CBT-I for sleep: learn how to fight insomnia
CBT-I for sleep helps chronic insomniacs sleep well again. If you’re reading this, I’m sure you know what a sleepless night feels like. Maybe you even have intimate knowledge of how awful chronic insomnia can be. When you’re stuck in the cycle of insomnia, you can’t imagine the future being anything other than one filled with stressful, sleepless nights. The tossing and turning each night, and never knowing when you’ll get another good night's rest.
Not only are the nights bad, but you are probably feeling tired all day. You might even worry about the toll it’s taking on your mental and physical health, or question its impact on work, marriage, and other relationships.
By the time our clients come to us, they’re desperate. Thankfully, we are experts in a treatment called Cognitive Behavioral Therapy for Insomnia (CBT-I), a type of therapy that offers better sleep.
CBT-I for sleep: how can it help?
When our clients come to us, many of them have been struggling with the symptoms of insomnia for months, sometimes years. They’re having trouble sleeping, both falling and staying asleep. For some people, the issue lies at the beginning of the night; they struggle just to fall asleep. For others, they wake up in the middle of the night, over and over again.
Others might be waking up really early in the morning, or their poor sleep quality might not feel restorative enough, even if they’ve gotten a “normal” amount of sleep. Regardless of what point in the night it’s happening, people with insomnia often experience daytime fatigue, mood issues (grumpiness, anxiety, feeling down). On top of that, most are tired of the stress of not sleeping and feeling really frustrated and stuck.
CBT-I helps our clients break out of the cycle of struggling to sleep and then stressing over not being able to sleep, which then makes getting to sleep even harder.
Cognitive Behavioral Therapy for Insomnia is the gold standard of insomnia treatment.
Over the short term, it’s as effective as sleeping pills, and long-term, it’s more effective and leads to better sleep quality as time goes on. The research has shown no negative effects in the long term from successful CBT-I treatment.
What does CBT-I for sleep look like?
Cognitive Behavioral Therapy for Insomnia is highly effective because it targets and treats the common sleep difficulties that most people with insomnia face. But it’s also individualized.
The core components of CBT-I are;
Sleep restriction therapy- The name of this procedure is somewhat misleading, because it includes restricting the amount of time that the person spends in bed awake; it isn’t restricting sleep time. The goal of sleep restriction is to consolidate sleep and reduce the amount of time that it takes to fall asleep, as well as the number of times you wake up throughout the night.
Stimulus control- Insomnia has a way of making you hate your bed, because it is associated with a lot of frustration and wakefulness. Stimulus control is a way to make sure that you begin to reassociate the bed with sleep, rather than frustration and alertness. You do this by limiting the amount of time you spend in bed awake and doing other activities.
Cognitive restructuring- When you aren’t sleeping well, your mindset can really suffer. Thinking about sleep brings on negative thoughts, feelings of frustration, and even anxiety. These negative thoughts/feelings can actually make it harder to sleep. Cognitive therapy techniques help to reduce the unhelpful thoughts and feelings around sleep that are impacting your ability to sleep.
Sleep hygiene education- This includes education about how to optimize your sleep environment, establish good sleep habits, including listening to your biological clock, and creating a regular bedtime routine.
Relaxation techniques- These techniques lower both physical and mental stress. Some examples of things that you might learn are progressive muscle relaxation and deep breathing exercises.
With the support of a CBT-I therapist, you will learn to utilize all of these techniques to improve your sleep and your life.
What to expect in CBT-I treatment
You might be wondering what this might look like in practice.
If I start CBT-I, what will this look like in my life?
CBT-I typically lasts between 4-8 sessions (but everyone is different!). These sessions happen every week or every other week, depending on where you are in your treatment plan. Each session is 50 minutes.
You’ll start with an assessment period where your therapist will get to know you and your particular sleep difficulties. During this time, your therapist will also be making sure to rule out any other potential causes of your sleep problems, like other sleep disorders or circadian rhythm disorders. Your later sessions will focus on implementing the techniques described above and tailoring them to your life.
Between sessions, you’ll track your sleep timing, duration, and quality in a sleep diary. This will help you to see your progress. It’ll also help both you and your therapist see the places you struggle and work to make improvements.
Making changes can be hard, and some people find that the beginning of treatment can be hard. Making these changes in sleep can cause you to feel extra tired. This can be scary, but it’s part of the process, and before you know it, you’ll be sleeping better. As your sleep gets better, we’ll slowly work towards maintaining these improvements and graduation from treatment.
Here are a few more specifics about some of the techniques used in CBT-I that you might be wondering about.
Sleep restriction: why it works
Sleep restriction is decreasing the amount of time you spend in bed to increase the quality of sleep that you get.
Your therapist will be your guide on when to get in bed, wake up, and the amount of time you try to sleep. Changing your sleep schedule can highlight how little sleep you’ve been getting despite spending quite a bit of time in bed.
The good news: most clients experience better sleep quality within the first week.
Often during the first stage, our clients are quite sleepy as they’re adjusting to the changes. But as time goes on, and you’re getting better sleep, our goal will be to make gradual changes to the amount of time that you spend in bed.
Going slowly ensures that these changes will be lasting. Your wake time in the middle of the night will decrease. Long-term, it helps you sleep better and longer.
A huge added benefit is that limiting the amount of possible time to sleep resets the circadian rhythm that was thrown off by insomnia.
Addressing anxiety around sleep
Sleep anxiety (think of this like sleep performance anxiety) occurs when someone who is having trouble sleeping becomes stressed about being able to fall asleep.
Sometimes this can look like counting down the hours or minutes left to sleep and worrying about whether or not said sleep will occur. Other times it looks like fixating on how terrible tomorrow will be if you don’t get enough sleep tonight.
The problem is that this sleep anxiety causes the body stress, which makes it even harder to fall asleep or return to sleep.
So the person’s worry about getting to sleep works against them.
Cognitive therapy techniques help with the negative thoughts mentioned above.
You learn to confront these thoughts in a way that reduces their impact on your sleep.
Overall, these techniques help you change your relationship with sleep so it isn’t something you dread anymore. They help you learn to trust your body’s ability to sleep again.
How long does CBT-I for sleep take to work?
If you’ve been struggling with insomnia, you’re probably wondering how long it takes for CBT-I to make a difference in your sleep patterns.
Many clients see some initial improvement in their sleep within the first or second week of treatment, even with an initial increase in tiredness. As treatment goes on, falling asleep becomes easier, there are fewer middle-of-the-night awakenings, and sleep quality continues to improve. For most, by 6-8 weeks, treatment comes to an end, and they’re ready to graduate from the program with no insomnia.
Some people see immediate improvement and only need 4-6 weeks of treatment, whereas some people need a little bit more time. Either way, our clients start experiencing better nights relatively quickly.
What if I’m taking medications for sleep?
There’s no need to make any changes to your medications before you come to see us. During your first visit, we will discuss which medications you take and talk about your goals. Some people decide that they want to start CBT-I first, then gradually taper off medications, while others decide not to stop medications at all. The choice is entirely up to you and your medical providers. We will work with you and your doctor to decide the best plan for you.
What happens after treatment ends?
The research shows that CBT-I maintains its progress with insomnia symptoms long-term better than medications or other treatments. But this doesn’t mean that once you’ve graduated from CBT-I, you will sleep perfectly every night.
You will still have a bad night here and there, because life isn’t perfect. But you will know what to do to get it back on course. Further, your sleep anxiety will not contribute to your lack of sleep anymore. You will know how to cope with that.
You’ll be able to trust the skills you’ve learned so that you can get back to sleep and won’t get stuck in an insomnia cycle again.
If you do have another period of long-term sleeplessness, a booster session is available to help you remember your skills and get back to sleeping well. If that’s you, contact us here.
What sleep problems does CBT-I help with?
CBT-I is an effective treatment for chronic acute insomnia, but this isn’t the only kind of insomnia that it works for.
It also helps with insomnia related to mental health conditions like;
Anxiety
Depression
Bipolar disorder
Post-traumatic stress disorder (PTSD)
It doesn’t just help with falling asleep, but also helps you to sleep through the night. It helps with learned insomnia and sleep issues resulting from shift work or some co-occurring medical conditions like chronic pain.
It can even help decrease dependence on sleep medications.
Does CBT-I help every sleep problem?
While CBT-I treatment can be helpful, it doesn’t work for everything. There are several sleep issues that CBT-I can’t help with unless the person is being medically treated as well.
Some of these concerns are:
Narcolepsy
Sleep apnea
Restless leg syndrome
If you suspect your sleep problems might be due to one of these conditions or something similar, it’s important to get a medical evaluation from your health care provider. If you’re unsure, don’t worry, our initial assessment will be comprehensive and will allow your sleep therapist to discuss your treatment options and help you evaluate if CBT-I is for you. If it’s not, we will help you figure out how to proceed.
How to find a CBT-I therapist
If you’ve found that do-it-yourself or even digital CBT-I (mobile app) treatments for insomnia aren’t working, it is important that you find a skilled CBT-I provider. Many therapists will say that they treat insomnia, but do not actually have expertise in sleep medicine or CBT-I. When searching for a CBT-I therapist, look for a specialist in behavioral sleep medicine. They’ll be able to provide the support and help you need to sleep better.
CBT-I is the first line of treatment for insomnia and can make a huge difference both short-term and long-term. The changes may take time and effort, but they’re worth doing.
If you’re hoping to get CBT-I for sleep, we can help at Rhythm Wellness.
