Sleep is one of the most important factors in physical and emotional health. Often when I see someone struggling with illness, caregiver burnout, or anxiety, getting better sleep is one of the first areas we need to address. The importance of sleep has been known throughout the ages. These lines from Shakespeare from over 400 years ago say it well:
"Sleep that knits up the revell’d sleave of care,
The death of each day’s life, sore labour’s bath,
Balm of hurt minds, great nature’s second course,
Chief nourisher in life’s feast”.
If you are struggling with sleep, you are certainly not alone. Roughly a third of Americans do not regularly get the recommended amount of sleep, and about 12% are diagnosed with chronic insomnia.
Various over-the-counter sleep aids and prescription medicines are almost a $ 100 billion dollar industry. If you’ve tried any of these, you may have also discovered the sad truth that they are only a temporary fix and long-term often have the unintended consequence of making sleep worse. You’ve probably heard about “sleep hygiene”, everything we do to promote a good night’s sleep, but you may not have heard about CBT-I.
What is CBT-I? (aka Cognitive Behavioral Therapy for Insomnia)
CBT-I is a structured, evidence-based approach, distinct from generic “sleep hygiene” advice that works with the negative thoughts and beliefs about sleep, retraining your association of the bed and bedroom with sleep, consolidating the time in bed so you begin to sleep consistently, and then gradually expanding the sleep window until you achieve your sleep goal.
Along the way, you regain confidence in your ability to sleep and can handle the inevitable hiccups and disruptions of sleep without getting completely thrown off track.
CBT-I or medication — Which is right for you?
Many people wonder why not take an Ambien or over-the-counter sleep aids if they know it works. While effective short-term for sleep, the problem is these medications interrupt the normal sleep structure that is important to brain health and memory.
Long-term use of over-the-counter antihistamine medications for sleep is found to be implicated in the development of Alzheimer’s disease.
CBT-I is considered the gold standard for insomnia and a first-line approach that promotes the body’s natural ability to sleep and all the important functions that go with it.
What to expect in Cognitive Behavioral Therapy treatment for Insomnia
CBT-I begins with a structured interview to assess the nature of your sleep difficulty. Are you having trouble falling asleep, waking up in the middle of the night and not getting back to sleep, waking too early, or a combination of the above?
Typically, treatment spans 6-8 sessions, first tracking and identifying your pattern of sleep, adjusting routines and behaviors to promote sleep, addressing counterproductive thoughts about sleep, and developing a sleep constriction schedule.
Sleep constriction turns the problem of insomnia on its head. Rather than trying to force yourself to sleep, you need to stay awake until it’s time to sleep instead. Along the way, sleep drive, the pressure you feel to sleep, naturally increases, reinforcing your body’s natural mechanism. Sleep onset, structure, quality, and consistency all improve, and you begin to regain confidence in your ability to sleep.
As the consistency improves, you can begin to increase the length of time until you are sleeping somewhere between seven to nine hours a night, waking up feeling rested and restored.
What is your insomnia really caused by?
Insomnia rarely shows up as a standalone issue. Often there are other contributing factors such as physical illness, caregiver burnout, anxiety, or grief that need to be addressed concurrently.
Improving sleep can often go a long way toward improving an individual’s ability to cope with challenges they face day to day and is a critical component for improving your emotional and physical health.
Don’t ignore problems with sleep
One or two nights of poor sleep may not be a concern, but ongoing difficulties with sleep need to be addressed for your own physical and emotional well-being. Many practitioners know the basics of sleep hygiene, but not all are trained in CBT-I.
If you are interested in learning more about how this approach may be of help to you, schedule a free initial consultation so we can talk more about your particular situation.