Insomnia

CBTDenver therapists are experts CBT for insomnia or CBT-I. CBT-I is now considered the first line treatment for insomnia by the American College of Physicians: https://www.acponline.org/acp-newsroom/acp-recommends-cognitive-behavioral-therapy-as-initial-treatment-for-chronic-insomnia Consumer Reports also named CBT-I as the top treatment for insomnia: http://www.consumerreports.org/sleep/how-to-fall-asleep-the-natural-way/

Insomnia is a common problem characterized by trouble falling asleep, staying asleep or getting restful sleep, despite the opportunity for adequate sleep. People with insomnia may take upward of 30 minutes to fall asleep and report that they are only receiving a few hours of sleep most nights. Insomnia may be diagnosed as a stand-alone issue or symptomatic of another physical or mental health issue.

Insomnia Symptoms

Insomnia is characterized by trouble falling asleep or staying asleep, and it is generally accompanied by other symptoms that may include:

  • Disturbed sleep
  • Waking too early
  • Daytime drowsiness
  • Irritability
  • Anxiety
  • Depression
  • Difficulty concentrating

Long-term insomnia is often associated with recurring stress or mental health disorders such as depression and anxiety. Insomnia is often associated with:

Insomnia may also be related to:

  • Medical conditions
  • Medications
  • Changes in environment, sleep habits or physical lifestyle
  • Regular caffeine or alcohol consumption

You should seek help if your insomnia persists for more than a month or makes it difficult for you to function while awake.

Cognitive Behavioral Therapy for Insomnia

Cognitive behavior therapy for insomnia (CBT-I) is an effective, evidence-based treatment for chronic sleep problems. Cognitive behavior therapy for insomnia is a structured program that helps you identify and replace thoughts and behaviors that cause or worsen sleep problems with habits that promote sound sleep.  While sleeping pills are often used to treat insomnia temporarily, CBT-I helps you overcome the underlying causes that are maintaining your insomnia.

In order to begin to make changes in your sleep patterns, your therapist will need to understand your sleep cycles, beliefs, and behaviors.  To help decide how best to treat your insomnia your therapist may have you keep a detailed sleep diary for one to two weeks.  Your sleep diary will help you and your therapist to recognize key patterns that need to be addressed in the therapy.  For example, negative thoughts and worries that keep you awake will be addressed.  Other structured assessment tools or questionnaires may be used as well.

The most common form of CBT-I (and best evaluated for effectiveness) includes the following techniques:

  • Cognitive component.  This means addressing your thoughts and beliefs about your sleep.  Worry and anxiety about your insomnia can lead to a spiral in which anxiety makes it harder to fall asleep, more anxiety ensues, making it harder to fall asleep…the pattern continues and reinforces itself.

 

  • Sleep restriction. Lying in bed awake can become a habit that can lead to and maintain insomnia. This technique temporarily decreases the time you spend in bed in order to compact your sleep and to make you spend less time in bed tossing and turning. With your clinician’s guidance, the time you spend in bed is gradually increased.

 

  • Stimulus control. This technique helps remove factors that condition the mind to resist sleep.  For example, staying up watching movies on your computer may condition you to stay awake rather than fall asleep. You will be coached to use your bed only for sleep and sex and to leave the bedroom if you can’t fall asleep within 30 minutes.

 

  • Sleep hygiene.  Sleep hygiene involves changing basic lifestyle habits that influence sleep. These include keeping the bedroom quiet, cool and dark; limiting caffeine intake later in the day, winding down and relaxing or practicing mindfulness at night.

CBT for Insomnia is generally conducted in the context of 4 to 12 individual therapy sessions occurring weekly. The number of sessions and total treatment time is often tailored to the patient’s preferences and the clinician’s judgment. It is important to understand that CBT-I is considered “active therapy.” That is, both you and your clinician will take an active part in your treatment. The other aspect of CBT-I that makes it an active therapy is that by the end of treatment patients have learned many of the tools they need to maintain improvements in sleep, particularly when they experience events which previously contributed to insomnia. This learning process is the reason that many patients continue to sleep well, and may improve further, even months after they have completed the CBT-I appointments with their clinician.