COGNITIVE BEHAVIORAL THERAPY FOR INSOMNIA — CBT-I
Restore sleepiness & get the sleep you’ve been searching for.
TOWSON, MD | ONLINE THROUGHOUT MARYLAND & FLORIDA
What is CBT-I?
Do you often feel like you are “tired but wired”? When you get into bed, does it feel like the moment your head touches the pillow your sleepiness vanishes? Achieving quality sleep can feel like an unachievable goal, especially for those with chronic insomnia. Truth is, sleep medication might not be as effective as you think it might be to treat your insomnia. This is because chronic insomnia involves the way you think about sleep and the “effort” you put into TRYING to sleep.
CBT-I is a brief, evidenced-based treatment that is effective for treating both short-term and chronic insomnia. CBT-I aims to relieve you of the frustrating symptoms of insomnia by specifically targeting the beliefs you hold around sleep, the things you do to TRY to sleep, and the way you feel about sleep in general. If you want better sleep, you have to stop trying. It sounds counter-intuitive, but CBT-I can help you fall asleep faster, stay asleep, and feel more rested during the day.
WHAT TO EXPECT
The CBT-I Process
CBT-I is typically 4 sessions spread out across 8 weeks. However, your therapist may recommend additional sessions in situations where you may need more support in understanding the foundational knowledge of CBT concepts, addressing cognitions, or increasing coping strategies.
Intake & Assessment
In the first appointment, your therapist will conduct a thorough assessment on your sleep history and determine whether CBT-I is the right course of action. Your therapist will ask you about your daily activities, mental health history, medical history, satisfaction with sleep, and more. The goal is to identify the thoughts, feelings, and behaviors contributing to your insomnia symptoms.
Key Components
1
Cognitive Interventions
Your mindset about sleep makes a difference. Through cognitive restructuring, you will examine your thinking patterns in efforts to reframe or “restructure” inaccurate or unhelpful thoughts about sleep.
2
Behavioral Interventions
Your habits matter. You will take a deep dive into the things you do before bed or what you do to TRY to sleep (aka sleep effort) that are ultimately prevent you from being a “good sleeper”. This could look like changing your sleep environment, controlling the amount of time you spend in bed, and/or implementing relaxation strategies to promote healthy pre-sleep habits.
3
Psychoeducational Interventions
Let’s assume that everything you once knew about sleep is wrong. With CBT-I, you will build a foundational knowledge of CBT concepts, gain understanding of your thoughts, feelings, and behaviors around sleep and how they contribute to insomnia, and learn relaxation techniques.
CBT-I TECHNIQUES
STIMULUS CONTROL THRAPY
Address the unhelpful associations that you have with your bedroom such as feelings of frustration or dread, poor habits that make sleeping more difficult like watching TV, eating, or scrolling on their phone. During CBT-I, the bed is used only for sleep and sex. The golden rule is "if you’re trying to sleep, stop trying.” You will be asked to get out of bed when you can’t fall asleep or when lying awake for more than 10 mins, only to return when feeling sleepy again. Alarms are set for the same time every morning (including weekends, vacations, etc.) and daytime naps are not recommended.
SLEEP RESTRICTION & COMPRESSION (SRT)
Limit the amount of time you’re spending in bed in order to increase your “sleep drive” and temporarily increase daytime fatigue. Think of sleep drive as building up enough “momentum” to actually fall asleep. SRT uses a sleep diary to calculate your total time spent asleep on an average night. Your time in bed will then be adjusted to reflect this amount adding 30 mins. Once you’re able to spend the majority of your time in bed actually sleeping, you can begin slowly increasing your time in bed. Sleep Compression is a gentler approach, gradually reducing your time in bed until it’s close to the time you actually spend sleeping.
HOMEWORK
Since CBT-I is a short term treatment and collaborative process, practicing the skills learned during sessions is super important. Homework is a crucial element of treatment. Your therapist will give you “experiments” to try in between sessions. This might look like using a sleep diary, practicing thought-challenging strategies, and implementing changes in your environment or behavior.
PSYCHOEDUCATION
Teaching you the importance of good sleep habits means expanding practices that boost and help sleep while reducing or getting rid of those that inhibit sleep. Topics may include are the impacts of nutrition, movement, and environment have on your ability to fall or stay asleep.
RELAXATION TRAINING
Learn techniques that you can easily build into your current routine to promote your body’s natural relaxation response and reduce the racing thoughts and tension that frequently come with lying in bed awake.
better sleep is possible.