Top 12 CBT Strategies for Insomnia

Do you have trouble falling or staying asleep or wake feeling like you haven’t rested at all? Chances are that you have experienced sleep problems at some stage in your life, often as a side effect of stress or other mental or physical complaints. For some sufferers relief isn’t in sight, and the disturbance to their sleep continues for over a month and impacts more significantly, this is known as insomnia.  Getting an accurate assessment of the origin of the sleep problem is vital to ensure you get sleep back on track. Discussing this with your GP is the first step to rule out any medical causes that need addressing.  Where the sleep problem is related to psychological factors (like worry, stress, depression) your GP will refer you to a psychologist for CBT treatment for insomnia and sleep-related problems.  This article outlines 12 CBT strategies to help you with your insomnia.

Psychological Treatment for Insomnia and Sleep Problems

Psychological treatment for insomnia and sleep problems assumes that physiological reactions, tension and worry maintain poor sleep as well as unhelpful sleep habits.  Habits like having an irregular sleep routine, too much coffee/tea and long day naps can maintain sleep problems over time.

CBT Treatment for Insomnia (CBT-I)

Cognitive-behaviour therapy for insomnia (CBT-I) is recommended as the first line psychological treatment for insomnia by Australasian Sleep Association (ASA).  Treatment that combines the use of mindfulness-based therapy with behavioral techniques (MBT-I) also has an immerging evidence base.  These therapies are recommended to be used wherever possible and medications limited to the lowest necessary dose and shortest necessary duration.  CBT-I consists of education, addressing unhelpful thinking and beliefs, reducing worry and tension and behavioral interventions (called sleep restriction, stimulus control) to improve sleep. Lets talk more about this.

1 – Addressing unhelpful thoughts and beliefs about sleep

Our unhelpful thoughts can lead to a ‘vicious cycle of insomnia’. Thoughts like “I will not be able to cope unless I have 8 hours sleep” are often triggered after poor sleep and in turn can lead to dread about going to sleep.  Triggering physiological reactions (e.g. tension) that can makes it impossible to relax and sleep and confirm your negative view of sleep. And so the vicious cycle continues..

Addressing this negative self-talk can help, examples are

• Staying here and now and avoiding fortune telling: For example, just because you have had poor sleep the last 3 nights doesn’t ensure you’re have a poor sleep again.
• Keeping things in perspective and avoid catastrophizing – For example, tiredness at work is not going to mean you’ll lose your job!
• Keep the balance, avoid all or nothing thinking – For example, changing thought from “I’m a terrible sleeper, I don’t sleep at all” to “I can have nights where I sleep less but others where I sleep better”.
• Stay with facts and avoid fear-driven thoughts – For example, I can function with less sleep, my body can repair and restore with any sleep I can get.
• Keep open minded to change, rather than overgeneralizing your experience with sleep – For example, changing “I’ve tried everything and nothing works” to “I’ve tried a number of strategies and they haven’t improved my sleep yet however, I know things can improve if I’m open to change, and think more optimistically.

Futher CBT treatment strategies for insomnia and sleep problems include:

3. Thought diaries to record your sleep related thoughts and challenging these.

4.  Accepting that sleep difficulties are a normal part of life when you are under strain.

5. Acknowledging that your view of sleep impacts on the quality of it.

6. “Letting go” strategies allow you to recognize that in the present moment you have limited to nil control over events in your future or past. To facilitate “letting go”, keep a notebook and pen beside       the bed, and if you find your mind full of worries at bedtime, write them down in your notebook – tell yourself, “there’s no need to worry about these now, I’ve noted them and can return to                   them tomorrow”.

8. Distraction like doing a puzzle, reading a book you CAN put down or magazine.

9. Use mindfulness exercises to relax mind and body. Free Apps like Smiling Mind or Utube have exercises tailored to help you fall asleep.

10- Sleep Restriction Techniques

Sleep restriction techniques work to regulate the sleep-wake cycle and involve limiting time in bed to the actual time asleep.  This helps avoid associations of wakefulness and frustration with bed.

It is important to only go to sleep when you are sleepy.

If you don’t fall asleep within 20 minutes or are awake during the night – it is important to get up and do something else (preferably an activity that takes your mind off sleep but does not overstimulate e.g. a puzzle, read magazine). Avoid time in bed when you are awake, including screens (e.g. TV, tech).

11- Sleep hygiene

Sleep hygiene refers to actions that bring on sleepiness. This includes:

• avoid consumption of soft-drink, coffee, food or alcohol at least 3 hours before bed.
• preferably no vigorous exercise within an hour of bedtime (ok with the exception of sex).
• Avoid naps all together, or keep it to a maximum of 30 minutes long and not too late in the day!
• Go to bed and wake the same time each day to train your body clock.
• move the clock out of view and try not to “clock-watch”
• reducing light in the room to darkness
• ensuring temperature is cool and a comfortable bed and pillow.

12- Light Therapy

Light therapy works using exposure to bright light to help adjust your circadian rhythm — physical, mental and behavioral changes that follow a roughly 24-hour cycle and respond primarily to light and darkness in the environment. Light therapy can help if you have tried other forms of treatment or if your doctor thinks this may work for you.

Simple ways to apply light therapy are walking outside in to the sunlight upon waking. Or sleeping with the curtains partly open so that in the morning light filters through.

Let’s recap with 5 quick tips for CBT Treatment for Insomnia and Sleep Problems

1. Challenge negative thinking, relax your mind and switch off using mindfulness
2. Stick to a regular bedtime and wake-time
3. Restrict stimulants (1-3 hours) before bedtime (caffeine, alcohol and exercise) and don’t stay awake in bed instead get up and try to get sleepy again
4. Get sunlight in the morning

If you have tried these treatments but you still struggle with getting restful sleep, see your doctor for a medical review to rule out any other possibilities for your sleep problems. You may wish to consult a psychologist to step you through a CBT program specifically for you. Molly Robbins, author of this blog, is trained in CBT-I and is ready to help you get back to a pattern of regular sleep. If you wish to consult our service, please download our Referral Form Here and take it with you to your long consulation with your doctor

For more information check out: sleephealthfoundation.org.au