Insomnia

Insomnia (difficulty falling or staying asleep) is not just a night time problem. It’s a 24 hour problem! When individuals do not sleep well at night, their daytime functioning at work and in their relationships suffers. Daytime sleepiness is not only aversive, but can interfere with concentration, affect mood, and decrease energy and productivity. Insomnia can be a stand-alone concern, or can arise in conjunction with anxiety, depression, or other comorbid medical conditions. Further, one’s risk of experiencing anxiety and depression increases if you already have insomnia. In general, the risk of insomnia increases with age.

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(212) 308-2440

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CBT Treatment of Insomnia

Cognitive behavioral therapy (CBT) has consistently been shown to be the best first-line treatment for insomnia. CBT improves sleep in more than 75% of insomnia patients and leads to a reduced need for sleeping pills. In addition, CBT has none of the side effects associated with taking sleep medications and has better long-term outcomes in terms of maintaining good sleep after treatment ends. This is because CBT provides people with strategies they can use to help themselves if the insomnia symptoms were to return, and therefore the benefits remain long after treatment ends. When engaging in CBT for insomnia, patients are often able to reduce, if not eliminate, the amount of sleep medication they take. This should be done in consultation with your physician.

Components of CBT for Insomnia

The crux of cognitive behavioral therapy for insomnia involves specific behavioral changes which your therapist will guide you through to enhance the efficiency of your sleep. People with insomnia often unknowingly engage in behavior that: a) inhibits sleep, b) disrupts circadian rhythms, and c) decreases their overall sleep drive. The behavioral component of CBT (Stimulus Control) addresses all three of these concerns by teaching the patient a new set of “Sleep Rules” (e.g., no napping, use the bed only for sleep and sex, get out of bed if you are awake. Another approach is called Sleep Hygiene which directs you to limit caffeine and alcohol, keep the bedroom quiet, dark and cool, have a quiet wind-down time before bed, and don’t exercise or do anything arousing for an hour before bedtime. These behavioral approaches assist in offering clear guidelines to make sure that the time you are in bed, you are actually sleeping! Often there is a big disparity between people’s actual sleep time and the amount of time they spend in bed. The idea that lying in bed longer will help you get to sleep is false. Lying in bed awake for long periods actually makes insomnia worse! Your therapist will work with you to identify your specific sleep problem(s), develop a specific individualized sleep plan to address them, and help monitor your progress.

In addition, your therapist will teach you cognitive strategies to decrease cognitive arousal (e.g., taking worries to bed) and address dysfunctional thinking patterns (e.g., “I’ll never get to sleep” and “I won’t be able to function tomorrow”) that may be keeping you awake. Further, you may be taught general stress reduction techniques and breathing exercises to calm anxieties and enhance restfulness. Many people with insomnia have beliefs about sleep that make them more anxious. These include the following: “If I don’t get enough sleep, I won’t be able to function”, “I need to get 8 hours of sleep every night”, or “I need to try harder to get to sleep”. Changing these beliefs can help reduce the stress of not falling asleep or staying asleep.

Another approach is Sleep Restriction Therapy which attempts to increase your sleep efficiency (that is, the amount of time you sleep while in bed). This involves limiting the total amount of time that you are in bed by initially reducing that time until your sleep efficiency increases to 85%. During the first two weeks you may find yourself tired, but eventually many people find that this resets their circadian rhythm and their insomnia is reduced. Specific guidelines can help you plan your approach following the guidance that your therapist suggests.

Finally, some patients benefit from Paradoxical Intention treatment which reverses your conscious goal while in bed. Rather than “trying to go to sleep” (sleep effort) the goal becomes “trying to stay awake”. This sounds counter-intuitive, but many people benefit from giving up on trying to sleep. You may notice in your life that sometimes when you “automatically” fall asleep it’s at a time you were trying to stay awake.

Nightmares affect 5 % to 8 % of the general population and are often a frightening experience for people that may be part of a sleep disorder that affects the quality of sleep and even the fear of going to sleep. Imagery Rehearsal Therapy is an empirically based approach that, together with cognitive therapy techniques, can help restructure and neutralize the experience of nightmares. Research has shown that this approach can be highly effective.

Unfortunately, not all psychologists (not even all cognitive behavioral psychologists) are trained in the skills needed to effectively implement CBT for insomnia. Here at the American Institute for Cognitive Therapy, we have specialists who have been trained specifically in this robust insomnia treatment. For more information, call 212-308-2440.

More Information on Insomnia:
“Cognitive Behavioral Therapy Should Be First-Line Insomnia Treatment” – Medscape.com

Cognitive-Behavioral Therapy for Insomnia: An Effective and Underutilized Treatment for Insomnia

Treatment Plans and Interventions for Insomnia: A Case Formulation Approach

For further information about the treatment of anxiety and depression please contact:
The American Institute for Cognitive Therapy
150 East 58th Street, Fifth Floor Annex
New York, NY 10155.
Tel: (212)-308-2440

Insomnia

Insomnia

CBT Treatment of Insomnia

Components of CBT for Insomnia

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