Use skills, not pills, for better sleep
Cognitive behaviour therapy for Insomnia (CBT-I) is a set of interventions to help you sleep better. This approach has been helpful for people looking for an alternative to drugs or supplements for healthy sleep. Disclaimer: Please discuss any changes to your medication with the prescribing medical professional in advance.
Most adults have experienced a sleepless night with the associated difficulties of sleepiness, irritability or concentration difficulties the next day. Occasional insomnia is normal, but chronic sleep difficulties can be debilitating. Clinical insomnia is defined as difficulty falling asleep or staying asleep, with perceived negative impact on daytime functioning. These symptoms are present at least 3 times per week for a minimum of 3 months.
CBT-I is different from sleep hygiene. Sleep hygiene includes such suggestions as:
- Avoid caffeine late in the day
- Keep the bedroom dark and cool
- Go to bed at the same time every day.
These are helpful ideas, but once insomnia has become chronic they are rarely enough to develop healthy sleep.
What to expect
CBT-I is effective and brief. The protocol calls for 2 to 8 sessions. The initial session is an intake interview. The clinician will ask questions to understand the history of your sleep problems and your current sleep habits to determine if you are a suitable candidate for this therapy. Together you will develop goals for treatment.
You will be assigned a sleep diary to assess your sleep and record progress. It is most helpful if this diary is completed each morning as soon after waking as possible.
Based on your sleep habits, your therapist will select interventions for your particular situation. The key components of CBT-I are stimulus control, sleep restriction and strategies to reduce high arousal in bed. Stimulus control strengthens the association between your bed and sleep. Sleepiness is used as the only cue for bedtime, and the bed is only used for sleep (with the exception of sexual activity).
Sleep restriction is limiting the time in bed to reduce unwanted wakefulness. The least pleasant part of this therapy, but it will work if you persist. Strategies to reduce arousal and encourage relaxation may include relaxation skills training, managing worry or anxiety, and challenging unhelpful beliefs about sleep.
CBT-I sessions are typically scheduled bi-weekly to allow you time to practice the particular skills and assess progress.
You can learn more about CBT-I from these recommended books:
Carney, C. & Manber, R. (2009). Quiet your mind and get to sleep: Solutions for insomnia in those with depression, anxiety or chronic pain.
Edginger, J. & Carney, C. (2014). Overcoming Insomnia: A cognitive-behavioural therapy approach workbook.
Morin, C. (1996). No more sleepless nights: Getting the sleep of your dreams.
Please note: links are provided for your convenience only. I do not receive any financial benefit from recommending these resources. These recommendations are based strictly on my professional opinion and experience.
If you would like guidance from a professional who can tailor interventions to your specific situation, please contact me.