Cognitive behavioral therapy for insomnia (CBT-I) is considered the first line treatment for insomnia. Why is that? Research widely supports the effectiveness of CBT-I. Too, it has been determined that sleep medications are problematic and ineffective when used long term.
CBT-I typically involves 6-8 weeks of weekly therapy sessions that promote cognitive and behavioral changes resulting in restorative sleep. In CBT-I we identify and target factors that interfere with getting to sleep and sleeping through the night. Predisposing, precipitating and perpetuating factors play a role in the development of insomnia. Perpetuating factors, such as coping strategies that may be briefly helpful, but long term are problematic, can lead to chronic insomnia. How does this happen? Repeated experiences of pairing the sleep environment (your bedroom) with wakefulness, frustration and anxiety can create conditioned arousal, thus leading to learned and chronic insomnia.
You may be a good fit for CBT-I if:
your are willing to complete a daily sleep journal
you are ready to make behavioral changes to your sleep routine and schedule
you are ready to do focused therapy work in session and between sessions to address anxiety and/or depression
you have no history of bipolar disorder, seizures, or untreated hypersomnolence
Let's Work Together
What to expect...
Assessment and Sleep Science
We will start with assessments of your mood and sleep experience using tools such as the Brief Mood Survey and the Pittsburgh Sleep Quality Index (PSQI). In addition, we will review the sleep science that provides the rationale for a cognitive behavioral approach to the treatment of insomnia. You will be asked to complete a daily sleep journal for 1-2 weeks prior to arriving at your first full therapy session. During your first one to two sessions, and throughout the therapy process, you will have the opportunity to share what is on your heart and mind, feel heard and understood, gain clarity on your treatment goals and ask questions about the process for resolving your insomnia. Yes, it is possible to resolve insomnia without medications using cognitive and behavioral strategies. With consistent, weekly engagement in cognitive behavioral work, you can achieve regular, restorative sleep.
Tracking your sleep daily will give us a good baseline to assess your sleep patterns and create initial modifications to your sleep schedule. Items included on the sleep journal include: time to bed, time to sleep and time awake, number of awakenings, medications or other substances (e.g. alcohol). Behavioral modifications to sleep can be challenging, but will lead to a complete reset of your sleep cycle, resulting in a return to regular, restorative sleep. It is important to note that these modifications need not be permanent. Once you are back to experiencing restorative sleep, you can confidently resume a more flexible sleep schedule, knowing you have the tools to get back on track any time you need to in the future.
Sleep Hygiene and Sleep Schedule
We will review and address any environmental and routine issues that may be interfering with regular, restorative sleep. We will review sleep hygiene items together, discuss and identify which items apply to you, and create a goal and action plan for each sleep hygiene item that may be contributing to insomnia. In addition, using data from your sleep journal, we will create a sleep schedule that will limit the amount of time you spend awake in bed and begin to develop a more consistent nightly sleep schedule. Initially, this can be quite scary. I will be here to support you through the entire process. Over a period of 6-8 weeks, your sleep schedule will become increasingly more consistent, and your experiences of frustration due to time spent awake in bed will lessen. You will experience increased alertness and energy during the day. Restorative sleep is in sight. No medications and sweet relief!
Cognitive Mood Management Tools and Relaxation Training
Cognitive behavioral therapy tools are vast and research repeatedly demonstrates the effectiveness of CBT for reducing and resolving symptoms of anxiety, depression and insomnia. When insomnia has been chronic, an anxious pattern often develops around sleep, including many anxious thoughts. Together we will address any maladaptive or negative thoughts about sleep, insomnia or the consequences of poor sleep. The tools we use are powerful and effective and result in positive modifications of thought, leading to reduced anxious arousal, reduced worry and fear, daytime and nighttime. Along with mood management tools, relaxation training , when done consistently, leads to overall reductions in base level arousal rates, creating a solid foundation for enjoying restful states. We will review options for creating your own practice of relaxation training. Finally, prior to ending treatment, we plan ahead for events that may lead to a return to old patterns of sleep, and apply relapse prevention tools. This typically takes 1-2 sessions. You can then leave therapy feeling confident you have the tools and knowledge to manage your mood and sleep. Sweet dreams!
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Riemann D, Baglioni C, Bassetti C, Bjorvatn B, Dolenc Groselj L, Ellis JG, Espie CA, Garcia-Borreguero D, Gjerstad M, Gonçalves M, Hertenstein E, Jansson-Fröjmark M, Jennum PJ, Leger D, Nissen C, Parrino L, Paunio T, Pevernagie D, Verbraecken J, Weeß HG, Wichniak A, Zavalko I, Arnardottir ES, Deleanu OC, Strazisar B, Zoetmulder M, Spiegelhalder K. European guideline for the diagnosis and treatment of insomnia. J Sleep Res. 2017 Dec;26(6):675-700. doi: 10.1111/jsr.12594. Epub 2017 Sep 5. PMID: 28875581.