Can’t Sleep? Do you find yourself tossing and turning all night and fatigued during the day? Don’t you feel refreshed when waking up from sleeping, either? It’s probably because when you have insomnia you are never really asleep and you’re never really awake. But you need not stress. There are many ways cognitive behavioral therapy for Insomnia (CBT-I) can help you with your sleep problems.
Insomnia is a common sleep disorder. Individuals with insomnia find it difficult to fall asleep, stay asleep, or both. Chronic insomnia occurs in about 10% of the population. Acute insomnia symptoms occur in about 30-35% of the population.
Insomnia can occur in isolation or along with other conditions that can include:
People can experience insomnia in distinct ways. Many people experience short-term (acute) insomnia, which lasts for days or weeks. Some experience long-term (chronic) insomnia that lasts for a month or more. Chronic insomnia is usually a result of traumatic life events or habits that disturb sleep.
How a person is affected by insomnia varies greatly. It depends on its cause, severity, and how it is influenced by underlying health conditions.
There are many potential causes of insomnia. The risk factors include:
Following are the common signs and symptoms of insomnia.:
Consider speaking with your GP regarding any of the symptoms you experience that might indicate insomnia. They can put you in touch with an Austrian accredited psychologist or psychiatrist. Our psychiatrists and psychologists are experienced in treating insomnia and other sleep disorders. They are here to provide caring, professional support to those in need.
Your healthcare provider will conduct a physical exam. He may ask questions to learn more about your sleep difficulties. He will review your sleep history, medical history, and medications.:
You may get a clinical diagnosis if:
CBT-I is a brief, highly effective, and safe behavioral health treatment for patients with chronic and acute insomnia. It is a form of CBT tailored specifically to address insomnia. CBT-I is a collection of skills or techniques that can effectively retrain you to trust your sleep system again. It helps correct any unrealistic thoughts or expectations that you might have around sleep. The thoughts that end up putting extra pressure on you. For example,’ I must get this many hours of sleep’. Hence, it makes sleep more difficult.
CBT-I typically involves 4 to 12 customized sessions. Patients are encouraged to modify their beliefs about insomnia.
Cognitive-behavioral therapy for insomnia is an effective treatment and can be given in a primary care setting by psychologists.
It is proposed that Cognitive behavioral therapy should be the first-line treatment for adults having chronic insomnia (American College of Physician ACP, 2016).
Research also suggests that there is a good deal of evidence for applying CBT as an initial treatment for chronic insomnia.
Likewise, a comparative meta-analysis of 21 studies showed similar short-term outcomes for CBT and pharmacotherapy. While CBT produced greater long-term benefits.
Clinical guidelines for the Evaluation and Management of Chronic Insomnia in Adults also suggest that :
Usually, people with chronic insomnia reach out to doctors for drug therapies that have serious side effects. CBT is likely to have very fewer side effects as compared to sleep medications. FDA only approves sleep medications for short-term use, ideally no longer than four to five weeks. This explains the paramount role of applying CBT in practice.
Skills learned in CBT provide long-term effectiveness. But, there is a degree of effort and self-discipline needed to commit to therapy as it is far more challenging than taking a pill. It offers many advantages over present-day pharmacotherapies. That’s not to say there’s never a place or time for sleep medications.
When CBT-I alone is not successful in improving the symptoms, it is recommended to go for sleep medications alongside CBT-I.
CBT-I works because it addresses the cause that drives insomnia
CBT-I is a multicomponent treatment because it combines several different approaches. Sessions may include cognitive, behavioral, and educational components
CBT for insomnia consists of five distinct components that work together to alter a patient’s sleep-related beliefs and behaviors, as well as their sleep environment
In terms of how these components are implemented, all practitioners generally follow a similar pattern, although they can be somewhat changed to meet your own needs. The following are the essential elements:
CBT-I includes several educational treatments aimed at improving sleep quality. A therapist may educate a client about
Cognitive therapy uses cognitive restructuring to target problematic beliefs and attitudes about sleep. For instance, needing 8 hours each night or napping to catch up on sleep loss. It builds up sleep anxiety for you, if you believe you should be sleeping in a certain way or that some part of your sleep is not normal when it quite is.
Additionally, you can also keep a sleep diary or a sleep log to have an overview of where you currently are in regards to your sleep. It helps you see your progress.
Sleep restriction is not about restricting sleep, it’s all about sleep efficacy and restricting time in bed. Many persons who suffer from chronic insomnia report sleeping for an average of four hours per night. The rest of the hours are spent tossing and turning in bed. Also, they are spent feeling anxious, worried, and frustrated. Sleep restriction is about reducing this sleep window.
The goal here is to consolidate sleep. Instead of spreading out tiny little snippets of sleep over a very long sleep, you get nice, strong, deeper, and more restorative sleep. It helps create and strengthen the association between bed and sleep.
People with insomnia associate bed with being awake and anxious. With bedtime restriction, you spend all your time in bed asleep. It retrains you to see the bed as time for sleep.
Stimulus control helps to associate bed with sleep and nothing else. Ongoing insomnia creates a negative learned association between bedtime and sleep. Stimulus control eliminates this association between bedtime and arousal. The technique ensures that you are not doing any activity in bed apart from sleep. Some habits include:
Above all, CBT-I also includes some kind of relaxation component. CBT-I therapists also suggest many relaxation techniques. The goal of relaxation techniques is not falling asleep, but the relaxation of mind and body.
This facilitates sleep and decreases physiological and cognitive arousal. The hour before sleep can be for relaxing and doing enjoyable activities.
Here are a few relaxation techniques commonly taught in CBT-I that serve as ways to elicit the relaxation response and help fall asleep:
PMR is a deep relaxation technique that involves tensing and relaxing different muscle groups one by one. This helps reduce muscle tension that leads to sound sleep.
Another way to engage the body’s natural relaxation response is through deep breathing and visualization exercises. Deep breathing exercises are also helpful tools have that can calm your mind.
These exercises involve taking slow deep breaths and rely on using mental images to create a sense of well-being in the body. This reduces stress and transition you to sleep.
Underlying stress and anxiety often result in insomnia. These simple exercises can help relieve the stress and tension that is stored in the body.
Hypnosis is a useful tool for enhancing sleep. In a deep hypnotic state, your subconscious is receptive to thoughts and ideas. During hypnosis, you can verbally repeat or listen to a relaxing thought such as ‘I fall asleep as soon as I lie in my bed’ or ‘I am relaxed and calm’.
Mindfulness meditation is about focusing on the present moment. It increases awareness of your breathing and body and makes you more conscious.
If a thought or emotion pops up during meditation, you just have to observe it without judgment, always returning the focus to your body and breath.
Additionally, guided and body scan meditations can also be of great help for insomnia. The act of focusing and increased awareness promotes relaxation, which helps you sleep.
Biofeedback teaches you to identify and master your body’s stress response. It can also use sensors to measure your physiological health such as heart rate, breathing, and muscle tension.
Strong sleep hygiene means having both a bedroom environment and daily routines that promote consistent, uninterrupted sleep. Following are some sleep hygiene rules:
Educating clients about the importance of good sleep hygiene is a core component of CBT-I. However, it is not an effective stand-alone treatment for insomnia.
Hence, CBT-I coaches engage patients to be active participants in their sleep health. They teach cognitive and behavioral skills that resolve chronic insomnia in 70% to 80% of patients often without medication.
CBT-I is often provided by a counselor, therapist, doctor, or psychiatrist trained in this form of treatment. Unfortunately, there aren’t enough CBT-I coaches despite the widespread call for its demand. To respond to this widespread call digital CBT-1 (DCBT-I) offers the benefits of CBT-I to a far and wider audience and is also as effective.
CBT for insomnia involves anywhere between 4 to 12 weekly 1-hour sessions by a qualified sleep therapist. The length of therapy also depends on the severity of your sleep disorder.
The risks of CBT are likely to be mild, but they may be uncomfortable at times. Although this treatment has demonstrated great efficacy in treating insomnia, it does require a degree of effort and self-discipline needed to commit to therapy.
Talking about painful experiences, thoughts, and feelings can be challenging and may cause temporary stress and discomfort.
Working with practitioners with experience in CBT-I can help manage the discomfort and challenges. Above all, it can take some time to learn and practice the skills.
CBT is a fantastic long-term solution for insomnia. It is a collection of skills and techniques and if you learn them, they are with you for life. It is not an ongoing prescription for the rest of your life with sleeping pills. Anytime, if your sleep gets disturbed again in the future, you remember all the skills that you’ve learned. You can reintroduce those skills into your routine to get your sleep back on track. As it is rightly said that:
It is highly encouraged to look into CBT-I as an initial treatment for insomnia. Usually, patients with insomnia do not view it as a clinically significant disorder that warrants medical attention. Anyone who experiences ongoing trouble sleeping and feels that is affecting his/her daily functioning should see a professional.
Contact our friendly coordination team to book an appointment with one of our clinicians if you are suffering from any sleep disorder. You can reach our friendly support team via webchat, phone, or email. You will need a referral (Mental Health Care Plan) from your GP to see one of our psychologists.