The role that sleep plays when it comes to our physical and mental health is quite crucial, and it manifests throughout our bodies when we’re deprived of sleep. Cognitive functions like memorization, planning, and maintaining attention, as well as our emotional balance are all significantly negatively affected when we lack sleep.
But sometimes, sleep inadequacy isn’t always entirely our fault: people struggle with sleep disorders like insomnia, having difficulty falling asleep and staying asleep, and only getting non-restorative sleep. Conditions like these have both lifestyle and genetics factors involved, and that’s why mental health professionals have utilized cognitive behaviour therapy for insomnia (CBT-I) to manage and treat sleep disorders.
Understanding Cognitive-Behaviour Therapy for Insomnia
Cognitive-Behaviour Therapy for Insomnia (CBT-I) is a structured, short-term therapeutic intervention designed to address the underlying causes of insomnia and promote healthy sleep habits. CBT-I is not a medication-based approach, as it focuses mainly on identifying thoughts, beliefs, habits, and other factors that contribute to sleep difficulties. As it tackles both cognitive and behavioural aspects, CBT-I is a more holistic approach than other non-medication treatments for insomnia.
How Does CBT-I Work?
1. Sleep Education
After having established some level of therapeutic alliance, CBT-I starts off with psychoeducation, where clients are filled in the current numbers and figures on their sleep condition, informed of the positive effects of sleeping on the brain as well as on different parts of the body, and educated on the multitude of factors that influence sleep quality such as genetics or lifestyle.
The therapist also includes explaining the different stages of sleep, the circadian rhythm, and how sleep disturbances negatively affect our overall well-being. By understanding the science of sleep, those who suffer from insomnia gain some insight into the mechanisms behind their condition, as well as an early briefing on the possible strategies they can use to improve.
2. Sleep Restriction
A core component of CBT-I, the goal of sleep restriction is to improve sleep efficiency. Sleep restriction involves reducing the amount of time spent in bed so that it matches the actual sleep duration of those who have insomnia.
By decreasing the time spent awake in bed, sleep restriction helps condition the mind of the client to have a stronger association between the bed and sleep. As sleep efficiency improves eventually, the time spent in bed is expected to gradually increase as well, allowing for longer, better quality sleep in turn.
3. Stimulus Control
Aiming to establish a strong connection the bed and sleep, stimulus control techniques are utilized by those with insomnia to condition themselves into using the bed and bedroom only for sleeping and for intimate activities. Further, refraining from doing activities like scrolling on social media or watching movies in bed, as those with insomnia may have associations with their supposed sleep environment that link with stimulating or arousing activities instead.
4. Cognitive Restructuring
Focusing on addressing and challenging unhelpful thoughts and beliefs about sleep like distorted thinking patterns and excessive worry, cognitive restructuring in CBT-I aims to reframe said thoughts and beliefs on sleep and develop more realistic and positive expectations on the end of the client.
If done the right way, cognitive restructuring can promote relaxation, reduce anxiety, and remove the psychological barriers that perpetuate insomnia as it identifies and challenges unhelpful and unhealthy thoughts on sleep and ultimately stops the cycle of anxiety and sleeplessness.
5. Relaxation Techniques
Some relaxation techniques that are used in CBT-I to help those with insomnia include diaphragmatic breathing and mindfulness meditation. These techniques aim to reduce the anxiety of those suffering from insomnia, as well as to promote calmness conducive to sleep.
One example of a relaxation technique is deep breathing exercises, which activate the relaxation response of the body, as well as slow down the heart rate. Another example is progressive muscle relaxation, which involves releasing and tensing different muscle groups in the body to induce relaxation.
Meanwhile, mindfulness meditation deals more with cultivating awareness of the present moment. Mindfulness meditation is also non-judgmental acceptance, ultimately aiming to decrease stress and induce mental relaxation. Ideally used before bedtime to calm the mind and body, mindfulness meditation facilitates a transition into sleep that’s more relaxed and smoother.
6. Sleep Hygiene
This refers to having healthier sleep habits and making the sleep environment more conducive for sleeping. To have good sleep hygiene, you must maintain a sleep schedule that’s consistent and see to it that you set a time to go to bed and a time to wake up every day, which applies even on weekends.
To successfully create a sleep-friendly environment, you must keep the bedroom well-ventilated, quiet, and dark, use smooth sheets and soft pillows, and do away with disruptions such as outside noise or excessive light.
Additionally, you should avoid engaging in stimulating activities when bedtime is approaching. Some examples of what you should refrain from doing include consuming caffeinated drinks and working out vigorously.
Effectiveness of CBT-I
CBT-I is proven highly effective, as it’s extensively researched on when it comes to treating insomnia. Multiple clinical trials and studies have mostly shown positive outcomes and long-term benefits of CBT-I for those with insomnia. Some key findings in these studies include:
1. Improved Sleep Quality
Constantly showing noticeable improvements in sleep quality among those with insomnia, research on CBT-I demonstrates that it helps decrease the time it takes to fall asleep, which is also known as sleep onset latency. Aside from these findings, CBT-I can also increase total sleep time and decrease the number of nighttime awakenings.
2. Lasting Effects
Another notable benefit of CBT-I is its efficacy, which proves to last long – the advantages that come with undergoing CBT-I tend to last even beyond the time of treatment. Those who undergo CBT-I often enjoy continued quality sleep, especially when they practice maintenance of healthy sleep habits.
3. Reduced Dependence on Medication
Unlike medication-based treatment methods, CBT-I is a more sustainable solution as it targets the underlying causes of insomnia, and helps people develop strategies and skills to manage their sleep challenges. Medical treatments may offer temporary relief, but the downside is that it can lead to dependency or even side effects.
4. Addressing Comorbid Conditions
Insomnia often co-occurs with other mental health conditions, like depression or anxiety. CBT-I has been found to help manage and treat both symptoms of insomnia and its associated psychological symptoms successfully. CBT-I also involves targeting cognitive and behavioural factors contributing to insomnia, and has been proven to improve our overall mental well-being.
5. Enhanced Daytime Functioning
Restorative sleep obtained through CBT-I translates into improved daytime functioning. Those who undergo CBT-I often report improved daytime alertness, sustained concentration, and stabilized mood.
6. Personalized and Tailored Approach
CBT-I carefully takes into account peoples’ unique sleep patterns, lifestyles, and other types of sleeping challenges that they may have. This personalized approach makes certain that the treatment increases its effectiveness and relevance, and ultimately, for the best results possible.
7. Suitable for Various Populations
Proven effective across different age groups, including adults, adolescents, and older adults, CBT-I has also shown positive outcomes for those with chronic medical conditions like chronic pain or cancer who also experience sleep disturbances because of their health conditions.
Accessing CBT-I: Choose a Trusted Psychological Clinic
CBT-I can be accessed from a multitude of sources – clients can seek CBT-I from psychologists and therapists, sleep medicine specialists, or specialized sleep clinics. Archways Centre for CBT in London, Ontario, stands as a reputable psychology practice offering evidence-based cognitive and behavioural therapies, including CBT-I, to those seeking relief from insomnia.
Conclusion
As insomnia continues to affect countless people, cognitive-behaviour therapy for insomnia (CBT-I) emerges as a promising evidence-based treatment option. By addressing the cognitive and behavioural aspects contributing to sleep difficulties, CBT-I empowers individuals to develop healthier sleep habits and overcome insomnia.
Author Joanna Jeffers, M.A., C.Psych.
