Cognitive Behavioral Therapy for Insomnia (CBT-I)

By: Suzanne Feinstein, PhD

It is estimated that between 50 and 70 million Americans have trouble falling asleep, staying asleep or obtaining quality sleep each night. This can stem from various issues, such as past trauma, obesity, health-related issues, and stress.

Insomnia can lead to a large number of physical and psychological problems. It can be difficult to overcome insomnia on your own without major lifestyle changes. Cognitive behavioral therapy has been shown to be an effective evidence-based approach for combating insomnia. In this article, we have constructed a helpful guide with key details on how cognitive behavioral therapy can aid in breaking the disordered sleep cycle. 

Stimulus Control

One of the most optimal ways of improving insomnia-related issues is to break the negative association between wakefulness and the bedroom. By controlling the amount of alerting stimuli in the environment, the mind and body can be retrained to unwind, relax and let go of the fear, frustration and dread of bedtime.

Decreasing the amount of sensory stimulation at night is one method of calming an overstimulated brain. Instead of screentime, brightly lit rooms, or loud environments, lowering pre-bedtime arousal levels can help cue the body that it’s time to wind down. Limiting technology and retreating to a quiet, dimly lit, private space can help reset the brain and support positive sleep habits. 

Listening to soft music, reading, and drawing are all calming pre-bedtime activities that can help people with sleep disturbances. Weighted blankets, warm milk or tea, comfortable bedding, and white noise machines are a few more ways to shift the stimuli in the environment to promote healthier sleep habits.

Sleep Restriction

As the name suggests, sleep restriction involves reducing the amount of time spent in bed. Essentially, the bed remains off limits unless it is strictly for the purpose of sleeping and sex. Since both activities are beneficial in reducing anxiety and promoting happiness, they assist in training the brain to make positive associations with the bed and a solid night of sleep.

By eliminating naps, keeping a record of sleep patterns, calculating the average number of hours you sleep per night, and maintaining a routine bedtime and wake time, you can set realistic sleep goals and break the frustrating cycle of insomnia. Once a more desired sleep schedule is underway, you can gradually increase the time in bed until you find an optimal amount of hours that work for you. 

It is important to remember that getting more sleep doesn’t always equal better rest. Additionally, not everyone requires the same number of hours of sleep. Some people function better on 8 hours of sleep and some find 5 or 6 hours to be adequate. 

Cognitive Restructuring

Cognitive restructuring requires people to change the distorted, negative and non-productive ways in which they think about sleep. People with sleep difficulties often worry excessively about how a lack of sleep can trigger health problems, traffic accidents, anxiety or depression. They fear that a lack of sleep can hinder their mental focus in school, at work, in sports, or in their personal relationships. They may even ruminate about how their inability to sleep may be untreatable and permanent. This worry triggers a stress response that perpetuates the chronic insomnia. 

By identifying the faulty thinking, and subsequently replacing it with more adaptive and positive thoughts about sleep, you can decrease the anxiety and negativity that triggers the nervous system response. This restructuring of thoughts is a powerful tool in improving insomnia.

Cognitive restructuring can be applied to various other aspects of your life. For instance, by changing your thought patterns surrounding your job, romantic relationships, and friendships to more positive ones, you can ultimately feel more empowered, less stressed, and as a result sleep better at night.

Relaxation Training

Progressive muscle relaxation is a highly effective technique in training the mind and body to work together to let go of daily tension. By focusing on tensing and relaxing isolated muscle groups in combination with coordinated breathing exercises, your body and mind will release more and more into a state of calm. This relaxation technique helps with overall emotional regulation and can be used both day and night.

Slowing down breathing, learning to breathe from the abdomen, and releasing fully through each exhale slow down the heart rate, lowers blood pressure, promote better circulation and helps us fall asleep. 

In addition to breathing and muscle relaxation, it can be helpful to unwind a couple of hours before bedtime with ambient music, a warm bath, or calming scents like lavender, jasmine, rose, and chamomile.

Using Cognitive Behavioral Therapy for Insomnia

If properly utilized, cognitive behavioral therapy is a first line treatment for managing insomnia. It promotes healthy lifestyle habits and can have lasting effects.

CBT recommendations include changing sleep routines, such as setting specific sleep and wake times, limiting the amount of time in bed, and eliminating napping. Therapy suggests lifestyle changes such as eliminating smoking, consuming too much alcohol, eating a balanced diet, limiting caffeine, and exercising regularly. You will also learn relaxation techniques along with a variety of sleep hygiene strategies.  

Finding a Professional

Finding a skilled professional who you feel comfortable with is an essential first step in combating insomnia. It is important the clinician has extensive knowledge in CBT and will take the time to answer any of your questions and concerns about the therapy process before scheduling an initial appointment. Ask them how they typically assess, evaluate, and treat sleep disorders, as well as the length of expected treatment, the fee structure, and how to navigate the insurance process.

Advanced Behavioral Health specializes in cognitive behavior therapy for insomnia(CBT-I). We strive to exceed all expectations and help our patients get their lives back on track. You’ll learn more about the benefits we provide when you get in touch with us today.

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