Should I try Cognitive Behavioral Therapy for Insomnia (CBT-i)?

Annie Miller TherapyBlog

If you are like many people reading this, you struggle with your sleep. Maybe you have trouble falling asleep, or it might be hard to stay asleep through the night. You are a light sleeper and wake up tired every morning. Or maybe you envy your spouse or friends who are “good sleepers” and make it look easy. You might have tried sleep medications in the past or you’ve heard about “sleep hygiene” and you have started to practice some of the techniques. But nothing has worked. If this sounds like you, cognitive behavioral therapy for insomnia, or CBT-i is worth considering.

CBT-i is a way to treat insomnia, without the use of sleeping pills. CBT-i helps you to take the effort out of sleep through implementing cognitive and behavioral strategies. With visits to a trained clinician, you keep a weekly sleep diary and work on scheduling and habit changes that positively impact sleep. At the same time, you also work on reducing the negative thinking around sleep and build confidence so that going to sleep is no longer stressful.

CBT-i is not always easy and you have to be willing to try one of the basic elements of treatment- sleep restriction. For some people, restricting sleep can feel daunting. Based on sleep diary data, we determine an optimal amount of sleep and we set a bedtime and wake up time that may be different from what you’re used to. By setting a sleep schedule, we get your body used to a routine and pretty soon you start to adjust. We also use a technique called stimulus control, where we work on behaviors that impact sleep drive. Specifically, we limit time in bed- you leave the bedroom when you can’t sleep and only return to bed when you are ready for sleep. The cognitive part focuses on your thoughts, feelings and expectations about sleep and insomnia.

So, does CBT-i work? The research shows that for many people, yes. CBT-i is one of the most studied and effective therapies for insomnia. It has shown to be effective at helping both the quality of sleep and helping people to sleep longer. And bedtime is less stressful and sleep takes less effort over all. In research studies, CBT-i works as well as sleeping pills in the short term and CBT-i is usually more effective than medication long-term. CBT-i does not have the side effects that medication does and should be considered before starting sleeping medication. Many sleep medicine physicians are using it as a first line treatment option. CBT-i is best performed with a trained therapist and the treatment is short-term. You can try CBT-i and many people only need 6-8 sessions to complete the treatment. You do not need to discontinue your sleep medication before starting CBT-i, but you may want to work with your physician to reduce your dose over time. CBT-i has also been shown to be helpful for anxiety, depression and chronic pain conditions.

If you sleep poorly and nothing you have tried has worked, consider CBT-i to treat your insomnia.