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Cognitive-behavioral therapy for insomnia

By Lila Havens, Staff Writer, myOptumHealth

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Fed up with tossing and turning instead of sleeping? Exhausted from waking at 3 a.m. and not being able to get back to sleep? Help is available in a form that might surprise you: talk therapy.

Sleeping pills may help if you get insomnia only from time to time, but they are not a solution for chronic insomnia. They may also cause drowsiness and other side effects. Cognitive-behavioral therapy is free of these drawbacks, and it is both safe and effective.

Cognitive-behavioral therapy (or CBT) for insomnia involves regular meetings with a specially trained therapist, usually for four to eight weeks. You complete a sleep diary and other assessment tools that help show where your problem lies. The therapist then teaches you strategies you use at home to overcome the problem and sleep better.

CBT for insomnia: how it works

CBT combines cognitive therapy with behavioral therapies to help treat insomnia.

Cognitive therapy helps you examine the anxiety and faulty beliefs you have about sleep. For example, being unable to fall asleep may make you anxious, which then makes it even harder to get to sleep. The therapist will help you recognize these unhelpful patterns and find ways to let go of them.

Behavioral therapies often include the following components:

• Stimulus control works on how you respond to your sleep environment. If you have trouble falling asleep, over time you may come to dread bedtime and being in bed. The goal of stimulus control is to change this feeling by helping you once again relate your bed with sleep. For example, you should use your bed only for sleeping and sex. Activities such as watching TV, reading or working should be done in another room because they are linked to wakefulness, not sleep.
• Sleep restriction works by limiting time spent in bed to the amount of time you actually sleep. For example, if you are currently getting only five hours of sleep a night due to insomnia, that is the amount of time you will spend in bed. This will make you more tired at first, but it may also mean you actually get to sleep faster. As you develop better sleep, the time you spend in bed is gradually increased.
• Relaxation techniques are ways to eliminate physical or mental stress that may be disrupting sleep. You may be taught techniques such as progressive muscle relaxation, meditation or guided imagery. You can use these at bedtime to help prepare yourself for sleep.
• Sleep hygiene is about creating habits that encourage sleep.You will be advised to keep your bedroom cool, dark and quiet and to avoid heavy meals, alcohol and caffeine at night. Getting moderate exercise in the afternoon can help foster better sleep.

Things to consider

• CBT for insomnia is not a quick fix. It may take a few weeks to start sleeping better. But it addresses the underlying issues causing sleep problems, so it is a better long-term solution to insomnia than medication.
• CBT for insomnia may be expensive. But the cost of treatment may be justified, because insomnia tends to recur. Once you learn these skills, you can use them again anytime you start to have trouble sleeping. 
• Insomnia may have a number of causes, including depression and thyroid disorders. CBT is not the proper treatment for these conditions or for other types of sleep problems. If you are having trouble sleeping, first see your doctor for an evaluation.
• Online CBT may be an option. A well-designed program works almost as well as face-to-face therapy, some small studies show. One program, called Sleep Healthy Using the Internet (SHUTi), has been funded by the National Institutes of Health. At present, it is only open to those involved in the current study. But you can sign up to take part in future studies or be notified when the program becomes available to the public. For more information, see the Web site at www.study.shuti.net..

View the original Cognitive-behavioral therapy for insomnia article on myOptumHealth.com 

SOURCES:

• Feldman MD, Singer CM. Insomnia. In: Ferri FF, ed. Ferri's Clinical Advisor 2009. Philadelphia, PA: Mosby Elsevier; 2009. Accessed: 09/02/2009

• American Academy of Sleep Medicine. Cognitive-behavioral therapy (CBT). Accessed: 09/02/2009

• National Sleep Foundation. Cognitive-behavioral therapy for insomnia. Accessed: 09/02/2009

• Ritterband LM, Thorndike FP, Gonder-Frederick LA, et al. Efficacy of an Internet-based behavioral intervention for adults with insomnia. Archives of General Psychiatry. 2009;66(7):692-698. Accessed: 09/02/2009

• Morin CM. Cognitive-behavioral therapy of insomnia. Sleep Medicine Clinics. 2006;1(3). Accessed: 09/02/2009