Anyone who lives with insomnia knows that it be extremely challenging. For people who seek it out, there are effective treatments available. Many of these can help people fall asleep more quickly, stay asleep and feel good upon wakening.
Medication can help, but most are addictive. Because of this psychotherapy is a more popular option.
One approach, cognitive behavioral therapy for insomnia (CBT-I) is a therapeutic approach that specializes in helping symptoms of insomnia. CBT-I helps you explore the connection between thoughts, behavior and how you sleep. During a session, the CBT-I therapist helps the person to identify thoughts and behaviors contributing to sleep problems.
How CBT-I Works
In CBT-I, thoughts and feelings about sleep are scrutinized to see if they are correct. Behaviors are explored to see if they promote sleep or detract from it. The therapist clarifies and reframes any misconceptions in such a way as to induce more restful sleep. CBT-I can be relatively short term and treatment typically takes about 4 to 8 sessions. Of course, the length varies depending on the person’s individual needs.
Part of the reason that is effective is because it combines several different approaches, such as cognitive, behavioral, and educational elements. These interventions are usually structured as follows:
- Cognitive techniques: Cognitive restructuring focuses on altering inaccurate and unhelpful thoughts about sleep.
- Behavioral techniques: Learning relaxation training, stimulus control and sleep restriction helps to create relaxation and reestablish healthier sleep habits.
- Psychoeducational techniques: The therapist gives information about the way in which thoughts, feelings and behaviors work together to effect sleep.
During the session, the many in which in technique is used varies widely depending on the therapist’s interpretation of the client’s needs. Below are some of the most common methods used in CBT-I.
For those who suffer from insomnia, incorrect thoughts about sleep can cause behaviors that can make sleep even more difficult, which in turn serves to reinforce dysfunctional thoughts. Previous experiences of sleeplessness often lead to worrying about falling asleep. This type of anxiety can cause a person with insomnia to spend more time in bed trying to force sleep.
Anxiety, depression, worry, over-thinking, and tossing and turning in bed can make falling and staying asleep more difficult. It can turn into a dysfunctional nightly pattern that can be challenging to break.
A CBT-I therapist uses cognitive restructuring to alter this cycle by identifying and changing the thoughts and beliefs that add to insomnia. Specific thoughts and beliefs addressed with cognitive restructuring include anxiety and depression over previous experiences of sleeplessness, unrealistic expectations about sleep and stress about being tired due to lack of sleep.
It’s common for someone with sleep problems to fear their bedroom because they associate it with anxiety and sleeplessness. Research has found that people with insomnia tend to think about behaviors that make sleeping more challenging, such as eating or watching television. The therapist uses stimulus control attempts to change these associations, reclaiming the bedroom as a place for restful sleep.
To counter this, the person only uses the sleep and sex. In addition, they get out of bed when it’s hard to fall asleep or when they are awake for more than 10 minutes. The person only goes back to bed when they are sufficiently tired. In addition, they set their alarm for the same time every day and avoid naps.
Relaxation techniques are great for reducing the racing thoughts and tension associated with lying in bed awake. The techniques increase the body’s natural relaxation response which calms the body and mind.
The most effective relaxation techniques are those that can be easily incorporated into a person’s routine. Often the therapist teaches exercises that involve taking slow, deep breaths. Research has found that this type of focused breathing decreases heart rate and lessens feelings of anxiety, anger and depression.
Although CBT-I therapy has shown efficacy in treating insomnia, one drawback is that it doesn’t always work quickly. For most people, it takes time to learn and practice the skills learned in therapy. In addition, some techniques, such as cognitive restructuring and relaxation training, change sleep habits slowly over time. A therapist should help track progress over time in order to identify improvements and and determine what strategies are working best.
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