Cognitive behavioral therapy (CBT) is a type of therapy used to address a variety of mental health conditions. This includes CBT for depression, CBT for anxiety, CBT for ADHD and CBT for post-traumatic stress disorder (PTSD). It’s also used to effectively treat sleep disorders like chronic insomnia, too.
A specialized form of the therapy technique known as cognitive behavioral therapy for insomnia (CBTI) has been found extremely helpful for some people who live with the sleep disorder. Read on to learn more about what cognitive behavior therapy is and how CBT can help insomnia symptoms.
What is CBT for Insomnia?
Cognitive behavioral therapy for insomnia (CBTI) is an evidence-based way to treat insomnia through therapy, without the use of sleep-inducing pharmaceuticals like Lunesta (eszopiclone), Sonata (zaleplon), or Ambien (zolpidem) — all of which have been attributed to various possible adverse side effects.
CBT for insomnia is a short, highly structured therapy treatment that, in true CBT form, helps you first identify, then replace negative thought patterns and behaviors that might be contributing to your sleep problem.
Insomnia is a challenging condition that causes trouble falling asleep, staying asleep, or getting back to sleep if you wake up in the middle of the night. According to the National Heart, Lung, and Blood Institute, nearly 50-70 million people live with a sleep or wakefulness disorder in the US.
It’s more than just not sleeping, though. Not getting enough or quality sleep can result in multiple health issues. High blood pressure, heart disease, diabetes, stroke, obesity, and even certain cancers have all been linked to poor sleep, so it’s something to take seriously.
How Does CBT Work for Treating Insomnia?
The American Academy of Sleep Medicine (AASM) estimates that about 30% of adult Americans live with symptoms of chronic insomnia. If you’re hoping to get a better night’s rest without using sleep aid medication, you might be wondering how CBT can help you form better sleep habits.
Insomnia cognitive behavioral therapy can help decrease both the frequency and severity of insomnia symptoms. In fact, according to 2022 multi-university research, CBTI has been proven so effective that it’s now considered the first-line treatment for insomnia treatment. This seems to be true for both uncomplicated insomnia (insomnia that occurs without any other mental health conditions), as well as when it occurs comorbidly (with additional mental health conditions).
“Cognitive behavioral therapy has become a commonly used evidence based treatment for a number of issues. Individuals dealing with insomnia have found a lot of benefits in using CBT. It concentrates on reframing thoughts about sleep, working on behavioral techniques (like relaxation skills), and educating on the importance of a balanced lifestyle that can encourage healthier sleeping habits. Talkspace has providers who specialize in CBT.”Talkspace therapist Minkyung Chung, MS, LMHC
Components of CBT
Cognitive behavioral therapy for insomnia is a therapy that, as the name suggests, teaches you to recognize and modify the beliefs or thoughts and actions that might be affecting your sleep habits. This style of therapy can eliminate negative thoughts while controlling the worry and nervousness that might be keeping you awake at night.
CBT for insomnia also focuses on developing positive behaviors that encourage restful sleep, like creating a blissful sleeping environment and relaxing your mind before bedtime.
Depending on your individual needs and the severity of your symptoms, your therapist might recommend any one (or several) of the various traditional CBT techniques, including:
- Cognitive therapy
- Relaxation training
- Behavioral strategies
Let’s look at each of these more closely.
CBT for insomnia uses sleep education as a primary tool to effectively teach you about proper sleep. A therapist will instruct you on methods you can use to control your thoughts and when bedtime is nearing.
You’ll also learn about behavioral modifications you can make to enhance the quality of your sleep. For example, you might try using a light-proof shade to make your room dark, diffusing some calming essential oils, or filling your space with ambient white noise.
Cognitive therapy is a component of CBT that involves correcting dysfunctional or harmful thought patterns that might be causing you to have difficulty falling or staying asleep. Ironically, worrying about falling asleep can keep you awake. This can become a cyclical, frustrating pattern that takes diligence and practice to break.
Part of learning how CBT can help insomnia might include focusing on restructuring negative or destructive thought patterns. You can instead work on anticipating, recognizing, challenging, and altering your thoughts in real-time. With patience, this can often lead to improved sleep.
It can be very difficult, if not impossible, to get a decent night’s sleep when you’re not relaxed. That’s why relaxation training is an integral part of CBT for insomnia. A therapist can show you relaxation techniques to reduce racing thoughts and excessive tension that might be part of why you tend to lay awake at night.
Possible relaxation techniques your therapist might suggest can include:
- Autogenic training — This involves using the power of your mind to relax your entire body.
- Self-hypnosis or guided hypnosis — You’ll learn to be intensely focused on your time and space while giving yourself positive feedback and suggestions.
- Progressive muscle relaxation (PMR) — A technique aimed at reducing anxiety that involves first tensing, then relaxing, major muscle groups throughout your body.
- Deep breathing exercises (pranayama) — Breathing slowly and deeply into your abdomen can help you achieve full oxygen exchange, slowing your heartbeat, helping you relax, and relieving anxiety that might be interfering with your sleep.
- Physiological monitoring and biofeedback — Through the use of an external device, you can learn how to regulate your internal processes so you can reduce tension and fall asleep faster.
Many therapists also recommend learning mindfulness meditation, which teaches you to consistently pay attention to your breathing and thoughts as they develop. Mindfulness can help you maintain better emotional control, which in turn can allow you to recognize problematic thought patterns that may be leading to poor sleep.
Aside from psychoeducation, cognitive therapy, and relaxation training, behavioral strategies like stimulus control and sleep restriction can be useful in combating insomnia.
Stimulus control involves reclaiming your bedroom as a space you use only for sleeping or having sex. It’s not for watching television, working, reading, social networking, or anything else.
Sleep restriction refers to setting rules about napping, excessive lying around, and other relaxing activities that might result in difficulty sleeping at night. Initially, this might cause some daytime fatigue, but many people find it helps them get more quality rest at night.
How Long Does CBT Take to Work?
We’re beginning to better understand how CBT can help reduce the symptoms of insomnia. There’s no set or determined timeline about how long CBT will take. That said, it is designed to be a short experience.
Most people find that even a very short amount of time spent with a cognitive behavioral therapist can be effective treatment when it comes to helping address a sleep problem. Often, CBTI can quickly allow you to develop and implement techniques at home aimed at helping you achieve more restful, peaceful, uninterrupted sleep.
“As with most techniques, variations exist in how long it takes for a particular treatment to be effective. This is due to human factors (consistency, motivation to change, etc.) that can delay effectiveness. However, with consistent treatment, it should take anywhere from 8 to 10 weeks to see treatment effectiveness.”Talkspace therapist Minkyung Chung, MS, LMHC
In conclusion, insomnia cognitive behavioral therapy is highly effective, so much so that it’s now thought of as a first-line treatment method. It teaches you to reform the thoughts and behaviors that might be affecting your ability to go to sleep, stay asleep, or otherwise enjoy a restful sleep. Getting enough sleep is imperative for your overall health (both mental and physical) throughout life.
If your sleep is disrupted and you can’t seem to get a grip on it, consider looking into in-person or online therapy with a professional who specializes in CBT for insomnia. Online cognitive behavioral therapy can help change your life for the better.