Not too long ago, I watched a BBC documentary called: Daisy Maskell: Insomnia And Me. I’ve struggled with insomnia pretty much all my life, so I was really interested in watching this BBC Three show. And I’m glad I did. I learnt of a new CBT technique that’s designed to help people with insomnia, CBT-I, so I’m sharing it with you.
What Is CBT-I?
First, for those that are unaware of what insomnia is, which probably means you don’t have sleep issues (lucky), insomnia is a common sleep disorder which makes it difficult to fall asleep, difficult to stay asleep, and cause you to wake up early. In short, you never get enough hours of good quality sleep. According to Koffel, Bramoweth, and Ulmer (2018), insomnia affects nearly a quarter of the US population, with at least a third being affected in the UK (Swift, Stewart, Andiappan, Smith, Espie, and Brown, 2012).
Oh, I should also tell you what CBT-I stands for, just in case. CBT-I stands for Cognitive Behavioral Therapy for Insomnia. Pretty straight forward. CBT-I explores the connection between how we think, the things we do, and how we sleep (Sleep Foundation).
CBT-I claims to be an effective treatment for insomnia, which uses a structured programme to identify and replace behaviours and thoughts that worsen your sleep issues with new habits to improve your sleep quality (Mayo Clinic).
How Can CBT-I Help Me Sleep?
An alternative to medication
This tops my list because taking sleeping pills isn’t a long-term solution. Sleeping pills can be addictive, and even if you don’t become addicted to them, no ethical doctor will prescribe them forever. Plus, there’re side effects to factor in and long-term costs, if you don’t have universal health care like my American readers. Thus, CBT-I could solve your sleep problems without having to take mediation.
Tackles the root cause
CBT-I helps you identify and overcome the root cause of your insomnia. There are a lot of other health and mental health conditions that have sleep issues as a symptom. For example, depression has sleep disturbance as a symptom. Thus, you may not realise you’re depressed and just think you have a sleep problem, but a course of CBT-I might identify the true cause as being depression. You can then get appropriate treatment to tackle the underling cause, the depression.
Because of how beneficial CBT-I is with treating insomnia, there is a push to create online CBT-I platforms and apps. You could skip seeing a therapist and use CBT-I as a self-help technique instead, so don’t be afraid to Google for online CBT-I options so you don’t have to wait to get support from a therapist.
Fortunately, Erten Uyumaz, Feijs, and Hu (2021) have reviewed several readily available CBT-I apps that you can download to help with your insomnia. All reviewed based on their CBT-I merits and usefulness (see below).
A sleep diary is a pretty basic technique but one that can help identify the issues that need working on. Keeping a diary of your sleep habits will help identify patterns, which can lead to solutions. There’s even an app that could help with tracking this information, which I recently reviewed, and that’s the Bearable app. Click here to read the review.
This is a combination of tackling the worry and frustrations you have that affect your ability to sleep while also removing barriers that have conditioned your mind to resist sleep.
Here you’ll look at fixing your sleep schedule through identifying the best time to go to bed and wake up so you can establish a new sleep pattern.
This one may sound counterproductive, but it’s not. I don’t know about you, but if I try to go to sleep before I’m tired, I end up having less sleep or almost no sleep at all. Therefore, this method stops you trying to force yourself to sleep by disregarding laying in bed if you’re not tired. You might use this method if the sleep rescheduling isn’t effective, in which case you’ll return to sleep rescheduling once your sleep quality improves.
With this technique, you’ll be discussing lifestyle changes that can be made to improve your quality of sleep. This could mean tackling your smoking, as nicotine is a stimulant, as is caffeine. Therefore, you might have to stop using either stimulant after a certain time, cut back on their use, or even think about going abstinent.
It could also mean cutting down on alcohol, because alcohol stops you from getting a good night’s sleep. That’s why you often wake up still feeling extremely tired after a session the night before with your mates. Drinking alcohol to help you sleep simply doesn’t work, because you can’t get the type of sleep your body needs.
You’ll also talk about setting up a sleep routine to help you wind down at night. Having such a routine will help train your body to prepare to go to sleep. And, this one might not be so popular, but exercising will be something you might have to do to help make your body feel tired.
Putting the day behind you
Pretty self-explanatory. It simply means you need to clear your mind of what happened during the day by working through them before trying to sleep.
If trying to put your day to rest doesn’t help before trying to sleep, or if you’re like me, your mind will always find something to fill the silence, then you’ll be taught some distraction techniques to use. For me, sleeping with the TV on helped, but that goes against the following technique.
Basically, you’re meant to make your bedroom a bedroom. You can do this by keeping it quiet (told you sleeping with the TV on goes against this technique), make the room dark, keep the bedroom cool, hide the clock, don’t have a TV in there, etc. Just not possible for me. I live in a single room that is my bedroom, my living room, and my dining room. Not an ideal living situation during the pandemic, either. Having another room to exist it would have been nice these last 20 odd months.
This could be simply teaching you relaxation methods to use before bed, but also ways to manage stress and even anxiety. You’ll learn many ways to quiet your body and mind, such as meditation and breathing exercises.
Instead of trying to make yourself sleep, this method will seek to do the opposite. You’ll try doing nothing to help yourself sleep, because for some, the effort of trying could make it harder for them to sleep. In short, you’ll be trying to learn to let go of the worry around your insomnia. If you sleep, great, if you don’t, it doesn’t matter.
Review and relapse prevention
If you’re getting good CBT-I, then you’ll also review your progress and be taught how to avoid relapsing into old sleeping habits and how to reestablish the healthier sleeping habit should you have a lapse.
How Effective Is CBT-I?
A study by Taylor and Pruiksma (2014) reviewed pervious studies into insomnia and co-occurring mental health conditions (depression, PTSD, substance dependency, and anxiety), finding that CBT-I was effective in treating insomnia and often helped the co-occurring disorder too.
Support for this comes from Swift, Stewart, Andiappan, Smith, Espie, and Brown‘s (2012) day long community CBT-I programme study, finding it to be effective in treating insomnia. Further support for CBT-I effectiveness comes from Waters, Chiu, Dragovic, and Ree (2020) who found it also works with people who have psychosis, like me.
And, just to round out this section with one last bit of supporting information, Fleming and MacMahon (2015) outlines how many clinical trials have established the effectiveness of CBT-I in the general population and, more recently, in those who have insomnia as a consequence of having cancer. This caught my eye because my mum had cancer, my nana died of cancer, and my uncle has had cancer twice.
As always, leave your feedback in the comments section below. Also, feel free to share your experiences CBT-I and insomnia in the comments section below as well. Don’t forget to bookmark my site and if you want to stay up-to-date with my blog, then sign up for my newsletter below. Alternatively, get push notifications for new articles by clicking the red bell icon in the bottom right corner.
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Unwanted Life readers.
Fleming, L., & MacMahon, K. (2015). CBT-I in cancer: we know it works, so why are we waiting?. Current Sleep Medicine Reports, 1(3), 177-183. Retrieved from https://doi.org/10.1007/s40675-015-0021-0 and https://link.springer.com/article/10.1007/s40675-015-0021-0.
Erten Uyumaz, B., Feijs, L., & Hu, J. (2021). A review of digital cognitive behavioral therapy for insomnia (CBT-I apps): are they designed for engagement?. International journal of environmental research and public health, 18(6), 2929. Retrieved from https://doi.org/10.3390/ijerph18062929 and https://www.mdpi.com/1660-4601/18/6/2929.
Koffel, E., Bramoweth, A. D., & Ulmer, C. S. (2018). Increasing access to and utilization of cognitive behavioral therapy for insomnia (CBT-I): a narrative review. Journal of General Internal Medicine, 33(6), 955-962. Retrieved from https://doi.org/10.1007/s11606-018-4390-1 and https://link.springer.com/article/10.1007/s11606-018-4390-1.
Swift, N., Stewart, R., Andiappan, M., Smith, A., Espie, C. A., & Brown, J. S. (2012). The effectiveness of community day‐long CBT‐I workshops for participants with insomnia symptoms: a randomised controlled trial. Journal of Sleep Research, 21(3), 270-280. Retrieved from https://doi.org/10.1111/j.1365-2869.2011.00940.x, https://onlinelibrary.wiley.com/doi/pdfdirect/10.1111/j.1365-2869.2011.00940.x, and https://onlinelibrary.wiley.com/doi/full/10.1111/j.1365-2869.2011.00940.x.
Taylor, D. J., & Pruiksma, K. E. (2014). Cognitive and behavioural therapy for insomnia (CBT-I) in psychiatric populations: a systematic review. International review of psychiatry, 26(2), 205-213. Retrieved from https://doi.org/10.3109/09540261.2014.902808 and https://www.researchgate.net/profile/Daniel-Taylor-23/publication/262811349_Cognitive_and_behavioural_therapy_for_insomnia_CBT-I_in_psychiatric_populations_A_systematic_review/links/55ca2ea908aebc967dfbdd21/Cognitive-and-behavioural-therapy-for-insomnia-CBT-I-in-psychiatric-populations-A-systematic-review.pdf.
Waters, F., Chiu, V. W., Dragovic, M., & Ree, M. (2020). Different patterns of treatment response to Cognitive-Behavioural Therapy for Insomnia (CBT-I) in psychosis. Schizophrenia research, 221, 57-62. Retrieved from https://doi.org/10.4137%2FSART.S18446, https://journals.sagepub.com/doi/full/10.4137/SART.S18446, and https://www.researchgate.net/profile/Milan-Dragovic/publication/340750291_Different_patterns_of_treatment_response_to_Cognitive-Behavioural_Therapy_for_Insomnia_CBT-I_in_psychosis/links/5ea7ca5fa6fdccd7945b6a83/Different-patterns-of-treatment-response-to-Cognitive-Behavioural-Therapy-for-Insomnia-CBT-I-in-psychosis.pdf.