In my experience, patients who seek therapy for depression or anxiety often report problems with sleep. These problems usually fall into one (or more) of three categories: 1) difficulties falling asleep, 2) difficulties staying asleep, or 3) waking up earlier than intended. If insomnia is brought on by recent life stress like trouble at work or in a romantic relationship, it is called acute insomnia. Usually, this short-term insomnia resolves itself and sleep patterns return to normal. However, if insomnia persists past a few weeks (chronic insomnia), it can exacerbate other psychological problems and evolve into a vicious cycle of a) sleeplessness and b) anxious thoughts about sleeplessness. When this is the case, insomnia treatment can be helpful.
Pharmacological interventions are often used for insomnia treatment, and they can be effective. However many people find the side effects of such medication difficult to tolerate. Cognitive-behavioral therapy (CBT) is a good option for people who do not want to rely on medication. Cognitive-behavioral treatment for insomnia focuses on several key elements. The first is learning sleep hygiene principles. This involves guidelines such as going to bed and waking up at the same time every day, keeping your bedroom at a comfortable temperature, decreasing caffeine and alcohol intake, and avoiding naps during the day. Another element involves stimulus control procedures. For example, it might be tempting to watch TV or use your computer/mobile device in bed, but studies have shown that this may interrupt sleep patterns over time as you come to associate watching TV with being in bed. Limiting your activity in bed to sleep may help to ‘re-train’ your brain to pair the bedroom with sleep (rather than “TV time” or “internet time”). Behavioral interventions may also be helpful in getting a good night’s rest. Incorporating more physical activity in your day, practicing relaxation techniques before bed, and creating a pre-sleep routine have all proven to be beneficial. Studies have shown that up to 80% of patients who implemented behavioral techniques reported sleep improvements in as little as a month. A more rigorous behavioral intervention is known as sleep restriction training, which is an insomnia treatment option for those with severe chronic symptoms.
If you have worries about your sleep, cognitive techniques may also be warranted. Cognitive techniques teach you to identify and challenge any distorted thoughts about sleep, and thus free yourself from the grip of insomnia. For example, some patients think and say that not getting a good night’s rest is going to “completely ruin” the next day. One can imagine how the thought of not functioning at work can lead to feelings of helplessness and increased anxiety. However, reminding yourself that you have in fact functioned before on very little sleep and have also gotten better sleep during subsequent nights may help alleviate the anxiety around falling asleep. Similarly, one of the most important things to remember is to NOT bring your problems to bed. If you find yourself replaying the day’s events or concocting ‘what-if’ scenarios, get out of bed, write your problems down on a piece of paper, and attend to them in the morning when your brain is fully functioning.
Some patience is required in CBT insomnia treatment, as these techniques can take time to take effect. However, they can lead to improved and long-lasting sleep quality. Given that we spend a third of our lives sleeping, CBT for insomnia can be a critical step in improving alertness, energy, and quality of life.