Cognitive Behavioral Treatment for Insomnia

Unlike medication, cognitive behavioral treatment for insomnia requires time and self-discipline. But you’re more likely to get a lasting effect. Learn more.

When you have insomnia, it’s hard to fall asleep. The condition can increase your risk for high blood pressure, heart disease, diabetes, and chronic pain. Cognitive behavioral treatment for insomnia, often called CBT-I, is a coaching process that can relieve the underlying causes. It teaches you to overcome insomnia without sleeping pills.

Several organizations have concluded that it’s best to try therapy before taking a medication for sleep. Sleeping pills may work right away, but there is no evidence that you’ll be sleeping at night once you go off the pills, and eventually they may not work, either. Because sleeping pills are intended as a short-term solution, your insurance company may not cover your prescription after a while.

Be prepared: It may take weeks or months of cognitive behavioral treatment for insomnia before you’ll feel rested. Stick with the program, however, and you’re likely to feel much better about yourself. People with mild or high levels of depression symptoms tend to become happier. Better sleep can even help end thoughts of suicide.

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At first you’ll go through a series of tests to understand your sleep. You’ll also keep a sleep diary. With those results, your therapist will give you advice tailored to you, and together you’ll track your progress.

It’s standard to meet for between five and 20 weekly sessions, each lasting 30 to 60 minutes. Sometimes you can meet every two weeks. Group therapy can work well, too. In some areas, it’s hard to find a group or therapist, so you may need to try an online program.

Consider CBTforinsomnia, CBT-iCoach (an app developed by Stanford and the U.S. Veterans Administration), Shuti (if you participate in a clinical trial), Sleepio (developed by scientists from the University of Oxford), or Sleep Tutor. All are backed by research.

Insomnia often begins with a change in your routine. Let’s say you have surgery and take painkillers for a while. If it makes you sleepy, you might start napping during the day. When you go back to work, you may have trouble staying awake all day.

One of the first steps is restricting when you sleep. If you’re used to napping, you will stop. If you’re used to going to bed very early but don’t sleep well during the night, you may need to go to bed later. In the beginning, you’ll be getting less sleep.

The goal is to nudge your body to be sleepy at the right times.

Another strategy, called stimulus control, focuses on changing your associations with sleep. For example, if you spend a lot of time in bed not sleeping, you may need to get out of bed, and leave the bedroom until you are sleepy again. The goal is to teach your body to link your bed and bedroom to sleep.

You may be breaking some of the standard rules of sleep, called sleep hygiene. It’s a good idea for everyone to avoid exercise, caffeine, alcohol and tobacco, and electronic screens before bedtime. Your room may be too hot or too bright. You will review these rules and learn which of your habits you need to change. Some of the changes aren’t obvious. Many people keep checking the clock when they’re up at night and become increasingly anxious. Your therapist may advise you to hide the clock, or even put it under the bed, where you can still hear an alarm.

If you’ve been staying up late on long phone calls, you may need to work with your friends and family to find other times to talk. Some people check their work email late at night — another recipe for anxiety. You might need to watch TV in your kitchen or den, rather than the bedroom.

After you recover, you’ll need to monitor your sleep so you don’t fall into bad habits again. Key points:

1. When you miss sleep, don’t try to make it up by sleeping more afterwards. Stay on your routine.
2. Whenever you have insomnia for more than a few days, put into practice all the recommendations you learned if you have let anything slide.

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