Insomnia: Cognitive Behavioral Therapy for Insomnia (CBT-I) may help
It’s 3am. You’re awake again. Instead of sleeping soundly, you groan inwardly. Rest feels so elusive. Breathing exercises. Visualizations. Didn’t I take melatonin earlier? Anxiety, dread, and despair set in. You think about checking emails for work. But your brain is so tired. Just as you almost fall asleep, a jolt of fear tightens your chest. The next day, you wake exhausted and hopeless that this cycle repeats, night after night.
Insomnia: Cognitive Behavioral Therapy for Insomnia (CBT-I) may help
It’s 3am. You’re awake again. Instead of sleeping soundly, you groan inwardly. Rest feels so elusive. Breathing exercises. Visualizations. Didn’t I take melatonin earlier? Anxiety, dread, and despair set in. You think about checking emails for work. But your brain is so tired. Just as you almost fall asleep, a jolt of fear tightens your chest. The next day, you wake exhausted and hopeless that this cycle repeats, night after night.
You crave that sweet spot where you wake happy. You want control over your sleep, so that you don’t have to revolve your work and relationships around bizarre hours. You want peace and a natural rhythm to your body, mind, and emotional energy throughout the day.
Cognitive Behavioral Therapy for Insomnia (CBT-I) is considered the gold standard and first-line treatment for chronic insomnia. Endorsed by the American College of Physicians (the largest medical specialty organization), American Academy of Sleep Medicine, American Psychological Association Division 12 (Society for Clinical Psychology), and numerous international sleep and behavioral medicine organizations, CBT-I is a 5-8 week psychotherapy treatment program.
Wait, what about medication, like melatonin, trazadone, or benadryl?
Every year, the American Academy of Sleep Medicine (AASM) conducts an independent review of major sleep medications available the market. Anonymous sleep clinicians, who report no pharmaceutical conflicts of interests, analyze peer-reviewed journal articles and clinical trials on outcomes for patients who use prescribed and over-the-counter medications as sleep aid. Year-over-year, all medications reviewed report “weak” recommendations. The American College of Physicians is the largest organization for medical doctors in the nation, and they recommend that medications for insomnia are only used for 4-5 weeks for short-term sleep issues.
Instead, clinicians across organizations agree that CBT-I is a non-invasive and effective first-line treatment for chronic insomnia, garnering “strong” recommendation from the AASM.
What is CBT-I?
CBT-I is a 5-8 session program that addresses underlying causes of chronic insomnia. CBT-I was originally developed through research with over 10,000 patients through a collaboration at Harvard Medical School and the University of Massachusetts. In their study, over 90% of participants showed significant improvements in sleep over the course of five sessions.
Since their first study in 1996, researchers and clinicians across longitudinal studies have shown the efficacy of CBT-I, for patients who adhere to program recommendations[1].
Why haven’t I ever heard about CBT-I for insomnia?
Most people seek medication or over-the-counter sleep aids for insomnia. However, CBT-I is considered the first-line treatment for chronic insomnia.
I have already tried EVERYTHING. Isn’t this just more sleep hygiene basics?
No. CBT-I is not simply sleep hygiene. The 5-session program addresses insomnia in multiple ways. But clients must take action and adhere to the program.
What are the risks?
Unlike medication, CBT-I has no side-effects as a form of psychotherapy.
I already have a therapist. Do I need to leave my current therapist to do CBT-I?
No, CBT-I is designed as an adjunct program, similar to EMDR or other briefer therapies. You do not have to leave your individual therapist. However, your CBT-I therapist may redirect you to speak with your individual therapist if other issues get in the way of the sleep program. Likewise, a physician may be recommended to screen for underlying health issues that impact sleep, such as sleep apnea, restless leg syndrome, or hormonal imbalances.
What can I do next?
A therapist trained and certified in CBT-I may help guide you through sleep challenges and give you tools to continue to maintain better sleep. There are only less than 1,000 certified CBT-I therapists in the United States who are qualified to deliver CBT-I. You may find someone you like through directories such as the University of Pennsylvania Perelman School of Medicine. Nat Newton, AMFT, PhD, RPS is an in-house clinician at Silver Lake Psychotherapy who is available to assist you today.
Contact therapy@silverlakepsych.com for more information.
Written by Nat Newton AMFT, PhD, RPS
Associate Marriage & Family Therapist
[1] Jacobs, G. D., Benson, H., & Friedman, R. (1996). Perceived benefits in a behavioral-medicine insomnia program: A clinical report. The American Journal of Medicine, 100(2), 212–216.
Why sleeptrackers could lead to the rise of insomnia – and orthosomnia
In our chronically sleep-deprived society, many are using gadgets and apps to measure the quantity and quality of their shut-eye. But they could be causing more harm than good
Why sleeptrackers could lead to the rise of insomnia – and orthosomnia
By Emine Saner for The Guardian
In our chronically sleep-deprived society, many are using gadgets and apps to measure the quantity and quality of their shut-eye. But they could be causing more harm than good
For more than nine months, Alex Whitecross’s routine on waking was to check the data about his sleep on his fitness tracker. And then he would feel quite anxious. “I started getting paranoid about how much sleep I was getting,” he says. Whitecross, a computer-aided-design technician from south Wales, says he bought his tracker in order to measure exercise, but became interested in the sleep-monitoring function. “I’m a lighter sleeper than my fiance so I thought it would help me, but it ended up having the opposite effect.”
Sometimes he would check it in the night and feel panicked about how many hours he had until his alarm would go off. In the morning, “I would wake up and look at it, and it would say I’d had five hours and 44 minutes sleep, and spent an hour and 25 minutes awake at night. It made me feel more tired, knowing how little sleep I’d got.”
Read the full article here to learn about how sleep trackers might be doing more harm than good…
Sleep trackers can be helpful in making an effort to get a good night’s sleep, says Hare. “They can be part of a move towards appreciating how important it is to get sleep. It’s only a problem if people read more into the data than the data can give them.”
Do you really need 8 hours of sleep every night?
When you can't sleep, you're desperate for help. And there's a booming industry waiting to tell you all the ways a lack of sleep can ruin your health -- and to sell you fancy gadgets to help you finally doze off.
When you can't sleep, you're desperate for help. And there's a booming industry waiting to tell you all the ways a lack of sleep can ruin your health -- and to sell you fancy gadgets to help you finally doze off. Shedding light on this flawed doomsday messaging, Dr. Jen Gunter explains why you shouldn't lose sleep over sleep -- and what to do instead.
Learn more from Dr. Jen Gunter here.
How to Help a Teen Who Can’t Sleep
Nearly a quarter of adolescents grapple with insomnia. Experts say small habit changes can make a big difference.
Jun Cen
How to Help a Teen Who Can’t Sleep
By Catherine Pearson for The New York Times
Nearly a quarter of adolescents grapple with insomnia. Experts say small habit changes can make a big difference.
With packed schedules, school days that kick off at 8 a.m. and the lure of screens, it’s little wonder that many adolescents in the United States don’t get enough sleep.
National estimates suggest about six in 10 middle schoolers get less than the recommended nine to 12 hours of sleep a night, while about seven in 10 high schoolers clock less than the recommended eight to 10 hours. And more than one in five adolescents grapple with insomnia, characterized by problems falling asleep, staying asleep or getting sufficient quality sleep (or some combination thereof).
“There are two basic things that happen” when teens hit puberty, said Dr. Judith Owens, the director of the Center for Pediatric Sleep Disorders at Boston Children’s Hospital. “The first is that there’s a shift in their natural circadian rhythms, so their natural fall asleep time and wake time shift later — by up to a couple of hours. The second thing that happens is their sleep drive slows.” So not only do adolescents want to stay up later, but their bodies are actually capable of doing so, she explained.
Despite these biological shifts, experts stress that sleep loss is not a normal or natural part of adolescence..
Here are some tips:
Change one poor sleep habit.
Consider a harm reduction approach to screens.
Encourage “strategic napping,” but be wary of the weekend catch-up.
Help your teen ruminate less.
For details on each tip, read the full article here.