Cognitive behavior therapy for insomnia

Cognitive behavior therapy for insomnia
Specialty	psychiatry psychology

Cognitive-behavioral therapy (CBT) can help relieve the anxiety linked to chronic insomnia.

Cognitive behavioral therapy

• Cognitive behavioral therapy (CBT) helps reduce anxiety about getting enough sleep.
• You learn to change negative thoughts and beliefs about sleep into positive thoughts and images, in order to fall asleep more easily.
• CBT helps replace the anxiety of “I need to sleep” with the idea of “just relax.”
• You learn how to change sleep habits that keep you from sleeping well.
• If in-person CBT sessions with a health professional are not available, video CBT sessions have been shown to be helpful.

Components of CBTI

CBT may include the following:

• Stimulus control.
• Sleep restriction.
• Relaxation therapy.

• Stimulus control When you have sleep problems for a long time, just getting ready for bed or getting into bed to sleep may cause you to start worrying that you will have another sleepless night. That worry then makes it very hard to fall asleep. Stimulus control can help you learn to connect getting ready for bed and being in bed only with being asleep. By using the bed and bedroom only when you're sleepy, the bed and sleep are linked in your mind. Stimulus control may include the following changes in your sleeping habits:
  • Go to bed only when sleepy and get out of bed if you do not fall asleep after a short time. Return to bed only when you feel sleepy.
  • Use the bed and bedroom only for sleeping, not for other activities.
• Sleep restriction Sleep restriction decreases the time you spend in bed sleeping. This makes you more likely to feel sleepy the next night. The time you can set aside for sleeping is increased when your sleep improves.
• Relaxation therapy Relaxation therapy is used to relieve muscle tension and stress, lower blood pressure, and control pain. It may involve tensing and relaxing muscles throughout the body. It is often used with guided imagery (focusing the mind on positive images) and meditation (focusing thoughts). Self-hypnosis at bedtime can also help you feel relaxed and sleepy. Relaxation therapy exercises can make it easier for stimulus control and sleep restriction to work for you.

Sleep habits

Good sleep habits help you fall asleep more easily and stay asleep. Habits and routines that may help improve sleep include the following:

A comfortable bed and bedroom

Making your bed and bedroom more comfortable may help you sleep. Some ways to increase bedroom comfort include:

• Keep the room quiet.
• Dim or turn off lights.
• Keep the room at a comfortable temperature.
• Keep skin clean and dry.
• Dress in loose, soft clothing.
• Keep bedding and pillows clean, dry, and smooth, without wrinkles.
• Use blankets to keep warm.
• Use pillows to get into a comfortable position.

Regular bowel and bladder habits

Regular bowel and bladder habits reduce the number of times you have to get up during the night. Waking during the night to go to the bathroom may be reduced by doing the following:

• Drink more fluids during the day.
• Eat more high-fiber foods during the day.
• Avoid drinking a lot before bedtime.
• Empty your bowel and bladder before going to bed.

Diet and exercise

The following diet and exercise habits may improve sleep:

• Stay active during the day.
• Get regular exercise but don't exercise within 3 hours of bedtime.
• Eat a high-protein snack (such as milk or turkey) 2 hours before bedtime.
• Avoid heavy, spicy, or sugary foods before bedtime.
• Avoid drinking alcohol or smoking before bedtime.
• Avoid foods and drinks that have caffeine, including dietary supplements to control appetite.

Other habits that may improve sleep include:

• Avoid naps.
• Avoid watching TV or working in the bedroom.
• Relax before bedtime.
• Go to sleep and wake up at the same hours every day, no matter how little you slept.

Hospital routines

Getting a good night's sleep in a hospital or other care facility can be hard to do. The good sleep habits listed above may help you. As a hospital patient, you may also:

• Ask caregivers to plan care so they wake you up the least number of times during the night.
• Ask for a back rub or massage to relieve pain or help you relax.

Medications for insomnia

Treatment without drugs does not always work. Sometimes cognitive behavioral therapies are not available or they do not help. Also, some sleep disorders are caused by conditions that need to be treated with drugs, such as hot flashes, pain, anxiety, depression, or mood disorders. The drug used will depend on your type of sleep problem (such as trouble falling asleep or trouble staying asleep) and other medicines you're taking. All of your other medicines and health conditions will affect which sleeping medicines are safe and will work well for you.

Some drugs that help you sleep should not be stopped suddenly. Suddenly stopping them may cause nervousness, seizures, and a change in the REM phase of sleep that increases dreaming, including nightmares. This change in REM sleep may be dangerous for patients with peptic ulcers or heart conditions.

External resources

• Sleep foundation CBTI
• Mayo Clinic CBTI
• Stanford sleep CBTI

Mobile apps for CBTI

• VA CBTI coach

Cognitive behavior therapy for insomnia Resources
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