Cognitive Behavioral Therapy for Insomnia

If you’ve been having trouble falling asleep, staying asleep, or have been waking up too early and can’t fall back asleep, you have insomnia. If this happens for at least three months, it’s chronic insomnia.

You may feel stuck in a pattern of sleepless nights and extremely tired days, but chronic insomnia is actually treatable — though not necessarily by reaching for a sleeping pill. Cognitive behavioral therapy for insomnia (CBT-I) is the preferred first line treatment for chronic insomnia disorder.

CBT-I empowers you to be your own coach by addressing thoughts and behaviors that are interfering with sleep. CBT-I can be used with or without sleep medications, though when used on its own, you get away from medication downsides and side effects.

Of course, CBT-I is no quick fix. As with anything new, it takes consistent effort and even some patience to see results. Mastering just a few CBT-I changes initially may be easier than trying too many all at once, which can get overwhelming and be counterproductive.

As explained in the name cognitive behavioral therapy, one aspect of CBT focuses on changing behaviors. In the case of insomnia, this means forming routines that encourage sleep. You may already be familiar with many of these practices. They include going to bed and waking up at the same time each day, relaxing before bed, avoiding caffeine in the late afternoon and evening, and exercising regularly. You should also avoid daytime napping and get out of your bed at night if you don’t feel sleepy, which helps your mind associate your bed with sleep.

But CBT’s other focus is “cognitive” — your thinking. Positive self-talk and calming your mind are two cognitive strategies to treat your insomnia and think your way to sleep.

Positive self-talk (cognitive restructuring)
When you’re having trouble falling asleep, you might find yourself thinking things like:

“I know I’ll be awake for hours.”
“If I don’t fall asleep right now, I’ll be exhausted tomorrow.”
“At this rate, I’ll only get a couple of hours of sleep.”
These thoughts are natural but can leave you more agitated and make it even harder to sleep. If left unchecked, these thoughts can become automatic and hard to break away from.

Identifying negative or irrational thoughts can be challenging. Automatic thoughts happen, well, automatically — so are difficult to control. Noticing these types of thoughts is a skill that can be learned and developed.

When you catch yourself thinking these negative thoughts, practice positive self-talk. For example, try flipping your thoughts to “I will be able to fall asleep” and “I’m still going to have the energy to have a great day tomorrow.” Relaxation techniques such as deep breathing, guided imagery or listening to a bedtime story also can help.

Another strategy for anxious thoughts about falling asleep is to remain passively awake. This means that you get in bed and calmly try to stay awake, rather than expecting to fall asleep. This can help reduce your anxiety and worry, counterintuitively helping you fall asleep faster.

Calming your mind
Maybe you struggle with a different kind of anxiety at nighttime – instead of worrying about falling asleep, you start to worry about all sorts of other things: work, kids, schedules, relationships and more. Did I send that email? How am I going to finish that project by Tuesday? Was I rude to her? My kid really needs to finish that history project.

Setting aside “worry time” during the day can allow you to focus on stressful thoughts and worries that may occupy your mind when trying to fall asleep or stay asleep. During this time, it can be helpful to write your thoughts and concerns down, then think through solutions within your power to control and “let go” of things outside your ability to influence.

After writing down your worries, some good questions to ask yourself include:

Can I make a concrete plan to resolve this worry?
Have I successfully dealt with this or a similar worry in the past?
Is this worry legitimate? Will it matter five years from now?
What might an optimist say about this situation?
When these thoughts or worries return when you are trying to fall asleep or stay asleep, remind yourself that you have dedicated time to work through these during the day.

Mindfulness practices also can be helpful to calm your busy mind and reduce your overall stress. Tai Chi, yoga and meditation can all be relaxing.

(Article attributed: Mayo Clinic)

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