Insomnia is often used as a catch-all term used to describe a general difficulty sleeping or a lack of sleep.
However, clinically, Insomnia is a mental health condition marked by one of three difficulties related to sleep that occurs with frequency (3 or more times a week):
1. A difficulty initiating sleep.
2. A difficulty maintaining sleep, with frequent awakenings or problems returning to sleep after awakenings.
3. Early-morning awakening with inability to return to sleep.
These problems must be causing problems for the person, must be ongoing for at least three months, and must not be due to a lack of adequate time to get sleep, or other medical or mental health issues (Such as lack of sleep due to and anxiety disorder, or due to chronic pain) . In children, Insomnia can also appear somewhat differently. For example, a child might display difficulty initiating sleep by refusing to go to bed without a caregiver’s intervention.
Luckily, there are several interventions that have been found to be helpful for insomnia. Although there are medications that can cause temporary relief, these medications can often have unintended side effects and may not create lasting improvement. Several sleep experts believe that instead of medication, the best option for Insomnia is Cognitive Behavioral Therapy for Insomnia (CBT-I), which is a structured, evidence-based approach designed to help individuals overcome chronic sleep difficulties. CBT-I was developed in particular to target the underlying causes of insomnia, leading to long-term improvements in sleep quality. CBT-I has also been developed to help both adults and children.
Understanding CBT-I
CBT-I operates on the principle that negative thoughts and behaviors contribute to sleep disturbances. CBT-I is often time limited, and can be completed within 6-8 weeks in individual or group sessions. By identifying and modifying these patterns, individuals can develop healthier sleep habits. The therapy typically consists of several core components:
- Sleep Hygiene Education – Developing good sleep habits is crucial for long-term success. Frequently, CBT-I begins by helping you learn about sleep hygiene as well as learning about your own current sleep schedule. You might be asked to document when and for how long you sleep. You might also be asked to avoid certain stimulants like caffeine and nicotine before bedtime, limiting screen time in the evening, and ensuring a sleep-conducive environment (cool, dark, and quiet). These adjustments help create a supportive setting for restorative sleep.
- Cognitive Restructuring – Often, people with insomnia learn to dread going to bed, as they believe that they won’t be able to get enough sleep, struggle to relax, or be kept up with anxiety about sleep. Cognitive restructuring is a technique that you learn that involves identifying and challenging negative thoughts about sleep, such as "I'll never get enough rest." Individuals learn to replace these thoughts with more realistic and positive perspectives. This step helps reduce anxiety and self-imposed pressure around sleep, allowing for a more relaxed approach to bedtime.
- Sleep Restriction– Many people with insomnia spend excessive time in bed, leading to fragmented and inefficient sleep. Sleep restriction works by limiting the time spent in bed to match actual sleep duration, thereby increasing sleep efficiency. Over time, as sleep improves, the time allotted for sleep is gradually increased to ensure adequate rest without excessive wakefulness.
- Stimulus Control– CBT-I encourages those with insomnia to use the bed ONLY for sleeping, thus learning to reinforce the brain’s association between being in the bed and being sleepy instead of being anxious or stressed. It involves setting strict rules, such as only using the bed for sleep and intimacy, going to bed only when sleepy, and getting out of bed if unable to sleep within 20 minutes. You might also be encouraged to avoid using the bed to read, listen to music, watch TV or videos and the like.
- Relaxation Techniques – Stress and anxiety are common contributors to insomnia. Relaxation methods such as mindfulness meditation, progressive muscle relaxation, guided imagery, and deep breathing exercises are introduced to help calm the nervous system and facilitate a smoother transition into sleep. Practicing these techniques regularly can improve sleep onset and quality.
Effectiveness of CBT-I
Research shows that CBT-I is one of the most effective treatments for chronic insomnia, often outperforming sleep medications in creating lasting, long-term changes to sleep. Many individuals experience significant improvements within a few weeks, with benefits persisting long after therapy concludes as well.
For those struggling with insomnia, CBT-I offers a science-backed, sustainable solution. By addressing both cognitive and behavioral aspects of sleep disturbances. If you would like to learn more about CBT-I, feel free to reach out to a member of our team for more information.