Sleep – so important to have, yet sometimes so hard to get. Whether it’s depression where you’re exhausted but can’t sleep or mania where you have too much energy to feel the need for sleep, insomnia is something that spans across diagnoses. For many of us, medications are an important part of getting a decent night of sleep, but there are a variety of other measures that can be tried, including cognitive behavioural therapy (CBT) specifically targeting insomnia. CBT for insomnia focuses more on the behavioural aspect than the cognitive, and there are books and manuals developed specifically for this area of focus. Here is an overview of some of the main elements of CBT for insomnia:
- Sleep hygiene: most of us are familiar with recommendations like avoid caffeine/alcohol/screen time before bed, don’t nap during the day, and get regular exercise
- Do a sleep log: while we may think we’re aware of our sleep patterns, chances are keeping a log will give a better understanding (there’s an example in the treatment manual link below)
- Increase sleep efficiency: this is the ratio of time asleep divided by time in bed; to increase sleep efficiency, the initial goal is to spend less time in bed. Initially this may mean less sleep, but in the longer term it will result in an improvement.
- Increase sleep drive: napping during the day makes us less in need of sleep at night
- Avoid negative associations with bed: with insomnia, staying in bed awake for long periods can lead to the bed being associated with being awake and frustrated. This can be changed by only going to bed when sleepy, only using the bed for sleep/sex, getting out of bed if you haven’t fallen asleep after about 15 minutes, and hiding the clock.
- Wake up at a regular time: this is essential in CBT for sleep, and is counterintuitive in many ways. The idea is to get up at the same time regardless of how long or how well you slept, even if it means disrupting a sound sleep. Bedtime is variable, but the goal is to keep the waking time consistent every day.
- Challenge thoughts related to sleep: some common sleep-related myths, according to the University of Washington’s treatment manual:
- I need 8 hours of sleep to survive
- If I don’t get a good night’s sleep, then … (something bad will happen)
- If I’m having trouble sleeping, I need to try harder
- If I have a bad night of sleep I should try to catch up on sleep later
The CBT-I Coach app from the U.S. Department of Veterans Affairs has some useful tools and trackers to apply this information.