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Insomnia and CBT

Medically Reviewed by Smitha Bhandari, MD on July 14, 2021

Many doctors will refer you to cognitive behavioral therapy for insomnia (CBT-I) before they prescribe sleeping pills. CBT is a type of talk therapy that guides you through behavior changes that can help you sleep better.

CBT-I has three main goals:

  • Condition your body for sleep
  • Break unhelpful habits
  • Reduce anxiety about sleep

Your therapist will decide which goals are most important for your specific problems. Then they’ll help you change behaviors and thoughts that keep you stuck in a cycle of poor sleep.

Unlike medication, which has side effects and you can only take for a limited time, CBT isn’t a temporary fix. It helps you learn new habits that can lead to better sleep long term. In fact, studies show that for some people, CBT works better than medication.

How Does CBT-I Work?

Your CBT-I therapist will use one or more of the following techniques:

Stimulus control therapy. You’ll work on eliminating the thoughts or practices that make your body resist sleep. You’ll also develop cues that tell your body it’s time to sleep and wake. Your therapist may suggest that you keep the same bedtime and wake time every day, avoid naps, and only get in bed for sleep and sex.

Sleep restriction. With this practice, you no longer lie in bed awake until you fall asleep. You spend less time in your bed, and in the process deprive yourself of sleep and make yourself more tired the next night. Eventually, your body can’t help but go to sleep. Once your sleep improves, you slowly start to spend more time in bed before sleep.

Sleep hygiene. Sleep hygiene means habits that influence your sleep. Your CBT therapist will help you curb bad sleep habits. They might recommend that you cut down on alcohol and caffeine, quit smoking, and get more exercise. You’ll also practice improving your sleep environment and routine by creating a calm, cool, and dark space for sleep and winding down before bedtime. This one's hard, but it may also mean putting devices away well before bedtime.

Relaxation training. Your therapist can teach you specific exercises that you can use to calm your mind and body before bed. Options include meditation, guided imagery, muscle relaxation, deep breathing, and more.

Passive wakefulness. Rather than lie in bed feeling anxious because you can’t fall asleep, in this method you try to stay awake. By focusing on the opposite goal, you let go of worry and fall asleep easier.

Biofeedback. Biofeedback uses a device that records certain biological signs from your body such as heart rate and muscle tension. Your specialist can review your patterns and help you change them to get better sleep.

Who Do You See for CBT-I?

Typically a psychologist or behavioral sleep medicine specialist provides CBT-I. Other health care pros who are trained in this type of therapy can also do sessions.

Depending on where you live, you may have trouble finding a trained CBT therapist. Certain organizations, such as the American Board of Sleep Medicine or Society of Behavioral Sleep Medicine, may be able to help you find behavioral sleep specialists in your area.

You can do CBT-I in person, online, or over the phone. Studies on digital CBT are in progress but suggest that it can be as effective as in-person sessions. If you don’t have in-person access, you can access therapy online with your computer or through an app on your smartphone.

How Long Does It Take to Work?

For some people, CBT helps their insomnia quickly. You may only need two sessions to get your sleep back on track. Most people need between four and six sessions to see a change. For some people it may take more.

WebMD Medical Reference

Sources

SOURCES:

Stanford Health Care: “Cognitive Behavioral Therapy for Insomnia.”

American College of Physicians Newsroom: “ACP Recommends Cognitive Behavioral Therapy as Initial Treatment for Chronic Insomnia.”

Mayo Clinic: “Insomnia treatment: Cognitive behavioral therapy instead of sleeping pills.”

Archives of Internal Medicine: “Cognitive behavior therapy and pharmacotherapy for insomnia: a randomized controlled trial and direct comparison.”

Medscape: “Insomnia Treatment & Management.”

Society of Behavioral Sleep Medicine.

American Board of Sleep Medicine.

Current Sleep Medicine Reports: “Digital Cognitive Behavioral Therapy (dCBT) for Insomnia: a State-of-the-Science Review.”

Translational Behavioral Medicine: “Smartphone apps for insomnia: examining existing apps' usability and adherence to evidence-based principles for insomnia management.”

 

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