Is this scene all too familiar? You roll over and look at the clock (or worse, you roll over and check your phone that lights up and floods your system with blue light, disrupting normal melatonin production). It says 2AM. But how can that be? You feel like you just fell asleep at 11PM! You quickly calculate – “It’s okay, if I fall asleep in the next 15 minutes I will still get 8 hours of sleep.” Next thing you know the clock says 3:15AM and you recalculate, this time feeling a little more uneasy. Finally, you are in a state of near panic because you are on the verge of getting 4 hours of sleep and well, that’s just “going to ruin my whole day!”
“I can’t function on less than 8 hours of sleep.”
“I’ll never pass my test now!”
“My presentation will go horribly and I will look ridiculous in front of my team.”
“I can’t tolerate this!”
and the list goes on….
So you begin your day feeling flooded with dread and apprehension and you haven’t even brushed your teeth yet.
If this does seem familiar, you may be part of the 6-10% of adults who meet criteria for insomnia (Psychiatric News 2016). You may also have reached out to your primary care physician and be taking sleep medication that may have helped initially or may be leaving you feeling sluggish and “hung over” in the morning. There is no doubt that when we feel sleep deprived we want immediate relief and therefore relying on medication makes perfect sense. However, the American College of Physicians (ACP) now supports a cognitive behavioral approach to treating insomnia that has proven to have longer lasting positive outcomes (Psychiatry News 2016).
Cognitive Behavioral Therapy for Insomnia (CBT-I) is a time limited treatment provided by a trained mental health or sleep expert. The ACP advises that CBT-I should be used as a first-line therapy for chronic insomnia. They state that it is preferable to medication because it is noninvasive, its effects are durable, and it avoids the negative side effects often found with sleep medications.
This evidence-based therapy includes a thorough assessment of sleep history, health concerns, mood disturbance, environmental contributors (such as shift work or having a new born), sleep efficiency (time asleep/time in bed), and daytime habits. Sleep diaries are often used to gather data before initiating changes in sleep behaviors. Experts look at an individual’s entire day to determine if certain behaviors may be creating a less than ideal sleep schedule; i.e. too much caffeine late in the day, rigorous exercise too close to bedtime. You may have heard this referred to as sleep hygiene and sometimes subtle shifts can make a huge difference.
And back to that list of frightening predictions mentioned above. CBT-I teaches individuals how to pay attention or observe thoughts in an effective, non-judgmental way and to develop more adaptive ways of thinking about sleep that ultimately decreases the dread we may feel due to a less than ideal night’s sleep.
“CBT-I combines several nonpharmacological interventions to help patients learn strategies to enhance sleep, examine beliefs and practices that hinder sleep, and adopt behaviors to promote sleep. CBT-I improves sleep and daytime functioning in 70 to 80 percent of treated persons, often without supplemental medication, according to an accompanying editorial. Patients generally maintain gains after completing treatment and understand how to manage insomnia if it recurs.”
Psychiatry News, 2016
Partners at Cognitive-Behavior Therapy Associates of Denver (CBT Denver) are experts in CBT-I and cognitive behavioral strategies for sleep disturbance. We treat primary insomnia as well as sleep disturbance that may arise as part of a broader mood or anxiety disorder. We utilize the principles of CBT-I in addition to teaching coping skills and mindfulness techniques that often improve mood, cognitive functioning, and overall quality of life.
For more information on CBT-I at CBTDenver please call 303-355-5133 or email us at email@example.com.
Further reading about the positive effects of CBT-I for insomnia can be found here: