Short Insomnia Therapy Beats Sleeping Pills
4 Half-Hour CBT Sessions Work Better, Last Longer Than Ambien
WebMD News Archive
Elements of CBT for Insomnia
As its name implies, CBT has two parts: cognitive and behavioral.
The cognitive portion of CBT requires people with insomnia to recognize, challenge, and change the ways of thinking that keep them from falling asleep.
"It involves educating insomnia patients about the fact they often engage in distorted, stress-inducing behavior about insomnia," Jacobs says. "We place an emphasis on their worries and anxieties about how their insomnia will affect their next-day performance and long-term health. We educate them about research showing that in most cases their concerns are not accurate."
CBT therapists provide information to counter negative thoughts relating to their problem.
People with insomnia also have distorted ideas about how well they actually sleep.
"Insomnia patients say, 'I never slept at all last night,' or, 'It took me until 4 a.m. to fall asleep,'" Jacobs notes. "But if you measure their sleep, you see they slept for four or five hours. In therapy sessions, they learn their perceptions of sleep are not quite accurate. And in these sessions we role play a little bit to give them replacement sleep thoughts."
The second part of CBT is behavior. This is what many sleep experts call "sleep hygiene."
The most important rule, according to Jacobs and Simon: Get out of bed if you can't sleep. Go to another room and do something that makes you drowsy.
"The most important thing is restricting time in bed so it most closely matches sleep time," Jacobs says. "People with sleep-onset insomnia average five hours of sleep -- but eight hours in bed. There is a huge mismatch between their actual sleep time and their time in bed. It actually inhibits their sleep drive. If they are out of bed, they build up more sleep drive and sleep better at night."
Here are Simon's other rules for sleep hygiene:
- Get up at the same time every day. Wake up by the clock. That should be within one or two hours of the same time, workdays as well as on weekends.
- Get as much light as you can during your desired waking hours. The biological clock is reset when you are exposed to bright light and we want as little light as possible during sleep hours.
- Go to bed at night only when you think you can fall asleep. Wake by the clock, but go to bed when your body tells you to.
- If you are having trouble sleeping, minimize naps during the day. Patients with insomnia often take naps. We tell them not to.
- Minimize drugs that disturb sleep. Caffeine has to be minimized. Minimize nicotine and alcohol, particularly in the hours before bedtime.
- Exercise regularly. The best time is early morning to midday. Try not to exercise within five to six hours of bedtime.
- It takes about an hour or so to unwind before going to sleep. So shut off the day an hour or two before bedtime. Stop watching news shows. If you need to, write down your daily worries in a journal and close it. Then take warm bath. Drink some warm milk with honey.
- Make your bedroom your sanctuary. This is where you get to enjoy eight hours a night of refreshing sleep.