InsomniaInsomnia (difficulty falling or staying asleep) is not just a night time problem. It’s a 24 hour problem! When individuals do not sleep well at night, their day time functioning at work and in their relationships suffers. Daytime sleepiness is not only aversive, but can interfere with concentration, affect mood, and decrease energy and productivity. Insomnia can be a stand-alone concern, or can arise in conjunction with anxiety, depression, or other comorbid medical conditions. Further, one’s risk of experiencing anxiety and depression increases if they already have insomnia. In general, the risk of insomnia increases with age.
CBT Treatment of Insomnia
Cognitive behavioral therapy [CBT] has consistently been shown to be the best first-line treatment for insomnia. CBT improves sleep in more than 75% of insomnia patients and leads to a reduced need for sleeping pills. In addition, CBT has none of the side effects associated with taking sleep medications, and has better long-term outcomes in terms of maintaining good sleep after treatment ends. This is because CBT provides people with strategies they can use to help themselves if the insomnia symptoms were to return, and therefore the benefits remain long after treatment ends.
For those not taking sleep medication, patients often see initial results in just four sessions, although they may stay in treatment longer to reach their optimal sleep potential. Treatment is usually around five to eight sessions. For those on sleep medications, the process likely will take longer. When engaging in CBT for insomnia, patients are often able to reduce, if not eliminate, the amount of sleep medication they take.
Components of CBT for Insomnia
The crux of cognitive behavioral therapy for insomnia involves specific behavioral changes which your therapist will guide you through to enhance the efficiency of your sleep. People with insomnia often unknowingly engage in behavior that: a) inhibits sleep, b) disrupts circadian rhythms, and c) decreases their overall sleep drive. The behavioral component of CBT addresses all three of these concerns by teaching the patient a new set of “Sleep Rules” (e.g., no napping, use the bed only for sleep and sex, get out of bed if you are awake, limit caffeine and alcohol, keep the bedroom quiet, dark and cool, etc.) and offering clear guidelines to make sure that the time you are in bed, you are actually sleeping! Often there is a big disparity between people’s actual sleep time and the amount of time they spend in bed. The idea that laying in bed longer will help you get to sleep is false. Laying in bed awake for long periods actually makes insomnia worse! Your therapist will work with you to identify your specific sleep problem(s), develop a specific individualized sleep plan to address them, and help monitor your progress.
In addition, your therapist will teach you cognitive strategies to decrease cognitive arousal (e.g., taking worries to bed) and address dysfunctional thinking patterns (e.g., “I’ll never get to sleep and I won’t be able to function tomorrow”) that may be keeping you awake. Further, you may be taught general stress reduction techniques and breathing exercises to calm anxieties and enhance restfulness.
Unfortunately, not all psychologists (not even all cognitive behavioral psychologists) are trained in the skills needed to effectively implement CBT for insomnia. Here at the American Institute for Cognitive Therapy, we have specialists who have been trained specifically in this robust insomnia treatment. For more information, call 212-308-2440.
More Information on Insomnia:
“Cognitive Behavioral Therapy Should Be First-Line Insomnia Treatment” – Medscape.com
For further information about the treatment of anxiety and depression please contact:
The American Institute for Cognitive Therapy
150 East 58th Street, Fifth Floor Annex
New York, NY 10155.
Anxiety Free: Unravel Your Fears Before They Unravel You by Robert L. Leahy
The Worry Cure: Seven Steps to Stop Worry from Stopping You by Robert L. Leahy
Clinicians may find the following books on cognitive behavioral therapy to be helpful in treating anxiety:
Leahy, R. L., Holland, S. J., & McGinn, L. K. – Treatment Plans and Interventions for Depression and Anxiety Disorders (2nd ed.)
Leahy, R. L. – Cognitive Therapy Techniques
Sookman, D. and Leahy, R. L. – Treatment Resistant Anxiety Disorders: Resolving Impasses to Symptom Remission