Can't Sleep?

From the WebMD Archives


"The study shows that this treatment is very effective with sleep-maintenance insomnia, which is far more common than sleep-onset insomnia," in which the patient has difficulty falling asleep in the first place, he tells WebMD. Sleep- maintenance problems are most common in middle-aged and older adults, Edinger says.

The patients receiving CBT were given a combination of education, time-in-bed restrictions, and stimulus control. Stimulus control is designed to "increase the stimulus value for sleep and eliminate the sleep-disruptive behaviors that have evolved over time," Edinger says.

For instance, subjects are trained not to think and worry while lying in bed, not to read or watch television in bed, and never to lie in bed for long periods. They are told to avoid daytime napping and to establish a standard rising time.

Time-in-bed restrictions are designed to reinforce the stimulus control by helping patients learn to use the bed only for sex and sleeping, he says.

People with insomnia often worsen their problems by thinking obsessively and negatively about their inability to sleep, says David Neubauer, MD, a sleep specialist at Johns Hopkins University School of Medicine in Baltimore who believes that CBT has a valid role in the treatment of sleeping disorders.

"This contributes to a vicious cycle of increasing distress about the insomnia," Neubauer tells WebMD. "One of the aims of the cognitive-behavioral approach is to help people think more positively about their sleep and less negatively about their symptoms."

CBT's intense focus on specific thoughts and actions that make up a pattern of behavior can help people reverse the state of "hyperarousal," or excitability, that insomniacs often feel when they are in bed, Neubauer says.

"A lot of time when people have insomnia they will stay in bed, frustrated by the fact that they are not able to sleep," he says. "It is easy to see how that time in bed soon becomes associated with the state of being hyperaroused."

The more time you spend agonizing about not being able to sleep, Neubauer says, the more likely that will be your pattern every time your head hits the pillow -- even though you may be desperately in need of sleep.