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Struggle with insomnia? Cognitive behavioral therapy can help

Posted on October 17th, 2023

Sleep is essential for your physical and mental well-being. Yet, millions of people worldwide struggle with insomnia, a sleep disorder that disrupts their ability to fall asleep or stay asleep through the night. 

Insomnia can have a profound impact on daily life. It can lead to fatigue, reduced productivity, and negative health consequences, including an increased risk of dementia

While medication is often a go-to solution, medications can have side effects and result in dependency. But cognitive-behavioral therapy (CBT) is a side-effect-free, highly effective, and lasting treatment option for anyone struggling with insomnia.

What is insomnia? 

Insomnia is characterized by difficulty falling asleep or staying asleep, or experiencing non-restorative sleep despite having ample opportunity. Insomnia can be short-term (acute) or long-lasting (chronic). And it may stem from various causes, including…

  • Stress
  • Anxiety
  • Medical conditions
  • Or lifestyle factors

The problem with treating insomnia with medication 

Many people turn to sleep medications to reduce their insomnia symptoms. Medications can be effective in the short term. However, they often come with drawbacks. These may include dependency, tolerance (requiring higher doses for the same effect), and side effects like drowsiness or impaired cognitive function during the day. 

Additionally, medication alone does not address the root causes of insomnia. Medication is a temporary fix rather than a long-term solution.

How cognitive behavioral therapy (CBT) treats insomnia effectively

Cognitive-behavioral therapy for insomnia is known as CBT-I. It’s considered one of the most effective treatments for chronic insomnia and is typically delivered by a trained therapist. 

CBT-I works by addressing the cognitive and behavioral factors that contribute to insomnia and teaching people healthier sleep habits. Unlike medication, CBT-I aims to give people the tools and skills they need to improve their sleep naturally and sustainably.

Here’s how CBT-I works: 

Assessment: The first step in CBT-I is a thorough assessment by a healthcare professional or therapist. This assessment identifies the specific factors contributing to a person’s insomnia and tailors the treatment plan to their individual needs.

Psychoeducation: Patients are educated about sleep and insomnia, including common misconceptions and beliefs that may make their sleep problems worse. Understanding the principles of CBT-I can help patients develop realistic expectations about their sleep.

Sleep restriction: A key component of CBT-I is sleep restriction. This involves limiting the amount of time spent in bed to the actual amount of time spent asleep. Initially, this may mean spending less time in bed than desired to increase sleep efficiency.

Stimulus control: This technique helps people reassociate the bed and bedroom with sleep rather than wakefulness. It involves guidelines like using the bed only for sleep and sex and leaving the bedroom if a person is unable to fall asleep after a certain amount of time.

Sleep hygiene: Patients are educated about creating a sleep-conducive environment and developing good sleep habits. This includes maintaining a regular sleep schedule, avoiding caffeine and alcohol close to bedtime, and reducing screen time before sleep.

Cognitive restructuring: This aspect of CBT-I addresses negative thoughts and worries about sleep. Patients learn to challenge and reframe these thoughts, which, in turn, reduces the anxiety and frustration that can contribute to insomnia.

Relaxation techniques: Relaxation exercises, such as progressive muscle relaxation or deep breathing, can help reduce anxiety and tension that interfere with sleep.

Bedtime routine: Developing a relaxing bedtime routine can signal to the body that it’s time to wind down and prepare for sleep. You can achieve this by…

  • Going to bed and waking up at the same times each day
  • Performing calming activities to wind down, such as taking a warm shower, reading a book, or listening to soothing music
  • Limiting screen time at least an hour before bed
  • Avoiding caffeine and alcohol consumption close to bedtime

Homework: Patients are often given specific tasks or “homework” to practice between sessions. Homework may include keeping a sleep diary, following sleep restriction guidelines, or practicing relaxation techniques.

Maintenance: Once people’s sleep patterns start to improve, a therapist helps them maintain these changes over the long term. This may involve periodic follow-up sessions.

CBT-I is typically delivered over several weeks, with regular sessions to monitor progress and make adjustments to the treatment plan as needed. CBT-I is a non-pharmacological treatment for insomnia that does not involve sleeping pills. However, in some cases, CBT-I may be used in combination with medication under the guidance of a healthcare professional.

What are the benefits of CBT-I?

CBT-I is highly effective at treating insomnia, and it has several advantages over medication. These benefits include…

Long-term success: Unlike medication, which often provides only temporary relief, CBT-I offers lasting benefits. Many people who undergo CBT-I find their improved sleep patterns continue even after treatment ends.

Minimal side effects: CBT-I is a drug-free approach, which means it doesn’t carry the risk of dependence or the side effects associated with certain sleep medications.

Addressing underlying causes: CBT-I dives into the psychological and behavioral factors that contribute to insomnia. It helps people understand and address the root causes of their sleep issues. 

Improved daytime functioning: Better sleep quality achieved through CBT-I leads to improved daytime alertness, cognitive function, and overall well-being.

Personalized approach: CBT-I is tailored to each person’s unique sleep patterns and challenges. It’s a highly personalized and effective treatment.

Insomnia is a common and frustrating sleep disorder, but it doesn’t have to be a lifelong struggle. Cognitive-behavioral therapy for insomnia offers a holistic and sustainable solution for getting a better night’s rest. 

By addressing the psychological and behavioral aspects of sleep, CBT-I empowers people to take control of their sleep patterns. That way, they can enjoy more restful nights and productive days. If you’re struggling with insomnia, consider consulting a CBT-I therapist to explore this evidence-based approach to better sleep.

Dr. Meghna Dassani has practiced dentistry for over two decades and is passionate about the role dentists play in whole-body health. You can learn more at her website:

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