Does CBT-I Work? Helpful Tips You Need to Know
If you’ve done any research on sleep therapy, you might be wondering, does CBT-I work?
The sleepless nights are a lot, and when insomnia symptoms are impacting quality of life, often our clients are desperate to find something that will actually help.
Something that’ll help them sleep better regularly.
CBT-I does work. The Society of Behavioral Sleep Medicine, the American Academy of Sleep Medicine, and many other healthcare provider organizations consider it to be the gold standard for insomnia treatment.
We’re going to talk about how it works and some mistakes to avoid.
What does the research show? Does CBT-I work?
As a first-line treatment for insomnia, Cognitive Behavioral Therapy for Insomnia or CBT-I has been shown to be effective. It helps improve the ability to fall asleep, stay asleep, and also assists with sleep quality and sleep efficiency (how restful sleep is).
It’s effective in both the long-term and short-term, and improves psychological outcomes.
When compared with sleep medication, the long-term effects show that CBT-I is the most effective treatment. At the same time, short-term medication can be slightly more effective at addressing lack of sleep, we'll talk about some of the reasons for that in this article.
The research is clear. If you want quality sleep now and in the future, CBT-I is your answer, and your healthcare provider will agree.
How CBT-I helps insomnia
CBT-I isn’t just a surface-level fix like the sleep hygiene advice you'll find online; it also addresses the underlying causes and symptoms of insomnia.
CBT-I worksby retraining your body's sleep-wake cycle. Starting with your sleep schedule.
It also helps with the sleep anxiety cycle. CBT-I uses cognitive therapy techniques to intervene with negative thoughts and thought patterns.
You also change the associations that your body connects to bed and implement relaxation training. This allows you to feel calmer around sleeping and being in bed.
What to expect before you start sleep therapy
The first step to working with most sleep therapists is a free consultation. This is where you meet with a team member over the phone,talk about your sleep issues, and get matched with your perfect sleep therapist (for instance, here at Rhythm Wellness, we have 4 therapists with different areas of expertise).
Next, you’ll start the intake process. With sleep therapy, there’s a possibility that they’ll send you to be assessed by another healthcare professional to rule out any other reasons for your sleep problem (like a medical condition). This is to make sure that CBT-I will be effective.
They’ll also send you paperwork to fill out before your first session. Some therapists will also have you start filling out a sleep diary.
What is sleep therapy like?
There are three stages to CBT-I treatment. The assessment phase, treatment phase, and maintenance phase. Each phase has specific goals and steps.
Assessment phase
The assessment phase of treatment often spans the first couple of sessions. During this phase, your therapist will ask you questions about your sleep, health information, and mental health history.
This is how your therapist learns where you’re at so they can tailor treatment specifically to your needs. This is also the phase where you get to know your therapist.
If you haven’t started already, your therapist will have you start using a sleep diary, which will track the amount of time you spend in bed and asleep.
You will also receive sleep education during this time, which is more than learning about optimal sleep hygiene and setting up the best sleep environment. It is also learning about the science of sleep and how to use this information to increase your ability to get quality rest.
Treatment phase
The treatment stage of CBT-I therapy is when you’ll apply everything that you’re learning. During this stage, you’ll continue to use your sleep diary to track your sleep. This is the phase where you’ll start making real changes towards getting better sleep.
Let's look at some of the sleep therapy solutions your therapist might use in treatment:
Sleep restriction therapy
Don’t worry, it’s not as scary as it sounds - we won’t actually be limiting your sleep!
Once you’ve collected enough sleep data about your typical bedtime, the hours of sleep you get, and the amount of time you spend in bed, your therapist will assign you a sleep window.
This is the amount of time your therapist will want you to spend in bed and is based on the amount of sleep you’re currently getting. So while the name is “sleep restriction therapy,” a better way to think about it is actually more like “time in bed restriction therapy”.
As the quality of your sleep improves, this sleep window will be adjusted.Relaxation training
This is where you learn to use relaxation techniques to help your body experience less stress and muscle tension while you’re trying to sleep.Relaxation training is an important part of this process because sleep and relaxation often happen together. You can’t really have quality sleep without relaxation.
Some techniques you might learn include deep breathing and progressive muscle relaxation, but other times it might be more focused on reducing stress in your life in other ways.
Cognitive restructuring
Here, you learn to use cognitive therapy techniques to address the unhelpful thoughts that make up your sleep anxiety and interfere with your ability to sleep well.Stimulus Control
You learn to once again associate your bed with rest and relaxation instead of stress, frustration, and exhaustion.
Each part of CBT-I brings you closer to your goal of easy, restful sleep.
Putting it all together
To some, all of this might sound really complicated, but they actually create a nice, balanced sleep structure that improves your sleep quickly.
Here’s an example of how they all work together:
After tracking your sleep for a bit, your therapist decides the best place for you to start is a 6-hour sleep window.
You are learning to relax your body, so you use progressive muscle relaxation to lower the physical stress in your body associated with being in bed.
You’ve learned to address the negative thoughts you have around sleep, so counting down the hours and worrying you’ll never sleep again no longer interferes with your sleep.
Doing all of this helps you to associate your bed with sleep and rest, decreasing the level of stress you feel around bedtime.
All of these skills work together to help you get better sleep. Of course, your therapist will add other interventions as needed to tailor treatment to your unique situation.
Maintenance phase
The last phase of treatment is where you continue to apply everything that you’ve learned and tweak it to fit your unique lifestyle and needs. Your sleep window will probably increase, and you’ll keep tracking your sleep. You and your therapist will continue to address any roadblocks.
During this phase, you’ll also learn to maintain your progress and prevent your insomnia from returning.
Once your sleep is improved, you’ll either graduate from therapy or move on to other pressing issues with your therapist.
What happens after you graduate from CBT-I therapy
Once you’ve graduated from sleep therapy, you’ll continue to utilize the skills you’ve learned. Every night isn’t perfect, but most of our clients continue to sleep better regularly.
If you find that your insomnia has returned, you are welcome to return to therapy for a tune-up session. During these sessions, we help you pinpoint what needs to be adjusted to get you back on track.
When will I sleep better?
When you’re struggling with sleep, it feels like it affects every aspect of your life. So you want whatever you try to work quickly. You want to feel confident that your efforts will get you back to sleeping.
CBT-I is not an immediate fix. While many of our clients report that they start getting better sleep within the first couple of weeks, it can take up to 8 weeks to see significant progress.
It’s important to pay attention to each improvement, no matter how small, because each incremental change is a step in the right direction.
CBT-I can be a lot of work. Some of the things that can extend your timeline towards consistently getting better sleep are: not applying the interventions strictly, unrealistic expectations, and underlying health or mental health issues that aren’t being addressed.
How do I know when CBT-I is working?
One of the nice things about this therapy is that tracking is built in. As you move forward in treatment, you’ll be able to look back through your sleep diary to see if there is a change. This will allow you to see the progress you’re making.
It’s important to remember that progress isn’t always linear. Some of our clients’ sleep decreases at the beginning of treatment. This is because your body is stuck in its old sleep patterns, and it can take a while to adjust to the changes you are making.
While some of our clients have a rocky start, by the fourth week, most clients are seeing some improvements, and by the time we’ve reached graduation, clients are sleeping better most nights.
Ready to try sleep therapy? Check out our detailed page and contact us.
When does CBT-I not work?
There are some mental health conditions where CBT-I might need to be adjusted by a professional therapist trained in CBT-I.
Specifically, insomnia related to Post Traumatic Stress Disorder and Bipolar disorder needs to be supervised by a trained therapist who understands these conditions and CBT-I.
There are also medical conditions that interfere with the effectiveness of this therapy. These conditions are sleep disorders like narcolepsy, sleep apnea, and restless leg syndrome. It also doesn’t work with certain circadian rhythm disorders.
Your therapist may send you to get a sleep study to rule out these sleep conditions. If you’re diagnosed with something that is contraindicated, together we can find an alternative treatment that’ll be helpful to you. Don’t worry, though, our sleep therapists are trained in treating much more than insomnia, so treatment can still be an option for you.
CBT-I didn’t work for me- what did I do wrong?
We occasionally see clients who have tried CBT-I before, and it wasn’t as effective as they thought it would be. The first step to take in a situation like this is to be evaluated for both health and mental health conditions that could interfere with the effectiveness of CBT-I.
The second step is problem-solving, what went wrong the first time. Here are some possibilities:
Doing it on your own
Some parts of CBT-I can be applied on your own. Other parts are more nuanced and need to be overseen by an experienced therapist.
If you’ve attempted this therapy on your own and it didn’t work, don’t give up, seek some professional help.Seeing a therapist who doesn’t have specialized training
Many therapists mistakenly believe that insomnia is always the result of another mental health condition, so expect that by treating that condition, they will automatically fix the insomnia. This is rarely the case.
It is important to find a therapist that has specialized training in sleep, because they will be better able to tailor the treatment to you and problem-solve when issues come up.Lack of relaxation training
Some people don’t put as much effort into this part of CBT-I as they should. As mentioned before, sleep and relaxation go hand in hand. If you aren’t able to relax your body and you’re still experiencing physiological or psychological stress around sleep, really sleeping better is going to be quite difficult.
If you are struggling with this step, it's important to communicate that to your therapist.Unrealistic expectations
If your expectations for how quickly or how well this therapy will work aren’t met, it can be hard to convince yourself to continue to take the necessary steps.
Talk to your therapist about what to expect and the estimated timeline for your specific case before you get started.Unresolved trauma
Trauma can impact your sleep and interfere with the effectiveness of CBT-I. Sometimes addressing sleep problems includes addressing unresolved trauma.
This is something you can also work on with your sleep therapist.
You deserve a great night’s sleep, every night
If you are ready to start experiencing better sleep, it’s time to start looking for a sleep expert trained in CBT-I. The sleep specialists at Rhythm Wellness can help you answer the question, “Does CBT-I work” for you? Reach out and schedule a consultation today.
