Cognitive Behavioral Therapy for Insomnia (CBT-I): How It Works?

If you suffer from insomnia, you’ll know exactly how debilitating the condition can be.

A lack of sleep affects every aspect of your life, from your performance at work to your relationship with your loved ones. And sometimes, just getting through the day can feel like an impossible task.

But thankfully, there are several treatments available that can help people with insomnia improve the quality and length of their sleep. And one of the most effective is cognitive behavioral therapy, otherwise known as CBT.

What is CBT?

What is CBT

CBT for insomnia is known as CBT-I. CBT-I is an evidence-based, clinician-led approach that can manage, improve, and even cure insomnia.

The practice works by identifying thoughts, feelings, actions, and behaviors that stop you from getting a good night’s sleep.

Rather than treating the symptoms, CBT-I focuses on the root cause of insomnia. And for this reason, it’s a more effective tool than interventions such as sleeping pills.

How Does CBT-I Work?

How Does CBT-I Work

During CBT-I sessions, your therapist will help you examine your thoughts and feelings about sleep and test their accuracy. You’ll also address your current actions and behaviors and determine if they are helping or hindering your sleep.

Once you’ve established a clear picture of thoughts, feelings, actions, and behaviors, your therapist will work with you to reframe and challenge any issues and misconceptions leading to your insomnia so that you can naturally get a better night’s sleep.

What To Expect During CBT-I?

CBT-I is a multi-component therapy that uses several different interventions, including:

1. Cognitive Restructuring

Cognitive Restructuring

People who suffer from insomnia often hold false and unhelpful pre-existing beliefs about sleep. These beliefs can increase and exacerbate behaviors counterproductive to a good night’s rest.

Cognitive restructuring helps you identify, challenge, and correct these beliefs. This breaks the cycle of negative and unhelpful thoughts and replaces them with new, positive, and healthy ones.

2. Behavioral Interventions

Behavioral Interventions

CBT-I incorporates behavioral interventions to rebalance your sleep-wake cycle.

Stimulus control helps change negative associations about your sleep spaces (e.g., your bed and bedroom) to make them more conducive to sleep.

By using the bedroom only for sleep and sex, our brains become attuned to feeling tired when we go to bed each night.

The practice involves getting out of bed when you fail to fall asleep for longer than ten minutes. You’ll engage in a relaxing activity and only return once you feel tired again.

Another common behavioral intervention is relaxation training. This incorporates techniques to reduce tension and ease a busy mind.

Breathing exercises are a common component, as well as hypnosis, meditation, and progressive muscle relaxation (PMR), which involves tensing and relaxing various muscle groups throughout the body.

Your practitioner may also use a behavioral intervention called paradoxical intention. This involves avoiding falling asleep when tired.

This somewhat strange-sounding method can help relieve performance anxiety that may stop you from drifting off. In turn, paradoxically, you may find yourself falling asleep quicker and more consistently.

Psychoeducational Approaches

Psychoeducational Approaches

Most CBT-I sessions also include psychoeducational approaches. These can give you a deeper understanding of the connection between thoughts, feelings, behaviors, and actions which affect sleep.

Psychoeducation places a large emphasis on sleep hygiene. It teaches the importance of diet, exercise, and other lifestyle choices. Plus, it helps you to create a healthy and supportive sleep environment.

How Many Sessions of CBT-I Will I Need?

A standard course of treatment of CBT-I lasts for around 6-8 sessions, but this may vary depending on the individual. Some people find they only need a couple of treatments to see a marked improvement, whereas others may need more long-term support.

But even a short course of CBT-I can be dramatically more effective than standard sleep hygiene interventions.

CBT-I Homework

For CBT-I to create a lasting change, you’ll need to practice the knowledge and skills you learn during sessions at home.

So, your therapist will also prescribe regular ‘homework’ assignments. These include focusing on your sleep hygiene habits and challenging your pre-programmed thoughts and beliefs about sleep when they arise.

Many practitioners encourage their clients to use a sleep diary. In it, you’ll record information about your sleep patterns and habits. This is then used to inform your treatment and help track your progress.

How Effective is CBT-I For Insomnia?

CBT-I is one of the most effective treatments for insomnia. In fact, research shows that it’s significantly more effective than pharmaceutical interventions such as benzodiazepine and non-benzodiazepine drugs when used on a long-term basis.

Sleeping pills can be beneficial as they treat the immediate symptoms of insomnia, but they come with various side effects. Plus, when a patient discontinues their use, usually, their symptoms return.

CBT-I, on the other hand, has been shown to have a much more enduring beneficial effect, with many people reporting a continuation in improving their sleep cycles for many years after initial treatment.

And with very few associated risks, it’s a more effective, much safer, more holistic treatment method than prescription sleeping pills.

In light of this evidence, the American College of Physicians now recommends CBT-I as a first-line treatment option for all adult patients with insomnia.

How Can CBT-I Improve My Insomnia?

70% to 80% of patients with primary insomnia experience an improvement in their condition after undergoing CBT-I.

Most people report falling asleep faster, staying asleep for longer, and a marked reduction in interrupted and broken sleep. And impressively, these results tend to be long-term.

But while this is certainly worth getting excited about, it’s important to remember that CBT-I is a process that doesn’t always provide results immediately.

It takes time, effort, and patience to progress, and there are plenty of new skills to learn along your CBT-I journey.

Most people with chronic insomnia have deep-seated beliefs surrounding sleep. These beliefs need to be challenged and addressed, but it won’t happen overnight. Yet, with a bit of practice and determination, CBT-I can be life-changing.

What are The Risks and Side Effects of CBT-I?

What are The Risks and Side Effects of CBT-I

CBT-I is a safe treatment for most types of insomnia. This includes chronic insomnia, comorbid insomnia, and even short-term insomnia.

But while evidence shows there are no serious side effects, CBT-I isn’t necessarily for everyone.

People suffering from depression, anxiety, or other psychological disorders that cause a lack of motivation and energy may struggle to stick with the CBT-I process.

Patients need to be motivated and engaged; for some people, this is too big a hurdle to cross.

That being said, a good therapist can make all the difference. They can help you to overcome the barriers of motivation and see the light at the end of the tunnel that CBT-I can bring.

It’s also worth noting that CBT-I asks the patient to confront thoughts and behaviors that aren’t serving them. And for some, this can be an uncomfortable or even painful process.

But while facing these aspects of your psyche may be challenging or cause temporary distress, it’s an important part of the healing process.

Working with a trained and accredited provider gives you the tools and support you need to manage the process. They’ll also help you cope with any discomfort which may arise during your CBT journey.

Where Can I Find a CBT-I Practioner?

CBT-I is now the primary recommended treatment for people with chronic insomnia, and many doctors, therapists, counselors, and psychiatrists are trained in the practice.

But with the large increase in sleep disorders in recent years, there aren’t enough trained practitioners to meet demand in many areas.

If you feel CBT-I could benefit you, the first step is to speak to your doctor. Some doctors may be able to provide CBT-I directly at their clinic, or they may refer you to a specialist with availability in your area.

The Society of Behavioural Sleep Medicine provides a global database of practitioners, which allows you to search by country and region. And in the United States, you can also find a provider through the American Board of Sleep Medicine.

Digital CBT-I

But if you’re struggling to find a qualified CBT-I practitioner or the cost of treatment is too high, you might want to consider digital CBT-I.

There are numerous online digital CBT-I services out there, including SHUTi, Sleepio, and the Conquering Insomnia Program, just to name a few. Some of these resources are completely free of charge, and some require a fee. But all are much more affordable than a traditional in-person CBT-I treatment course.

Digital CBT-I has been shown to be an effective treatment for chronic insomnia. In fact, many people experience dramatic results similar to in-person CBT-I. But it’s not for everyone.

Some people may find more success working face-to-face with a licensed provider.

CBT-I Tips to Try at Home

Working with an in-person or digital CBT-I provider is the most effective way to tackle insomnia. However, you can still implement many of the basic strategies of CBT-I and good sleep hygiene on your own.

Here are a few tips to try at home.

1. Get Out of Bed if You Can’t Sleep

Get Out of Bed if You Can’t Sleep

One of the primary tenants of CBT-I is that the bedroom should only be used for sleep and sex. So, if you’re lying awake for more than ten minutes, get up and engage in a relaxing activity, like reading a book. Then, when you feel tired enough, go back to bed again.

2. Keep a Sleep Schedule

Keep a sleep schedule

Your body’s circadian rhythms thrive on routine. So, waking up and going to bed at the same time each day, even on the weekends, is an essential part of a healthy sleep schedule.

3. Create an Evening Sleep Ritual

Create an Evening Sleep Ritual

In the evening hours, help your body and mind wind down with relaxing activities. Things like taking a bath, meditating, inhaling essential oils, and reading a book are all helpful. Make these habits an everyday bedtime routine.

4. Practice Healthy Sleep Hygiene Throughout The Day

Practice Healthy Sleep Hygiene Throughout The Day

Try to get outside into the fresh air and take plenty of exercise during daylight hours. Reduce your alcohol consumption and cut out coffee and other caffeinated beverages in the afternoon. Also, try to avoid eating your evening meal too close to bedtime.

5. Ditch Electronic Devices

Ditch Electronic Devices

Avoid using your smartphone, laptop, or tablet for at least two hours before you go to bed. These blue light-emitting devices disrupt the circadian rhythm. And a disrupted circadian rhythm increases the severity of chronic and short-term insomnia.

Conclusion

Insomnia can be a debilitating condition. A lack of sleep affects every aspect of our lives, and without enough shut-eye each night, it’s impossible for our minds and bodies to thrive.

Thankfully, CBT-I has shown amazing promise as a first-line treatment for insomnia. Plus, it’s a much safer, more effective long-term solution than prescription sleeping pills.

So, if you have insomnia, talk to your doctor about how CBT-I could help you.

Plus, for more tips on tackling insomnia, check out our guide to cures and treatments here.

Reference

  1. https://stanfordhealthcare.org/medical-treatments/c/cognitive-behavioral-therapy-insomnia/procedures/stimulus-control.html
  2. https://div12.org/treatment/relaxation-training-for-insomnia/
  3. https://div12.org/treatment/paradoxical-intention-for-insomnia/
  4. https://pubmed.ncbi.nlm.nih.gov/20853442/
  5. https://pubmed.ncbi.nlm.nih.gov/12683477/
  6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3481424/
  7. https://pubmed.ncbi.nlm.nih.gov/27136449/
  8. https://www.sleepfoundation.org/insomnia/types-of-insomnia
  9. https://www.nhlbi.nih.gov/health/insomnia/treatment
  10. https://www.behavioralsleep.org/
  11. https://absm.org/

Sarah Wagner

I'm Sarah Wagner, and I founded Sweet Island Dreams in 2022. It's a blog dedicated to helping people mental vacation virtually anytime they want. By providing information about the best sleep of your life, I help people drift away to paradise without ever having to leave their bed!