Cognitive Behavioral Therapy for Insomnia (CBT-I) or How to Change the Myths about Sleeplessness

The American Academy of Sleep Medicine has declared that Monday, March 12, 2018, is Insomnia Awareness Day. Each night millions of people in the U.S. struggle to fall asleep or stay asleep. For some, this is only a brief problem. But for others, insomnia can become a severe, ongoing struggle.

AASM

AASM

The statistics vary depending on where you look. Some say one-in-three people suffer from insomnia. Others put the number of sleepless people at 60 million. Regardless of the total, it is estimated that 10% of those with insomnia suffer with it chronically, while another 15-20% have short-term acute insomnia that can last for three months, caused by serious problems such as loss of a job, the death of a spouse, or other serious problems. Even more, 30-35% have very brief bouts of sleeplessness.
While sleeping pills can help for acute insomnia, they are never a good solution for someone who has chronic insomnia. And recent research has shown that CBT-I can be even more effective than medication for those suffering from chronic insomnia. Let’s look at some myths about insomnia and how sleeplessness can be helped with Cognitive Behavioral Therapy.
Myth #1: Insomnia means that I can’t get to sleep. In fact, insomnia can include trouble going to sleep, staying asleep, or even problems waking up too early in the morning. Edward has a high-stress job in New York that requires him to make a 5:30 AM boat in the morning. He has always had trouble waking up, and his anxiety about waking on time never goes away. As a result, he wakens three or four times a night and rarely has an unbroken stretch of quality sleep. He is chronically tired.
Myth #2: I can learn to get by on less sleep. After all, we don’t all need the same amount of sleep. And I can always nap. While we don’t all need the same amount of sleep, we all need a significant amount of quality sleep. And you cannot make up on the weekend for what you do not get during the week. Diane struggles with insomnia during the week and then tries to make up for it by sleeping in on Saturday and Sunday and sometimes taking long naps. As a result, she then has trouble going to sleep on Saturday and Sunday nights also.
Myth #3: There is nothing really wrong with me, so insomnia must be all in my head. I’ll just have a drink to relax. It is true that worry and depression can play havoc with good sleep, but so can physical illness and other factors. However, having a drink is not the answer, any more than continual use of sleeping pills will help. Having an evaluation with a sleep specialist in order to rule out physical problems can be a first step before starting CBT-I for insomnia.
Myth #4: Since I can’t sleep, I’ll just spend some more time playing video games, answering my email, or watching TV in bed. Unfortunately, screen time has the opposite effect of relaxing you. The light and noise levels decrease melatonin in the brain and make it harder to get quality sleep.
Anyone who wants to combat insomnia has to work on what is called sleep hygiene. In other words, they need to create an appropriate sleep environment and create consistency in their habits related to sleep. Not all techniques work for everyone, but here are some CBT-I techniques that can help:
*Create a dark, cool, and quiet environment in your bedroom. More melatonin (a substance that can cause sleep) is produced in a darker environment. Think of your bedroom as your sleep haven, and not a place to do work, play with the dog, or plan the project that is due next month. Some therapists recommend getting out of bed if you do not fall asleep in about 30 minutes and going to another room to read or relax. By only sleeping in the bed, you are less likely to associate the bed with work, video games, etc. However, this technique can be controversial.
*Improve your sleep education. Research has shown that avoiding certain things shortly before bedtime can enhance sleep. These include alcohol, caffeine, exercise and other stimulating activities. Napping during the day can also hurt sleep patterns.
* Relaxation techniques can help combat insomnia. You can find many different kinds of relaxation online or can be taught by a Cognitive Behavioral therapist. For people who struggle with sleeplessness, learning to relax both in mind and body can provide help and lead to better sleep.
*Be consistent about your sleep schedule. Many people are consistent during the work week, and then make dramatic changes in that schedule on the weekend. Research has shown that people usually become sleepy 24 hours after they went to sleep and also wake 24 hours after last awakening. Sticking to this can enhance your sleep-wake cycle. For some, getting up earlier can help.
*Cognitive restructuring, learning to change one’s inaccurate thoughts, can help in situations like the case of Edward. Examining the evidence about how often he has actually overslept, and perhaps even changing his perceptions about how long he does sleep, or how long he is awake, can help improve his sleep.
Some people say that they have tried the techniques above and they have not worked. However, when interviewing them, I often find out that they tried them for a couple or three days, and never really stuck with them enough to break old habits and establish new ones.
Don’t give in and just accept that you will always have insomnia. It is a problem that can be tackled like many others, with a team of medical and psychologic professionals.

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