Can Cognitive Therapy Solve Sleep Issues?

Are you among the millions of people who struggle to get adequate and restful sleep each night? Medication is often presented as a solution for sleep issues, but it’s not the only one. Cognitive behavioral therapy for insomnia, also known as CBT-i, can help as well. Here’s a closer look at CBT-i and how it works to promote higher-quality sleep:
 
What is cognitive behavioral therapy?
 
Cognitive behavioral therapy is a psychotherapy tool that’s used to treat mental health disorders, chronic pain, and many other issues. According to the Cleveland Clinic, cognitive behavioral therapists focus sessions on helping the patient identify and talk through unhelpful thinking patterns, beliefs, and behavioral patterns that could be contributing to their problems. The next step involves replacing these faulty patterns and beliefs with healthier ones. That way, the patient can cope more effectively when challenging situations and emotions arise.
 
How effective is CBT-i?
 
Cognitive behavioral therapy for insomnia is generally considered to be an effective treatment. The Sleep Foundation cites multiple studies showing this therapy’s benefits and efficacy for a wide range of patients. It also cites a recommendation by the American College of Physicians that CBT-i should be used first, with sleep medications only to be prescribed when therapy isn’t effective. It’s important to note, though, you may need to go through several CBT-i sessions before seeing consistent improvements. These can take place in person or through an online service.
 
How is CBT applied to sleep issues?
 
CBT-i can involve a variety of approaches, but they’re all focused on helping you change the thoughts and behaviors that contribute to your insomnia. Per the Sleep Foundation, this can include cognitive restructuring to target unhelpful and inaccurate thoughts, helping you identify and change the anxieties, expectations, and misguided beliefs that create stress and keep you from falling asleep in a timely manner. You may also learn relaxation techniques — like deep breathing, progressive muscle relaxation, and meditation — to combat unhelpful thoughts and better prepare your mind and body for sleep.
 
Other CBT-i treatments place the focus on your sleep behaviors and routines. Stimulus control reserves your time in bed for nighttime sleep and sex — no reading, watching TV, taking naps, or using your smartphone — so you won’t associate it with being awake. If you can’t get to sleep after a specified length of time, stimulus control also involves getting up and doing something else until you’re ready for slumber.
 
Another CBT-i behavioral technique is sleep restriction and compression. According to the Sleep Foundation, this involves keeping a sleep diary so you know how many hours a night you’re actually asleep. Then, you limit your total time in bed to this amount plus 30 minutes, gradually increasing it as your mind and body get better at associating time in bed with sleep.
 
CBT-i may also involve improving overall sleep hygiene. Depending on your specific situation, this could mean cutting back on alcohol and caffeine, exercising more, not looking at electronic screens before bed, making your bedroom more conducive to comfortable sleep, creating a consistent sleep schedule, and sticking to consistent bedtime routines.
 
If you’re struggling with sleep issues, CBT-i is one of the most helpful ways to tackle the problem and make your nights restful again — and it’s likely to be the approach that your physician or therapist suggests first.