpetuate insomnia.
Cognitive Behavioral Therapy for Insomnia challenges these dysfunctional habits and beliefs using:
- a sleep diary—recording when you go to bed, how long it takes to get to sleep, the hours spent sleeping versus overall time in bed, when you wake up, and when you drink coffee or alcohol.
- sleep restriction therapy—limiting the amount of time in bed, which increases the sleep drive through sleep deprivation. Strictly limited at first, time in bed is gradually increased over several weeks.
- stimulus control—re-framing your thoughts to associate your bed with sleep rather than wakefulness. The basic rule is if you’re not sleeping, get out of bed, leave the room, and do a quiet activity like read a magazine until you feel tired enough to go back to bed.
- sleep hygiene—using basic good sleep habits such as regular bedtime and wake time, limiting alcohol and caffeine, keeping the bedroom cool, avoiding electronics before bed, and eliminating light sources in the bedroom. Although sleep hygiene can support good sleep, these tips alone aren’t effective if you have insomnia.
- relaxation therapy—using yoga, deep breathing, or guided meditation to decrease the body’s stress response and induce sleep. Like sleep hygiene, relaxation techniques can help, but aren’t enough to combat insomnia.
Learn more about CBT-I
If you’re suffering from chronic sleeplessness, talk to your primary care doctor or make an appointment with a sleep medicine specialist. (Before seeing a specialist, always check with your insurance company to make sure you don’t need pre-approval for the visit!)
Rather than immediately writing a prescription for a sleeping pill (which are only marginally effective and have LOTS of side effects), most sleep docs prefer to use CBT-I as a first-line treatment.
CBT-I is highly effective, and unlike sleeping pills, it continues to work long after the patient has stopped treatment.
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For CBT-I to work best, however, patients need to be motivated and commit to the time and effort involved.
If you want to learn more about CBT-I before you decide, check out the National Sleep Foundation, or pick up one of these books at your local library.
For the tech savvy, there are several internet-assisted CBT-I programs. These are effective, and useful if you live in an area that doesn’t offer sleep therapists.
If you just want to try out a few Cognitive Behavioral Therapy for Insomnia techniques on your own, here are my tips for CBT-I “light.”
- Reduce the time you spend in bed.
- Don’t go to bed unless you are sleepy.
- Don’t stay in bed unless you are asleep.
- Get up at the same time every day.