Insomnia Treatment
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Learn to quickly identify the maintaining factors that contribute to the cycle of insomnia.
Cognitive Behavioral Therapy of Insomnia
Cognitive Behavioral Therapy of Insomnia (CBT-I) is an individualized, structured, and data-driven form of psychotherapy that targets particular patterns of behavior and thought associated with chronic insomnia.
How is Insomnia Diagnosed?
While no specific criteria have been established as an adequate number of hours of sleep, Insomnia is a diagnosis based on one's subjective complaint and impaired daytime functioning. Frequent aspects of daytime impairment include fatigue, irritability, problems with attention/concentration, and distress regarding initiating or maintaining sleep.
Oftentimes, acute Insomnia occurs as a normal and possibly even adaptive response to a significant life stressor. Certain patterns of thought and behavior in reaction to this sleep difficulty serve to perpetuate and/or exacerbate the problem, giving the Insomnia a "life of its own" as it turns into a chronic condition. These reactions include the development of negative and worrisome thoughts about sleep, maladaptive sleep habits and compensatory behaviors, as well as overall daily stress.
How Does CBT-i Work?
A typical course of treatment begins with the patient recording a sleep diary for one to two weeks. The sleep diary will provide the 'data' that will assist the clinician and patient in measuring and guiding the treatment, as well as evaluating the severity of the insomnia, and identifying behaviors that maintain the insomnia.
The most common additional interventions for chronic insomnia include the following:
Sleep Restriction Therapy
The clinician and patient work to increase sleep consolidation and efficiency by establishing a fixed wake time and decreasing sleep opportunity to an amount that equals one's average total sleep time.
Cognitive Restructuring
Working collaboratively to recognize and reappraise one's negative and worrisome thoughts and expectations can serve to decrease associated anxiety, frustration, and arousal associated with insomnia.
Sleep Hygiene Education
Sleep hygiene instructions address a variety of behaviors and environmental conditions that can influence sleep quality, and will be reviewed and tailored to each individual case.
Relaxation Training
Cultivating one's ability to engage the relaxation response can improve sleep by countering one's daily stress responses and produce physiological changes associated with sleep.
Stimulus Control Therapy
Considered to be the first line behavioral intervention, stimulus control instructions limit the amount of time one spends in the bedroom while awake and the behaviors engaged in to strengthen the association between the bedroom and bedtime with rapid sleep.
Negative Sleep Thoughts
People with chronic insomnia often experience negative and worrisome cognitions regarding sleep that can have a significant adverse impact on sleep. Some examples of negative sleep thoughts include:
- "I didn't sleep a wink last night."
- "I must get eight hours of sleep."
- "I'll never be able to work effectively tomorrow."
- "There's something wrong with me."
- "I hate bedtime."
- "I can't sleep without my sleeping pill."
Such negative thoughts regarding sleep can have a powerful effect on making one feel anxious, frustrated, and mobilizing the stress response and the brain's wakefulness system. Such thoughts are often times automatic, inaccurate, and make it more difficult to fall asleep.
Maladaptive Sleep Habits
In an attempt to cope with transient insomnia, people often engage in an array of compensatory sleep habits that ultimately serve to develop and perpetuate chronic insomnia. Such habits include:
- Extending sleep opportunities by going to bed earlier, sleeping later, or spending more overall time in bed.
- Taking naps.
- Attempting to relax in bed by reading or watching television.
- Using increased alcohol to promote sleep or increased caffeine to combat daytime fatigue.
- Reducing physical activity and exercise due to fatigue.
Chronic Primary Insomnia is maintained by such patterns of compensatory behaviors, as well as certain thoughts and associated physical reactions that are targeted for change in treatment.
