CBT-I is short for: Cognitive Behavioral Therapy for Insomnia and is considered the gold standard treatment for insomnia. It is consistently shown to improve sleep with no side effects and outperforms sleep medications and other treatments in numerous research studies! When sleep hygiene and stress management are not enough to improve your sleep, CBT-I can help.
Cool things CBT-I can do:
· Improve sleep quality and help you spend more hours asleep
· Reduce waking throughout the night or too early in the morning
· Slow down brain waves at night to help with relaxation and sleep
· Reduce worry and rumination about sleep
· Reduce tension in the body and lower heart-rate
· Improve daytime sleepiness
· Balance the sleep and wakefulness systems
· Reduce anxiety and depression
· Promote healthy habits
· Improve flexibility in the autonomic nervous system
Let’s talk about the different components of CBT-I.
Cognitive and emotional skills
The C in CBT-I stands for “cognitive” which includes our internal experiences such as thoughts, memories, urges, body sensations, and emotions. With insomnia of all kinds, there are often negative and anxiety-provoking thoughts and experiences present such as “I won’t get enough sleep tonight and won’t do well at work,” “I’ll never get to sleep,” “if I don’t get enough sleep, I’ll be useless tomorrow,” “nothing I do helps,” “one night of bad sleep will ruin my week,” counting the hours before you need to wake up, anxiety throughout the day about fatigue or sleep problems, anger and frustration while staring at the ceiling, etc. When we get hooked by these thoughts – when they are dominating, intrusive, and jerk us around – it is easy to experience emotions such as anxiety, sadness, fear, and frustration. These thoughts often result in us behaving in ways that are not helpful for sleep such as worrying, ruminating, watching the clock, staying in bed and trying to fall asleep, etc. The cognitive skills in CBT-I help you respond differently to and develop a new relationship with these negative sleep thoughts and feelings so you can act in the ways that are most helpful for overall health, wellness, and sleep.
The B in CBT-I stands for “behavioral” which covers a whole host of behavioral strategies to improve sleep. These include stimulus control, sleep restriction and compression, and relaxation training.
Stimulus control focuses on creating and maintaining a soothing bedtime environment and limiting activities in the bedroom to just sleep. Many of us (especially us who work from home!) have developed some unhelpful habits in bed such as watching TV, arguing with our spouses, working on our laptops, doomscrolling social media, etc. We also may stay in bed when we can’t fall asleep (or fall back to sleep) and “try” to fall asleep. All of these behaviors impact the brain’s ability to form a strong connection between your bed and sleep.
Sleep restriction and compression focuses on limiting the amount of time spent in bed if you are not sleeping. This stage of treatment occurs after a detailed log about sleep is kept by the patient so we can determine how much time you are in bed, how much time you are asleep, and how much time you are awake. Based on these numbers (and calculating something called “sleep efficiency”), a new sleep schedule will be created to minimize the amount of time spent in bed not sleeping.
Relaxation training helps the mind and body relax by stimulating the parasympathetic nervous system. This part of your nervous system governs the “rest and digest” response which can reduce stress, anxiety, frustration, rumination, and worry. There are so many strategies for this ranging from tech-assisted relaxation (biofeedback) to meditation to deeply relaxing practices like autogenic training, yoga nidra, and progressive muscle relaxation.
Learning more about sleep is an important part of CBT-I. There is so much information to be found about sleep and not all of it is helpful or even true! Dispelling sleep myths, learning more about how the body and nervous system works, and developing strategies based on the current research is an important part of treatment.
Importance of homework
CBT-I is a collaborative process between the therapist and the patient and requires work outside of sessions. The therapist will give a variety of homework assignments to help ensure treatment progress such as keeping a sleep diary, practicing relaxation exercises, logging thoughts about sleep and practicing cognitive skills, practicing good sleep hygiene, and/or writing down stressors and other struggles to problem-solve in sessions. Since therapy sessions are only 45-50 minutes of your week, it’s so important to practice what you’re learning between sessions.
This information is not a replacement for assessment and treatment by a sleep specialist, physician, and/or therapist.
For more support and guidance, book a consultation with me to get started with a specialized treatment for insomnia called Cognitive Behavioral Therapy for Insomnia (CBT-I).