Cognitive Behavioral Therapy for Insomnia (CBTi)

cognitive behavioral therapyCognitive behavioral therapy is fast becoming the preferred method of treatment for insomnia. It consists of a number of techniques designed to help you understand the causes of insomnia, develop good sleep habits, and learn how you can actively create a good night’s sleep.

Cognitive behavioral therapy is delivered as a course set over a number of weeks. Each week you gain a little more understanding of your sleep problem and are given new tips and techniques to help you sleep better.

Advantages of Cognitive Behavioral Therapy

Cognitive behavioral therapy is completely natural and drug free. It offers many advantages over sleeping pills:

  • Tackles the heart of the insomnia problem rather than just masking the symptoms
  • Just as effective as sleeping pills at sending you to sleep
  • Contains none of the nasty sleeping pill side effects
  • Much more effective at treating chronic insomnia
  • Offers a reliable long term solution to insomnia

Cognitive Behavioral Therapy Techniques

There’s no set structure for cognitive behavioral therapy, but it generally contains 5 elements. These are:

  1. Stimulus control
  2. Sleep restriction
  3. Relaxation training
  4. Cognitive therapy
  5. Sleep education & sleep hygiene

How much focus is given to each element usually depends on the individual needs of the patient.

Stimulus Control

Goal of Stimulus Control

To create a strong mental association between your bed and sleep.

Why it works

People with insomnia spend long nights staying awake. They associate the bed with stress and anxiety. The moment you get into bed, instead of preparing to sleep, your body anticipates staying awake all night. You feel a sense of dread and your heart starts pounding as you mentally live the prospect of not being able to fall asleep. Stimulus control reprograms this negative association.

How it’s performed

  • Only go to bed when you’re feeling sleepy
  • Only use your bed for sleep and sex
  • Get out of bed if you’re still awake after 30 minutes

Sleep Restriction

Goal of sleep restriction

To teach you that you can fall asleep quickly and without any sleeping pills by ensuring you go to bed feeling sleepy.

Why it works

Restricts your time in bed to teach your body that bed time is time for sleep. Works alongside stimulus control to create a strong mental link between getting into bed and falling asleep. Causes mild sleep deprivation to encourage your body to fall asleep.

How it’s performed

Work out the total the number you spend asleep by counting the hours between when you first fall asleep and when you wake up. Do this over a number of nights to determine the average time you spend asleep each night.

That average time spent asleep then becomes the only time you’re allowed in bed. Even if it’s only 5 hours. No napping outside of these hours is allowed. If you don’t get enough sleep during this time, tough.

Gradually increase time allowed in bed only if your sleep efficiency is above 85%. Sleep efficiency is the number of hours awake divided by the number of hours asleep times by 100.

Relaxation Training

Goal of relaxation training

Teach yourself how you can disconnect with your thoughts, enabling you to relax and drift off to sleep.

Why it works

Thoughts act as a barrier between you and sleep. Stressful thoughts create a stress response within the body keeping state of alertness and unable to fall asleep. By removing these thoughts or by thinking only sleepy thoughts your body can wind down and fall asleep.

How it’s performed

A number of relaxation techniques are available such as:

Try them all to find a relaxation technique that you find works best. Don’t expect it to work perfectly straight away. Spend time to really master it.

Cognitive Therapy

Goal of cognitive therapy

To create a more realistic picture of your insomnia by gaining better understanding of the condition. Creates feelings of reassurance and optimism about your treatment potential.

Why it works

People who have been suffering with long term insomnia often have unhelpful thoughts and beliefs that serve to keep them stuck or even make their insomnia work. Examples include:

  • I have a chemical imbalance
  • I can’t sleep without sleeping pills to sleep
  • My insomnia is different to everyone else’s
  • I’m incurable
  • I can’t cope without 8 hours sleep

These thoughts and beliefs can become a self fulfilling prophecy

How it’s performed

  • Write down all your thoughts and beliefs about your insomnia
  • Go through each of them one by one and assess their accuracy

This is something you can do by speaking to someone knowledgeable about sleep or looking up the information yourself.

Sleep Hygiene & Education

Goal of Sleep hygiene and education

Learn more about insomnia. Know what causes it and how to avoid it. Understand what creates a good night’s sleep.

Why it works

People with insomnia are often completely unaware of bad sleep habits. Completely unknowingly, you can engage in these bad habits and completely ruin the prospect of getting a good nights sleep. By identifying these bad habits, you can replace them with ones that promote sleep.

How it’s performed

Educate yourself to understand why some people fall asleep easily and effortlessly and why others stay awake. Implement good sleep habits into your own life to:

  • Establish a good sleep schedule
  • Create a relaxing sleep environment
  • Create a calm mindset to help you drift off to sleep

Getting Cognitive Behavioral Therapy

Cognitive behavioral therapy is often administered as a series of one on one sessions or a series of group sessions. The biggest problem with cognitive behavioral therapy is availability. Demand very often outstrips supply.

Most sleep professionals are specialized neurological doctors whose preferred method of treatment is giving out sleeping pills. Cognitive behavioral therapy requires a trained psychologist who has specialized in sleep problems. Since cognitive behavioral therapy is so new, there are simply not enough of these people around.

Another problem is getting the time to attend the sessions. If you can’t get in person cognitive behavioral therapy, there are a number of books you can use to learn the techniques yourself.

Alternatively, I’m in the process of creating an online course containing cognitive behavioral therapy techniques designed to help you fall asleep faster and totally eliminate insomnia. It will be available around April/May 2014. If you want to be the first to know when it’s ready, sign up for my newsletter using the box below.