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What Is Cognitive Behavioral Therapy for Insomnia?

Insomnia is longer-term sleeplessness which makes it difficult to either fall asleep or stay asleep.

The leading insomnia therapy is called Cognitive Behavioral Therapy for Insomnia (CBTi). CBTi as therapy for insomnia is supported by decades of randomized clinical trials showing its effectiveness in both sleep onset and sleep maintenance insomnia.1

Adressing insomnia's root causes

Normal stressors often cause short-term sleeping trouble. It may, in fact, be our thoughts and behaviours that keep that sleeping trouble momentum going – and turn it into full-blown insomnia.

Medications can sometimes help people get to sleep in the near term, but CBTi addresses the root causes of chronic sleeplessness by tackling the thoughts and habits that create insomnia.

How can CBTi help?

CBTi can give people deeper and longer sleep in the long term than some medications.2 I suspect it's more effective in the long run because the process teaches people skills that can be used throughout their life and empowers them to feel able to do something to help themselves.

Additionally, there is evidence that overall daytime functioning, sleep-related thinking problems, sleep anxiety, and both time – to sleep and staying asleep measures improved beyond any other treatment group.3

It is helpful in a large proportion of people for whom it is suited, and many international medical associations recommend such as the treatment of choice for chronic insomnia.1

What is CBTi?

CBTi is a set of interventions designed to improve a person's behaviour and thoughts as they relate to sleep. In one-to-one settings, these are often adapted, depending upon the therapist's experience, but the general construct of treatment usually incorporates stimulus control and time in bed restriction, alongside mindfulness and relaxation strategies and acceptance and commitment therapy approaches.

Stimulus control

Stimulus control is a method to modify our "relationship" with the bed. Why would we do this? Typically, when people sleep well, the association they have with their bed is that it is the place they sleep and feel rested. If we are not sleeping well, night after night, but we stay awake when we are in bed, we can begin to disrupt our healthy physical and emotional relationship with our bed. If we've been doing this for a long period of time, we can start to associate being in bed with being awake. And we come to associate our bed with tossing, turning, and feeling frustrated. Stimulus control and mindfulness and acceptance therapy types of techniques help people reassociate their beds with sleep and restful relaxation.

Time in bed restriction

The overall goal of time in bed "restriction" is to help "consolidate" sleep by increasing sleep drive and helps reset any changes in your normal sleep rhythms, which can be disrupted by very broken sleep.4 There are several approaches to this, however, the overarching suggestion is to not go to sleep until sleepy (but avoiding a situation where someone may be having an evening "nap") and getting up at the same time of day - at least for the duration of the treatment.

Reducing sleep anxiety

In CBTi, people also learn how to examine sleep-related thoughts and feelings, and to challenge or adapt incorrect or exaggerated beliefs. This can help take away some of the sleep anxiety that can develop in some people. This sleep anxiety can be, for some, the main factor that keeps their insomnia going. This reduction in sleep effort and anxiety can be essential to recovering from insomnia, regardless if someone is on medications or not.

What to know before beginning CBTi

This might all sound amazing – but beware that CBTi is not suitable for everyone.

CBTi may not be safe for some people with certain physical or mental health conditions, or who are undergoing specific other psychological therapies. CBTi needs to be adapted for some other groups, as well – and so people considering CBTi should always consider working with a qualified clinician for their safety and wellbeing. Always check with your doctor before making any changes that can affect your health.

Have you tried CBTi? What was your experience? Share in the comments below.

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This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

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