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Cognitive Behavioural Therapy for Insomnia (CBT-I)

Getting a good night's sleep is essential for your well-being, yet mental illness can make getting sufficient sleep difficult. One approach to helping patients with insomnia is cognitive behavioral therapy specifically targeting insomnia (CBT-I). It has been shown to be an effective treatment. A good starting point is keeping a sleep log. It will give you a better understanding of your sleep patterns and help you identify areas for improvement.



Behavioral elements


Sleep hygiene


Sleep hygiene is a set of behaviors that promote better sleep at night. Most of us are familiar with many of these recommendations, including:


  • avoid caffeine later in the day (there’s a caffeine content list here); alcohol and nicotine can also interfere with sleep

  • avoid screen time close to bed, as the blue light tells your brain that it’s time to be awake

  • don’t nap during the day

  • get regular exercise, although not right before bedtime.


Boost sleep drive


The drive to sleep comes from an accumulation of tiredness during the day. Napping during the day cancels out some of this accumulated sleep drive, making it harder to get to sleep at night.


Increase sleep efficiency


Sleep efficiency is the ratio of time asleep divided by time in bed. For people dealing with insomnia, sleep efficiency is typically quite low; there’s a lot of time spent in bed while awake.


To increase sleep efficiency, you need to start by spending less time in bed. This can be difficult, as it usually means sleeping less at first. However, it will allow you to establish a better sleep pattern.


You should only go to sleep when you’re sleepy; trying for a consistent bedtime can mean spending more time in bed awake.


If you’re in bed awake for more than 15 minutes, you should be getting out of bed. Get up and do something that’s not very stimulating, and only go back to bed when you start to feel sleepy. Rather than clock-watching to monitor that 15 minutes, try using a meditation or nature sounds track that lasts about 15 minutes; if it finishes and you’re still awake, get up.


Wake up at a regular time


This is essential in CBT-I, even though it’s counterintuitive in some ways. The idea is to get up at the same time regardless of how long or how well you slept. Getting up at a set time should happen even if it means disrupting a sound sleep. Waking up at the same time every morning gets your sleep drive started at a consistent time each day.


Challenge thoughts related to sleep


Some common sleep-related myths are:


  • I need 8 hours of sleep to survive

  • If I don’t get a good night’s sleep, then … (something bad will happen)

  • If I’m having trouble sleeping, I need to try harder

  • If I have a bad night of sleep I should try to catch up on sleep later


Thought patterns like these increase the level of anxiety around sleep and can push you into behaviors that actually worsen sleep.


The behavioral changes related to spending less time in bed awake can also help to change feelings of frustration and negative cognitions that can become associated with bed. You shouldn’t be doing anything in bed other than sleep or sex.





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