Cognitive behavioural therapy (CBT) for insomnia
Cognitive behavioural therapy (CBT) for insomnia targets both beliefs and
activities related To sleep and bed, but overall, the approach is more
behavioural than cognitive. When done With a therapist, it involves around 4-
10 weekly sessions. CBT for insomnia is consistently The most recommended
intervention in treatment guidelines for chronic insomnia, and There’s a lot of
research evidence that’s demonstrated its effectiveness.
Key interventions involve stimulus control, i.e. controlling what happens in
bed, and sleep Restriction, which involves decreasing the amount of time spent
in bed to compress sleep Into a shorter block of time. Sleep hygiene is also
incorporated, and progressive muscle Relaxation is often added in as well.
The starting point is keeping a detailed sleep log to get the clearest picture
of what’s actually Happening with your routine and your sleep. This includes
keeping track of:
• Time in bed and time of lights out
• Time to fall asleep
• Number and duration of awakenings
• Time from final awakening to getting out of bed
• Daytime naps
• Alcohol
• Medications that affect sleep
, Sleep Myths and Other Sleep-Related Thoughts
Working with thoughts plays much less of a role in CBT for insomnia
compared to other Forms of CBT. The cognitive aspect is focused on thoughts
and beliefs that can end up Interfering with sleep and promoting insomnia.
When experiencing insomnia, it can be easy to get into a pattern of trying too
hard to sleep.
This can involve cancelling activities because of feeling tired or concerns
that the activity Might interfere with sleep, spending excessive amounts of
time in bed awake, and becoming Rigid around bedtime behaviours.
While insomnia may begin as something that’s triggered to a large extent
by external factors, When it persists and maladaptive beliefs and behaviours
develop in response, it can turn into Conditioned insomnia. When this happens,
all of the cues that should be associated with Being asleep become associated
with being awake instead.
Beliefs about sleep
Often we have beliefs about sleep that on the surface seem very
Reasonable, but they end up promoting anxiety when we are unable To sleep.
That anxiety then feeds into the insomnia, creating a vicious Cycle.
The Dysfunctional Beliefs and Attitudes about Sleep scale (available here)
identifies the Following beliefs that tend to perpetuate insomnia:
• You need 8 hours of sleep, otherwise the day will be ruined
• It’s important to “catch up” on lost sleep
• Not sleeping will have significant health consequences
• You won’t function the next day if you can’t sleep
Cognitive behavioural therapy (CBT) for insomnia targets both beliefs and
activities related To sleep and bed, but overall, the approach is more
behavioural than cognitive. When done With a therapist, it involves around 4-
10 weekly sessions. CBT for insomnia is consistently The most recommended
intervention in treatment guidelines for chronic insomnia, and There’s a lot of
research evidence that’s demonstrated its effectiveness.
Key interventions involve stimulus control, i.e. controlling what happens in
bed, and sleep Restriction, which involves decreasing the amount of time spent
in bed to compress sleep Into a shorter block of time. Sleep hygiene is also
incorporated, and progressive muscle Relaxation is often added in as well.
The starting point is keeping a detailed sleep log to get the clearest picture
of what’s actually Happening with your routine and your sleep. This includes
keeping track of:
• Time in bed and time of lights out
• Time to fall asleep
• Number and duration of awakenings
• Time from final awakening to getting out of bed
• Daytime naps
• Alcohol
• Medications that affect sleep
, Sleep Myths and Other Sleep-Related Thoughts
Working with thoughts plays much less of a role in CBT for insomnia
compared to other Forms of CBT. The cognitive aspect is focused on thoughts
and beliefs that can end up Interfering with sleep and promoting insomnia.
When experiencing insomnia, it can be easy to get into a pattern of trying too
hard to sleep.
This can involve cancelling activities because of feeling tired or concerns
that the activity Might interfere with sleep, spending excessive amounts of
time in bed awake, and becoming Rigid around bedtime behaviours.
While insomnia may begin as something that’s triggered to a large extent
by external factors, When it persists and maladaptive beliefs and behaviours
develop in response, it can turn into Conditioned insomnia. When this happens,
all of the cues that should be associated with Being asleep become associated
with being awake instead.
Beliefs about sleep
Often we have beliefs about sleep that on the surface seem very
Reasonable, but they end up promoting anxiety when we are unable To sleep.
That anxiety then feeds into the insomnia, creating a vicious Cycle.
The Dysfunctional Beliefs and Attitudes about Sleep scale (available here)
identifies the Following beliefs that tend to perpetuate insomnia:
• You need 8 hours of sleep, otherwise the day will be ruined
• It’s important to “catch up” on lost sleep
• Not sleeping will have significant health consequences
• You won’t function the next day if you can’t sleep
