Can’t sleep? It’s all in your head!

Insomnia. It’s the worst. You lie in bed, tossing and turning at night. You become frustrated that you haven’t fallen asleep. Your frustration keeps you awake. You become more frustrated…it’s a vicious cycle. You’re exhausted the next day. You lie down the next night and start the cycle all over again.

As one who struggles with chronic insomnia, I am constantly looking for ways to improve my sleep. I recently learned about Cognitive Behavioral Therapy for Insomnia (CBT-I), a specialized form of Cognitive Behavioral Therapy (CBT). CBT is a form of psychotherapy that aims to change maladaptive patterns of thinking or behavior, by helping the patient identify negative or irrational thoughts or emotions and correct them. CBT is an effective treatment for several psychiatric illnesses including depression, anxiety and panic disorders, bipolar disorder, obsessive-compulsive disorders, and eating disorders (Hofmann et al., 2012). As of now, the exact mechanisms by which CBT works are unclear…we just know it works. Researchers have explored cognitive mechanisms such as developing adaptive coping thoughts, behavioral mechanisms such as associative learning (remember Pavlov and his dogs?), and physiological mechanisms including normalization of physiological arousal.

CBT-I is becoming increasingly popular and is recommended by the American College of Physicians as a first line of treatment for insomnia (Qaseem et al., 2016). Components of CBT-I include stimulus control, sleep restriction, cognitive therapy, relaxation techniques, and sleep hygiene education. Basically, CBT-I works to retrain your brain to associate the bedroom with sleep and reduce the conditioned anxiety related to difficulty falling asleep.

This relatively new facet of CBT brings good news for insomniacs. You can do it without the meds! Anyone who has been through this knows that it’s not fun to become dependent on medication for sleep. What if you forget your meds on a trip? What if you run out? You immediately spiral right back down hole of frustration followed by more frustration followed by no sleep. Most interestingly, CBT-I has proven to be just as effective or more effective when compared to medications. A meta-analysis comparing the effectiveness of CBT-I to benzodiazepines, zolpidem, and zopiclone—all of which are commonly prescribed sedatives for sleep—found that sleep quality improved more with CBT-I (Mitchell et al., 2012). Using CBT-I for sleep improvement and maintenance may help avoid some of the adverse reactions that often come with these medications including increased dependence, brain fogginess, sleep walking, and withdrawal.