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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.
"A lot of people with insomnia are sleeping or nodding off at the dinner table or before bedtime, but as soon as they get in bed they are anxious," he says.
But the best treatment for any particular individual with sleep problems will vary from person to person, and it's too simplistic to say that CBT is right for everyone, Neubauer says.
Some people will have insomnia that turns out to be caused by sleep apnea -- a disorder in which the breathing apparatus stops momentarily, causing the sleeper to awaken. Also, insomnia may be related to side effects of medication or to an underlying major depression that requires medication.
"We believe everybody who has difficulty with insomnia should be evaluated, and consider a wide range of possible causes and treatments," Neubauer says. "Everyone needs to have individualized treatment."
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