Relaxation techniques can help reduce the racing thoughts and tension that often accompany lying in bed awake. Instead of immediately reducing time in bed to the amount of sleep they get on a typical night, time in bed is gradually reduced until it is reasonably close to the time they spend actually sleeping. Sleep compression is a slightly different, and more gentle approach, often used with older people. Once a person spends the majority of their time in bed sleeping, they can begin gradually increasing their time in bed. Time in bed is then adjusted to reflect this amount, plus 30 minutes.įor example, if a person is trying to sleep 8 hours a night but only getting 5 hours, they start by adjusting their bedtime to spend 5 hours and 30 minutes in bed. Sleep restriction begins by calculating the total time spent asleep on a typical night using a sleep diary. It is not recommended for people with certain medical conditions that can be made worse by losing sleep, such as bipolar disorder and seizures. This technique is intended to increase the drive to sleep and can temporarily increase daytime fatigue. Sleep restriction limits time spent in bed in order to reestablish a consistent sleep schedule. People with insomnia often spend too much time lying in bed awake. Clients are instructed to set an alarm for the same time every morning and are discouraged from taking daytime naps. Clients are instructed to get out of bed when it’s difficult to fall asleep or when they lie awake for more than 10 minutes, only going back to bed when they are tired again. Stimulus control attempts to change these associations, reclaiming the bedroom as a place for restful sleep.ĭuring treatment, the bed is only used for sleep and sex. They may also associate their bedroom with habits that make sleeping more difficult, like eating, watching TV, or using a cell phone or computer. Many people with insomnia begin to dread their bedroom, associating it with wakefulness and frustration. Homework is often assigned to allow time to practice these skills between sessions. Inaccurate thoughts are identified, challenged, and altered with the help of a trained provider who can assist in evaluating them more objectively. Common thoughts and beliefs that may be addressed during treatment include anxiety about past experiences of insomnia, unrealistic expectations of sleep time and quality, and worry about daytime fatigue or other consequences of missed sleep. This can become a frustrating, nightly cycle that can be difficult to break.Ĭognitive restructuring begins to break this cycle through identifying, challenging, and altering the thoughts and beliefs that contribute to insomnia. Both worry and excessive time in bed can make falling and staying asleep more challenging. This worry may lead to spending excessive time in bed to try to force sleep. In people with insomnia, inaccurate or dysfunctional thoughts about sleep may lead to behaviors that make sleep more difficult, which then reinforce the dysfunctional thoughts.įor example, prior experiences of insomnia may lead to worry about falling asleep. Here are some common techniques used in CBT-I. The order and flow of each component can vary based on the provider’s approach and the unique needs of each person. Psychoeducational interventions: Providing information about the connection between thoughts, feelings, behaviors, and sleep is central to CBT-I.Behavioral interventions: Relaxation training, stimulus control, and sleep restriction promote relaxation and help to establish healthy sleep habits.Cognitive interventions: Cognitive restructuring attempts to change inaccurate or unhelpful thoughts about sleep. Sessions may include cognitive, behavioral, and educational components. Treatment may be as short as two sessions when given by a primary care doctor.ĬBT-I is often called a multicomponent treatment because it combines several different approaches. Treatment often takes from 6-8 sessions, although the length may differ depending on a person’s needs. A provider will then clarify or reframe misconceptions and challenges in a way that is more conducive to restful sleep. Thoughts and feelings about sleep are examined and tested to see if they’re accurate, while behaviors are examined to determine if they promote sleep. During treatment, a trained CBT-I provider helps to identify thoughts, feelings, and behaviors that are contributing to the symptoms of insomnia. How Does CBT-I Work?ĬBT-I focuses on exploring the connection between the way we think, the things we do, and how we sleep. Fortunately, effective treatments are available that can help people fall asleep faster, stay asleep, and feel more rested during the day.Ĭognitive behavioral therapy for insomnia (CBT-I or CBTI) is a short, structured, and evidence-based approach to combating the frustrating symptoms of insomnia.
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