I nsomnia can be considered a lack of sleep because of poor quality or poor quantity of sleep. Frequently, when we suffer from insomnia, our sleep is fragmented; we experience difficulty falling asleep, multiple awakenings during sleep and difficulty falling asleep, or we wake up too early and cannot return to sleep. If this continues, the accompanying fatigue and emotional disruption can wreak havoc on our ability to work, maintain a positive outlook, and be productive in our lives.

One or two nights of patchy or nonexistent sleep can have you wondering if you have insomnia. After a week or so, you know there is a problem. The issue now is what to do about it. Insomnia affects approximately 25% of Americans every year. It is characterized by an inability to fall asleep and/or stay asleep. There are several treatments for insomnia depending upon severity. These include:

• Medication
• Lifestyle Changes
• Behavior Therapies
• Sleep Restriction
• Light Therapy

While there are a variety of different treatments for insomnia, cognitive behavioral therapy is effective and does not require drugs, making it one of the first courses of action when insomnia rears its head.

What Causes Sleep Problems? 

Sleep disturbances like insomnia can cause, result from, or simply exist alongside, other conditions. As such, it is important to distinguish exactly what is causing the problem, and to address it completely. OptiMindHealth providers will often work together to address insomnia by utilizing a combination of behavioral strategies, and sometimes medical therapies designed to provide symptom control and longer term maintenance of healthy sleep patterns.

What is Cognitive Behavioral Therapy?

Cognitive behavioral therapy is a structured psychotherapy program that treats mood disorders and the issues that follow, such as insomnia. These types of programs attack negative thought patterns and actions and challenge their origins.

Breaking down the adverse thoughts about yourself and the world you live in influences negative and self-destructive behavior. The goal is to replace the behavior that keeps you awake with healthy habits that promote good sleep. Often called CBT-I, cognitive behavioral therapy for insomnia is proven to work for even severe cases of insomnia by identifying and replacing the thoughts and behaviors that keep you from getting the sleep you need.

When Should I Get Help?

About 10% of insomnia is problematic enough to cause perceived daytime impairment or distress (1). There are a variety of treatment options for insomnia, both medication based and otherwise. Examples of non-medication based treatment include sleep hygiene, relaxation, and cognitive-behavioral therapy. In fact, according to the American College of Physicians, cognitive-behavioral therapy for insomnia (CBT-I) is recommended as the initial treatment for long-term insomnia (2). Other interventions in coordination with other medical providers might be required as well, depending on the specific nature of the problem at hand. 

What is CBT-I and How Does it Work?

Cognitive behavioral therapy for insomnia utilizes a two-part approach to tackle sleeping problems. The cognitive part of this type of therapy works to identify thoughts or beliefs that keep us up at night. The behavioral part aims to develop and implicate good sleep habits and behaviors.

A big part of insomnia is the constant flow of negative thoughts that go through our minds when we lay down to sleep. It often feels like we activate a switch just by laying down for the night. Our brains take that as a sign to begin ruminating over the day’s events, past situations, future circumstances, and conversations you should have or plan to have. These thoughts run through your mind constantly and suddenly you find its morning and you’ve barely slept a wink.

Cognitive behavioral therapy for insomnia is a time-limited treatment choice that helps reduce insomnia and addresses psychological stressors. CBT-I usually lasts four to eight sessions and each session is organized with techniques and skills building to help you improve sleep. Your counselor will work with you to complete and review sleep patterns in order to identify behaviors that lead to poor sleep. Using a systematic approach, the goal is to decrease the amount of time spent lying awake in bed. Additionally, education and skills building to promote healthy sleep habits is offered throughout the course of CBT-I work.

Elements of Cognitive Behavioral Therapy for Insomnia

Cognitive behavioral therapy for insomnia is applied using several techniques. These include:

• Sleep Restriction
• Stimulus Control
• Relaxation Training
• Biofeedback
• Sleep Hygiene
• Sleep Environment Improvement
• Passive Awake State

Typically, the most effective treatment approaches include the use of more than one technique, described below:

Sleep Restriction

Spending too much time in bed awake can lead to poor sleep. The sleep restriction technique reduces the time spent in bed as well as the time available to sleep. Missing a little sleep makes you more tired the next night.

Stimulus Control

Removing the factors that generally keep you awake has a great effect on sleep. Avoid naps and set a strict bedtime and wake time. Leave the bedroom after 20 minutes of insomnia and do not return until you feel sleepy. All of these actions may be employed with the stimulus control technique.

Relaxation Training

Muscle relaxing, meditation, imagery, and yoga are all forms of relaxation training. These techniques train your mind and body to relax at bedtime. When you begin to put these tips to work, your body eventually realizes this happens at bedtime and begins to calm down and ease into sleep.

Biofeedback

You can use biological signs such as muscle tension and heart rate to identify sleep issues. A sleep specialist can view the results of a biofeedback test and show you how to adjust them to encourage healthy sleep.

Sleep Hygiene

Smoking, alcohol, caffeine, and lack of exercise all impact the amount and quality of sleep you are able to get. Sleep hygiene therapy involves changing lifestyle choices that have a negative impact on sleep. Don’t drink alcohol or caffeine before bed. Get enough exercise during the day and stop smoking to improve sleep patterns.

Sleep Environment Improvement

The room you sleep in has a lot to do with the quality of sleep you are getting. Improve the sleep environment by removing televisions and covering LED clock displays. Keep the room as dark, quiet, and cool as possible to get the best sleep.

Passive Awake State

Worrying about falling asleep can keep you awake. Therapists use a technique called paradoxical intention for insomnia. During this activity, you try to stay awake. You fight any feeling of tiredness to remain awake for as long as you can. Sleep begins to occur more naturally when the performance anxiety to fall asleep at a certain time is diminished.

Getting Help

Practically anyone with a sleep issue can find some relief with cognitive behavioral therapy for insomnia. It is helpful to those suffering from primary insomnia as well as those with physical symptoms such as chronic pain or mental issues such as anxiety or depression. The effects of cognitive behavioral therapy for insomnia generally have lasting effects and pose no significant known risks, making the treatment approach a safe and effective one for many who struggle from insomnia. 

Sleep medicines are effective as a short-term remedy in certain situations after a careful exploration of risks and benefits has taken place taking in consideration your goals. Medications work best when you just need relief during stressful times. The death of a loved one, divorce, or losing your job are examples that could cause short-term sleepless situations where medications can be helpful. Cognitive behavioral therapy for insomnia is useful for situations where long term insomnia has been an issue. People who are worried they will develop a medication dependency and those who have adverse side effects with medications will find cognitive behavior therapy most useful.

Experiencing insomnia, even for a short while, can have a traumatic effect on all facets of your life. Seeking the guidance of an experienced counselor is the first step to getting back to the restful sleep you need to thrive. Make sure whoever you chose to help you has training and experience in cognitive behavioral therapy for insomnia. 

OptiMindHealth invites you to contact us to schedule a consultation with one of our experienced providers in sleep matters. Our highly trained staff looks forward to helping you overcome your battle with sleep and learn to fall asleep in a healthy, fast way. An OptiMindHealth provider skilled in delivering CBT-I interventions can help you with improving sleep, reducing your dependence on sleep medicines, and improving your general sense of well-being by helping you get the rest you need at night. Request an appointment today to find out more about how CBT-I and other treatment options for insomnia could help you. 

(1) National Institutes of Health State of the Science Conference statement on Manifestations and Management of Chronic Insomnia in Adults, June 13-15, 2005.

(2) Guidelines Committee of the American College of Physicians. Management of Chronic Insomnia Disorder in Adults: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2016;165:125-133.

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