CBT for Insomnia (CBT-I)
What is CBT-I?
- Cognitive-behavioral therapy for insomnia (CBT-I) is a therapeutic technique that implements cognitive strategies to help people overcome insomnia. Therapists using CBT-I implement a structured plan to assess, intervene, and ultimately change your sleep behaviors so that you can get a better night’s sleep, all without the use of medication! This process can take some time; typical CBT-I programs last for about 8-10 weeks, with weekly or biweekly face-to-face sessions with your therapist. The best part is that each plan can be specifically tailored to your needs in a way that optimizes your sleep!
What’re some skills I can learn?
- Improving Routines
- One of the main ways to impact your sleep habits is to create them! Establishing a routine can train the mind and body to know that when you’re in bed, you’re ready to sleep. Try to engage in certain activities that help calm your mind and recenter yourself before bed. This might take some trial-and-error, but designing a bedtime routine that works for you is integral in preparing for a good night’s sleep.
- Re-Condition Yourself
- Help your body realize that where you sleep is only for sleep. This one might be tricky! If you’re doing other things, such as work, watching tv, or even eating, your brain will also associate your bed with those activities.
- Build Your “Sleep Drive”
- Movement is key in building “sleep drive.” Sleep drive is the bank we build over the course of the day that helps us fall asleep at night (think of a balloon expanding as you make deposits to your sleep drive). This means that good sleep starts as soon as we wake up. During the day, your therapist will help you engage in activities that will add to our sleep drive (such as increasing physical activity). One trick to jumpstart your sleep drive is to get up as soon as you wake up in the morning. Its so tempting to don’t hit that snooze button! Your therapist will help you to wake up, put your feet on the ground and get up to start your day. Try leaving a comfy robe nearby to make the transition easier!
Myth: I have difficulty falling asleep, so I have insomnia.
Fact: Difficulty falling asleep is one of four symptoms generally associated with insomnia. The four symptoms are:
- Difficulty falling asleep
- Waking up too early and not being able to get back to sleep
- Frequent awakenings
- Waking up without feeling refreshed
Insomnia can be a symptom of a more serious sleep disorder or other medical problem. Fortunately, insomnia can often be treated! When insomnia symptoms occur more than a few times a week and impact a person’s daytime functionality, the symptoms should be discussed with a health care provider.
Myth: Melatonin and other over the counter sleep aids will help you sleep better.
Fact: When sleeplessness is a short-term problem with a known cause, such as jet lag or a physical injury that keeps you awake during the night, your doctor may feel a natural sleep aid is worth trying. On the other hand, if you suffer from long-term sleep issues, sleep aids may not be very useful, as it is important to get to the heart of the matter.
According to practice guidelines from the American Academy of Sleep Medicine (2017) and the American College of Physicians (2016), there’s not enough strong evidence on the effectiveness or safety of melatonin supplementation for chronic insomnia to recommend its use. The American College of Physicians guidelines strongly recommend the use of cognitive behavioral therapy for insomnia (CBT-I) as an initial treatment for insomnia.
Myth: Exercising before bed will always disturb your sleep
Fact: Exercising before bed might actually help fill up your metaphorical balloon and build your sleep drive. Here, it’s important to remember that everyone’s bodies are different! For some folks, exercise tends to be a stimulating activity, which would make it more difficult to fall asleep. For others, though, exercising helps you engage in more movements which can ultimately lead to a higher sleep drive when the day is ending. Understanding how exercise impacts your body might take some experimenting, but it’s helpful to know in order to impact more satisfying sleep.
Myth: You can catch up on sleep by sleeping in
Fact: When you sleep in, you actually make it more difficult to establish a healthy sleeping pattern. Think back to your sleep drive: if you sleep in but still plan to go to bed at your normal time, you’re actually giving yourself less time to fill up your balloon. Experts recommend “following the routine not the emotion” and getting up at your normal time. Though it might be a challenge, you’ll set yourself up for success to fall asleep later on that night.
Myth: If you’re having trouble sleeping, you have insomnia
Fact: Insomnia is just one of a variety of different sleep concerns. Insomnia is most often categorized by trouble falling asleep and staying asleep. Sleep apnea, which can certainly impact one’s ability to fall asleep and stay asleep, occurs when an individual’s breathing tends to start and stop sporadically throughout the night. Sleep apnea is often accompanied by snoring and fatigue. This type of sleep disorder requires a sleep study to be conducted in order to diagnose.Others might also suffer from Delayed Sleep-Phase Syndrome, which occurs when your internal circadian rhythm does not align with the typical sleep-wake cycle. All of these conditions might impact quality and duration of sleep. It’s important to start treatment by assessing the exact sleep concern in order to know if CBT-I is the right course of treatment for you!