CBT for Insomnia – Everything You Need to Know
Sleep is vital for our body and mind to function optimally during the day. Without regular restful sleep, we struggle to function, to keep up with our responsibilities, and find our mood can be markedly impacted. However, insomnia is a common sleep disorder that prevents many people from falling asleep or sleeping restfully throughout the night.
Thankfully, there are a variety of treatments that can help you overcome insomnia – even from your home turf. Online psychotherapy has always been a “thing,” albeit a “small thing,” but now with COVID altering everyone’s lives, online psychotherapy has catapulted into a “gigantic thing.” Now, if you suffer from chronic insomnia, you can get cognitive-behavioral therapy (CBT) right from the comfort of your home!
In this ultimate guide, you’ll learn everything you need to know about CBT for insomnia (CBT-i) including information on how it works, types of treatment, research studies, and relapse prevention.
What is Online CBT for Insomnia (CBT-I)?
Online CBT-I is a web-based cognitive behavioral therapy program that insomnia sufferers can utilize and complete at their own pace and in the comfort of their own home. The goal of online CBT-I is to provide information, tools, resources, and techniques to users to help change the way they think about and respond to their sleep troubles.
Online CBT-I treatment offers users an individualized, hands-on approach to treating insomnia. Most therapy programs start with a questionnaire to get a better handle on your current condition and give moderators and experts an idea of what areas of your sleep habits need improvement. While all online CBT-I programs offer different benefits, most include guidance from a sleep expert, discussion groups, videos, guided meditation techniques, a sleep journal, and educational articles to help inform you about insomnia and other common sleep disorders. Most online programs are completed over the course of 6-8 weeks.
So, what exactly is CBT-i?
CBT-i is a form of psychological therapy which helps to address the thinking patterns and behaviors which are contributing to insomnia. CBT-i teaches you to replace unhelpful thoughts and behaviors which feed into your insomnia, with positive, helpful thoughts and behaviors to help you get a restful sleep.
The American Academy of Sleep Medicine explains that CBT-i, “helps you change actions or thoughts that hurt your ability to sleep well. It helps you develop habits that promote a healthy pattern of sleep.”
Rather than just masking the problem, CBT-i helps you to get to the root causes of your insomnia and find healthy coping strategies. The strategies you learn through CBT-i can help you to tackle any future sleep problems, and enable you to continue getting the restful sleep you need.
To fully understand how CBT-i works to improve sleep, it’s important to discuss what cognition is and how your thoughts and feelings directly impact your behavior. By changing and controlling these thoughts, you can change unhealthy habits and improve sleep.
One of the core principles of CBT is that thoughts about ourselves, others, and the world around us are what control our emotional reactions and behaviors. Thinking requires a lot of time and energy. Your mind is naturally wired to be efficient, which is why we often react to situations and events without giving them much thought. These are called mental shortcuts. While these shortcuts save time, they also leave out important information, creating inaccurate assumptions known as cognitive biases. By accepting these cognitive biases without question, we often process information inaccurately. For example, accepting the fact that if you’re anxious before bed, you’ll never fall asleep or that because you were up too late, you need to sleep in the next day. These are all preconceived ideas that, if challenged, you could change to benefit sleep quality.
CBT helps you to understand that people have different emotional reactions to similar situations based on how each individual views the situation. A lot of this has to do with past experiences and, sometimes, traumas. This supports the premise behind CBT that it’s the situation that makes you feel a certain way but, instead, your interpretation of the situation. These same principles can be applied when examining how you think and feel about sleep.
How Cognition Affects Behavior
Changing your behavior is the fastest way to change how you think and feel about something. By accepting new information based on an actual experience, your mind is forced to challenge previous assumptions. The premise behind CBT is to engage in new behaviors and learn from new experiences to help change your cognitive assumptions about the world around you, including sleep. By harboring and accepting negative thoughts about yourself or a particular situation, you’re making it difficult to change. CBT works to challenge these thoughts through behavioral experimentation.
Connecting the Dots
CBT works to help you change how you feel about something. Unfortunately, most people have little control over their emotions. While you can’t always control your feelings, you can gain control over your thoughts (cognitions), which directly impact your behaviors.
In terms of cognitive-behavioral therapy for sleep, the way you think about sleep and approach going to sleep will directly impact your behavior and ability to fall and stay asleep. For example, if you feel anxious before bed each night and accept the fact that you won’t be able to fall asleep and that will negatively impact your ability to function the next day, you’ll likely be lying awake for a long time. If instead, you go to bed with a clear mind, feeling organized and relaxed, you’re much more likely to fall asleep within a few minutes and sleep deeply all night long. While this sounds like an “easy” fix, achieving this level of relaxation, calm, and acceptance takes time. But that’s where CBT-i can help.
By now, you’re probably wondering how CBT-i works to help you change these thoughts and assumptions. Here are some of the most common CBT-i methods for improving sleep.
One of the first, and most important aspects of CBT-i, is sleep education. You’ll typically learn about the science behind sleep, why sleep is important, what happens when you don’t get the sleep you need, about sleep cycles, and more! This 2020 article on the topic explains that sleep education, “includes a review of the circadian rhythm and homeostatic sleep drive and how these normal functions impact sleep.”
This education gives you a solid basis to work from during the rest of your therapy. It also helps you to understand why it’s vital to be dedicated to the therapy program, and how the program will work.
Sleep Hygiene Education and Training
As part of this education, you will also get sleep hygiene education. Sleep hygiene refers to positive habits which can help you sleep. You’ll learn all about the importance of good sleep hygiene and how it can make a significant difference to your sleep quality. Through sleep hygiene training, you’ll learn to identify your own poor sleep habits that are interfering with your sleep and perpetuating insomnia. You’ll learn how to replace these habits with helpful sleep hygiene habits to actively tackle your insomnia. This article on the topic explains that “This method of therapy is used to correct things you do regularly that disturb your sleep. Sleep hygiene consists of basic habits and tips that help you develop a pattern of healthy sleep.”
Sleep hygiene includes changes such as:
- A consistent sleep schedule: By going to bed and getting up at roughly the same time each night and day, you help to regulate your body clock. Your mind will get used to going to sleep at that time of night, and with consistency, you’ll begin to feel tired close to ‘bedtime’.
- Making your bedroom comfortable: It’s important that your bedroom is used for sleep and relaxation only. It’s also vital that your bedroom is comfortable and conducive to sleep. This might include making sure your bed is comfortable; making sure your bedroom is not too hot or too cold; using dimmed lighting and blocking out external light; and so on.
- Winding down before bed: Setting aside 20 minutes to half an hour before bed each night to unwind and get your mind in a relaxed mindset for sleep can make a huge difference. This might include things like taking a bath, reading a book, or listening to calming music. It will also entail avoiding the use of electronics during your wind-down time, like a smartphone or TV.
- Reducing naps during the day: While short naps can be helpful, if you’re struggling with insomnia it can help to reduce or eliminate them so that you are more tired at night.
- Watching what you eat and drink: You’ll learn that it’s important not to go to bed hungry or too full, as this can make you uncomfortable. Eating a small, light snack before bed can be useful, and avoiding big heavy meals close to bedtime. It’s also important to avoid stimulants in the few hours before bed, such as nicotine, alcohol, and caffeine.
- Exercise during the day: Exercising can help your mind and body to be tired in a healthy way ready for bed. It can also help to regulate your mood and reduce stress. It’s also really helpful to get out in natural light during the day, to regulate your circadian rhythm (it relies on environmental cues such as sunlight to know when you should be asleep).
You might also learn what you should do if you wake up during the night to help you to get back to sleep more effectively. This might include not keeping a clock near the bed so you’re not checking the time; changing rooms if you can’t sleep for 20 minutes or more; practicing relaxation techniques; and so on.
Keeping a Sleep Diary
The next stage is often being asked to keep a sleep diary. You may be provided with a template or printout to follow and fill in each day. Alternatively, you may simply be asked to keep note of specific things. You can also find sleep diary templates online.
A sleep diary will typically keep track of:
- – What time you went to bed and got up
- – How many hours of sleep you got
- – How many times you woke up during the night
- – Whether you felt refreshed in the morning
- – Which sleep hygiene habits you kept up with that day
- – How you felt emotionally when you went to bed
You’ll be asked to be consistent with your sleep diary and take a few moments to fill it out each day. This helps your therapist and you to identify patterns in your sleep, along with habits that may have contributed to your problems sleeping that day. The Sleep Council explains that “The diary will help to pinpoint if you’re consistently waking at a similar time, what you’ve done that day, what you’ve eaten, etc to see if there is any pattern.”
Once you’ve pinpointed specific thoughts, feelings, or behaviors that are contributing to your insomnia, it’s far easier to address them. Your therapy becomes much more effective when you can focus it on specific issues you’re having and change those patterns so you can get the restful sleep you need.
Stimulus Control Therapy
A stimulus refers to anything, either external or internal, which causes a response. Stimulus control therapy focuses on altering stimuli that are contributing to insomnia and focusing on building a positive association between the bedroom and sleep.
This part of CBT-i is based on the idea that if you use your bedroom for things that stimulate you to be in an awake state, then your mind will make the association between the bedroom and being awake. Therefore, you will feel awake when you’re in your bedroom. This might include things like watching TV, doing work, or having stressful conversations in your bedroom.
Instead, you’ll be taught to keep the bedroom for relaxation, sleep, and sex only. These will be strict rules you’ll be asked to implement and be consistent with. You’ll also be encouraged to only go to bed when you feel tired. If you are tossing and turning after 20 minutes, you’ll be asked to change rooms and do something relaxing, until you feel sleepy and ready to go back to bed. If you stay awake and restless in bed, it builds the association between bed and wakefulness. If you are only in bed when you feel tired, it strengthens the positive association we want between the bed and sleep.
With consistency and over time, you’ll begin to find that your mind automatically associates being in the bedroom with relaxation and sleep. Your mindset will shift when you move into the bedroom and you’ll begin to feel tired, ready for a restful sleep. The American Academy of Sleep Medicine states that: “this method helps you to fall asleep more quickly after you get into bed. You begin to have a positive response toward going to bed at night. Instead of being frustrating, it becomes relaxing and restful.”
With Sleep Restriction Therapy (SRT), you’ll be given strict limits as to how much time you can spend in bed. These limits will apply regardless of how long or how well you’ve slept. The first restriction you’ll be given will be the number of hours you usually sleep restfully, even if this is only four or five hours. You’ll only be in bed for that amount of time, and will set an alarm to get you up after your time is up.
Once you’re sleeping peacefully with that amount of time in bed, the restriction will be eased and you might be advised to add an hour. Once you’ve adjusted to that amount of time and are sleeping throughout, you’ll add another hour and so on. This continues until you reach the recommended amount of sleep for your age.
Often when we lie in bed awake, we become stressed and anxiety builds: we might start worrying about the impact lack of sleep will have on us the next day, and begin to feel distressed. This anxiety actually makes it even harder to fall asleep. This method works to combat this
The word paradoxical refers to something which is the opposite, or which seems contradictory to what you are trying to achieve. This method encourages you to lie in bed without doing anything to try to fall asleep. You might even be asked to try to stay awake in bed as long as possible.
The word paradoxical refers to something which is the opposite, or which seems contradictory to what you are trying to achieve. This method encourages you to lie in bed without doing anything to try to fall asleep. You might even be asked to try to stay awake in bed as long as possible.
Cognitive restructuring focuses on helping you to identify negative thoughts and beliefs which might be keeping you up at night. As we mentioned, when we’re stressed at night and are having negative thoughts about sleeping, this actually contributes to the cycle of insomnia. With cognitive restructuring, you’ll be taught to identify these negative thoughts and instead actively replace them with a more positive thought.
Cognitive restructuring can also involve other techniques such as setting aside ‘worry time’. This might be 10 to 15 minutes each day. During this time, usually in the early evening so it’s well before you head to bed, you can talk about or write down your worries. This gives you a set time and permission to get these worries out of your head. The idea is that the rest of the time you’ll be able to focus on relaxation. This helps to stop worries cropping up at bedtime.
Other cognitive restructuring techniques focus on distraction as a way to shift your mind away from negative thoughts. This might involve thinking about positive memories in bed to keep your mind busy. It may also entail listening to an audiobook, sleep sounds, or some calming music as a way to occupy your mind while you drift off to sleep. Alternatively, guided imagery might be advised. This uses audio of a calming voice guiding you through imaging a calming scene or a story to ease you into sleep.
While cognitive restructuring focuses on changing negative thoughts or distracting from them, thought blocking methods focus on blocking negative thoughts from presenting themselves in the first place. This can be done in several ways, the first of which is articulatory suppression This method involves mouthing a short word repeatedly every three or four seconds. The word should be something short and without any emotional meaning, such as ‘the’ or ‘and’ for example.
This makes formulating any thoughts difficult, and so prevents negative thoughts. This article on thought blocking from Sleep Station explains that “The underlying psychology is complex, but the theory is that mouthing a word requires a lot more mental power than just thinking it and the use of that mental power causes a blocking of the original intrusive thought.”
If needed, you could add to this process by imagining a shape while you mouth the word. This is often useful if you have intrusive thoughts at bedtime which involve imagery. You could also add a mental puzzle if you need to increase the challenge further, such as counting backward in specific multiples, at the same time as mouthing your chosen word.
Imagery distraction is another way to do this, which is similar to guided imagery. You’ll focus on a memory or a scene and really engage in it vividly. The idea is that you’ll be so engaged in focusing on the details of this imagined scene, that your mind won’t be free to produce negative thoughts.
Is Online CBT Beneficial for Insomnia?
The short answer is, yes!
According to a Current Psychiatry review, online cognitive-behavioral therapy for insomnia (CBT-I) is an effective treatment for sleep issues, anxiety, and depression. Note: Depression is often a symptom of insomnia. It is common to experience “the blues” when you don’t get enough sleep.
The review focused on in-person and online CBT-I studies and found that online CBT-I is just as effective as in-person CBT-I in improving insomnia and depression symptoms. As a result, researchers concluded that both in-person and online CBT-I is equally beneficial for improving sleep quality years after the therapy.
Similarly, a recent study found that online CBT-I is 2x effective in reducing depression symptoms, as compared to antidepressants. Researchers also found that online CBT-I not only improves sleep quality, but also reduces chronic pain, fatigue, fibromyalgia, PTSD, anxiety, mood swings, and high blood pressure. It also helps insomniacs with substance abuse/addiction issues better manage their co-morbid conditions.
Online CBT-I can help you sleep more soundly at night, regardless of your natural sleep patterns or circadian rhythm. It can also reduce or eliminate nightmares and night terrors and hot flashes – common causes of insomnia.
Contrary to popular belief, prescription sleep aids may not help you fall and stay asleep at night, but there is a good chance online CBT-I will. In fact, studies suggest that prescription sleep aids (i.e. Sonata, Ativan, or Ambien) alone may not be as beneficial as they claim. A 2012 study found that sleeping pills were no more effective than placebo pills. In fact, participants who took a prescription sleep aid only fell asleep 10 minutes earlier than normal. Moreover, the sleep aid caused people over the age of 65 to experience significant side effects.
During the course of the study, researchers discovered that prescription sleeping pills occupy the same neurobiological routes as addiction. After examining 33-34 studies, researchers concluded that there is a connection between prescription sleep aids and an increased risk of death. Thus, results suggest that self-guided, internet-based cognitive-behavioral therapy (CBT-I) may significantly reduce insomnia symptoms more effectively than sleeping pills.
Researchers also found that the mild-to-moderate benefits of online CBT-I far-outweighed the risk of significant side-effects (i.e. agitation, daytime sedation, dementia, overdose, impaired memory, mental confusion and disorientation, suicidal thoughts, etc.) of prescription sleep aids. Thus, researchers concluded that online CBT-I is an accessible and convenient way to help insomniacs get more sleep at night.
How Does Online CBT (CBT-I) Work?
The goal of online CBT-I is to explore the relationship between your thoughts, behaviors, and sleep habits. During treatment, a trained CBT-I therapist helps you identify and address thoughts, feelings, and behaviors that could be negatively affecting your sleep. Any sleep-related thoughts and feelings are thoroughly examined – to determine if your sleep-related fears and/or worries are realistic. If not, your therapist works with you to reframe how you see sleeping and remove any fears associated with sleeping – so you get a good night’s rest.
The goal of your therapist is to challenge any misconceptions that could be preventing you from getting a peaceful sleep. Treatment often takes 6 to 8 sessions to complete; however, the length of the therapy is largely dependent on your specific sleep issue(s). For instance, your treatment plan may be as short as 2 to 3 sessions or as long as 6 months, depending on your needs and goals. CBT-I (online and in-person) is considered a multicomponent treatment because it involves cognitive, behavioral, educational, and homework components.
The ultimate goal of online CBT-I is to provide cognitive-behavioral therapy in the comfort of your home, on your own time, and without hassle. The aim is to change your thought processes, so the “thing” that is keeping you awake loses its power, allowing you to peacefully slumber the night away.
What to Expect from an Online CBT-I Program
CBT-I treatment usually lasts between 4 and 8 weeks, depending on the program. In-person sessions are held one-on-one with a sleep specialist or therapist. Online CBT-I programs usually come in the form of guided videos that are created and hosted by sleep experts. Specialists suggest you complete 1 video per week, after which you’ll apply the proposed techniques, document your progress in your sleep diary, and then revisit these the following week before moving on to the next lesson. While in-person sessions may last up to 60 minutes, online videos are generally shorter and more concise. That’s because there’s no time for a back and forth report with a therapist. Instead, you watch the video, take notes, and review any parts you feel you want or need to.
After documenting your thoughts, behaviors, and sleep patterns in your journal, you can review this information with your therapist, sleep expert, or coach. They’ll offer you guidance to help you adjust your goals and achieve continued progress and success. Some online therapy programs offer this service via chat or telephone.
How Long Does it Take for CBT-I to Work?
There’s no clear-cut answer to this question. Numerous factors determine how well you’ll respond to CBT-I and how long it will take to see results. One reason for this is that everyone’s thoughts and feelings about sleep are different. Your insomnia and sleep troubles may be rooted in years, or even decades, of prior beliefs. It will take time, patience, and a variety of techniques to help you overcome these assumptions and start making changes.
Additionally, different lifestyles and circumstances can impact the success rate of CBT-I. Some people have more challenges and hurdles to face than others. For example, new or expecting mothers and shift workers may take longer to establish healthy sleep patterns than someone who lives alone in a quiet, comfortable setting.
Some people will see improvements as soon as a few weeks while, for others, it might take months. The good news is, help is possible. One study involving 41 people with chronic insomnia found that 61% of participants that were treated using CBT-I were in clinical remission after 3 months of treatment.
What Does the Research Say About CBT-I?
A 2009 study also found that approximately 80% of insomniacs gained an additional hour of sleep time each night after using an online sleep program. Approximately 40% of these users reported a reduction in “sleeplessness” each night, and almost 36% of the users reported falling asleep more quickly while using an online CBT-I sleep program.
Lastly, nearly 20% of the users experienced a lower level decline (from insomnia) at their jobs. A 2017 study also found that online CBT-I programs may reduce “wakefulness” and improve sleep quality in approximately 81% of insomniacs.
A 2016 study found that insomniacs who supplemented in-person CBT-I with an online CBT-I coaching tool had an easier time completing program tasks and staying on-track in-between sessions. As a result, the users felt that they received a much better outcome because of the combined approach.
A highly effective sleep program that has had tremendous success in helping insomniacs find some much-needed relief is Somnus Therapy CBT-I sleep program.
Who Can Benefit from CBT-I?
People of all ages, ethnicities, and genders can benefit from CBT-i. Insomnia is often a secondary condition, which means that another condition, circumstance, or illness is at the root of your sleep troubles. This is known as co-morbid insomnia. By identifying this trigger, you’re one step closer to easing your insomnia symptoms. CBT-i has proven effective at improving both mental and physical symptoms associated with insomnia.
Chronic insomnia is most commonly linked with mental health disorders like depression, anxiety, and hypertension. For those suffering from insomnia due to these conditions, CBT-i can offer relief for both your sleep and your state of mind. In one psychological study, participants who suffered from a mental health disorder who received CBT-i showed an improvement in insomnia symptoms as well as their depression, anxiety, and overall psychological well-being.
It’s also comorbid with most major health conditions including cancer, diabetes, and heart disease. CBT-i is also effective across a variety of populations and doesn’t carry the same risks as other sleep treatments and medications including dependency and cognitive impairment. CBT-i’s versatility and effectiveness are what make it such an attractive treatment option for many people.
Combining CBT-I with Other Treatment Methods
Because insomnia takes on many faces and impacts different people in different ways, most therapists and online sleep therapy programs utilize several treatment methods to achieve results. Here are a few of the most effective CBT-i methods you can combine to achieve optimum results.
Mindfulness techniques are commonly integrated into CBT-i to reduce stress and help you relax ready for sleep. Mindfulness focuses on being present at the moment, rather than worrying about the past or future. It has many benefits and is proven to help people with insomnia get to sleep more easily, as well as improve their sleep quality.
Mindfulness techniques used in CBT-i are guided, meaning you’ll be guided through the process by a therapist or a recorded audio. Types of mindfulness used in CBT-i include:
- Guided meditation: Meditation involves sitting or lying down in a comfortable position, with your eyes closed or relaxed. You’ll be guided into a deeply relaxed, meditative state. You’ll feel the tension leaving your body and feel at peace. If your mind wanders, you’ll be encouraged to acknowledge your thoughts and let them drift past you. You’ll then be guided to bring your focus back to the present.
- Guided visualization: You may also hear this referred to as guided imagery. This involves being guided into a relaxed state and being asked to visualize a very calming scene. You’ll be asked to engage all of your senses to make the scene more vivid. You might even be guided through imagining falling into a deep sleep. As we mentioned earlier, guided visualization is often used as a distraction technique as part of the cognitive restructuring method of CBT-i.
- Breathing exercises: Breathing exercises involve focusing on your breathing to keep you grounded in the present, and to promote relaxation. They can come in various forms. You may be asked to take a deep breath, hold it for a few moments, and then release it slowly. This deep breathing helps to slow your heart and respiratory rate, helping you to relax.
- Progressive muscle relaxation (PMR)PMR involves being guided through tensing and then relaxing each individual muscle group throughout your body. As you do so, muscle tension leaves your body and you are able to reach a state of deep relaxation.
The aim of teaching these relaxation exercises through CBT-i is to give you the tools you need to continue practicing mindfulness in the long term in your own time. These exercises can be done at any time of the day, and still improve sleep. Alternatively, they can be done in bed at night to actually help you drift off to sleep.
Biofeedback is another treatment that is often integrated into CBT-i. The treatment involves learning to be aware of your physiological processes, particularly those involved in stress. This awareness then allows you to learn how to control and calm these processes, reduce stress, and improve sleep.
This is done by using monitors to actively show you the changes in your physiological processes in reaction to stress. You’ll then see them change or slow down in reaction to you learning to calm them. Cleveland Clinic explains that “Using a computer, special software, and sensors placed on the body, stress levels are recorded and the patient can learn to control normally involuntary processes such as heart rate, blood pressure, and muscle tension that increase under stress.”
When biofeedback methods are focused on tackling insomnia, you may also learn to become aware of and have influence over your brainwaves, as well as other processes. This is known as neurofeedback. It’s done through small sticky sensors on your scalp, connected to a computer. It’s completely pain-free and non-invasive. This can be pivotal in helping you sleep restfully, as brainwaves slow as we reach deeper stages of sleep.
Hypnotherapy is not commonly used during CBT-i as with our two relaxation methods, but it can sometimes be used so it’s important to mention it. Hypnotherapy involves sitting in a comfortable position with your eyes closed: you’ll be guided into a very deep state of relaxation, often known as a hypnotic state.
In this state, you are more open to suggestions. This can be useful in changing thought patterns and behaviors which may be contributing to insomnia. This relaxed state can also be really useful in actually helping you to drift off to sleep and releasing stress. Don’t worry, unlike the hypnosis shown in shows and on TV, real hypnosis can not make you do anything you don’t want to do. You’re always in control and can wake up at any time you like. The relaxed state simply helps you to be more open to suggestions and change.
Comparing CBT-i with Other Treatment Options
Not all insomnia treatment methods are the same. Some offer short-term results like sleep aids, pills, and certain medications, while others take time to work and provide more long-term results. When discussing CBT-i, the results are long-lasting but the process takes time and practice. Remember, you’re trying to change thoughts you’ve accepted as reality for years. It will take time to make this shift in thinking, but once you do, the benefits will last as long as you utilize the tools, techniques, and exercises you’ve learned.
If you need a short-term resolution, sleeping pills and medication can help. During times of extreme stress or anxiety or after days without sleep, medication can offer the instant relief you need. But sleep aids aren’t without risk of dependency and unwanted side effects, which is why they should only be used short-term or when in need. While sleep aids simply relieve insomnia symptoms in the instant, CBT-i works to address the underlying cause of your insomnia. In some cases, a combination of medication and CBT-i works best.
Relaxation Techniques to Improve the Effectiveness of CBT-i
Even after completing an online CBT-i program, you’ll need to work at achieving continued success and quality sleep. By adopting certain relaxation techniques, you can reduce worry and put yourself in the right mind frame for success.
Relaxation training is used to help you relax both your mind and body. This also helps you reduce any tension or anxiety that might keep you awake or wake you up throughout the night. You can use relaxation training at night before bed or during the day, leading up to bedtime. The goal of relaxation training is to help you control your breathing, mental focus, and muscle relaxation. Used in combination with biofeedback, you learn to control and change how tense your muscles are. This technique requires intense focus and concentration, making it difficult for some.
One of the main goals of relaxation training is to reduce worry – not only your worry over sleep but in all things. By doing so, many insomnia sufferers learn to reduce their worry and anxiety at night to promote quality sleep. Another common relaxation technique is known as cognitive restructuring which involves identifying your anxious or worrisome thoughts at the moment, what emotions accompany these thoughts, and how strong the emotions are. Try writing these worries down in a journal or diary. By doing so, you force your mind to slow down long enough to identify your biased way of thinking. While you can’t prevent these worrisome thoughts from entering your mind, you can control your reaction to them.
The act of changing how you respond to your worrisome thoughts is known as cognitive defusion. Think of how many thoughts enter and exit your mind every day. Some are fleeting while others you mull over for some time. We also place more importance on certain thoughts than others, but at the end of the day, they’re all simply that – thoughts. When you learn to control and sort them appropriately, you gain control over your life and your sleep habits.
One of the major hurdles to reducing and responding to worry is that you don’t often notice your response. It happens automatically. Having the power to pause and make active, conscious choices about a single thought means taking an unbiased, outsider’s perspective on the situation. Mindfulness is one such way to achieve this and is a popular method of CBT-i.
Another example would be, in a moment of extreme worry, switching your mind from obsessing over negative thoughts to focusing on specific sounds, smells, or sights.
Designated Worry Time
Because you can’t prevent worrying about sleep altogether, it’s important to give these worries the attention they deserve. One way of doing this is to create a designated time for worrying, or DWT. When you notice yourself worrying during the day, instead of addressing these thoughts immediately, write them down and revisit them later during your DWT. If you find that these worries are something you can address, make a plan to do so. If it’s clear you can’t do anything about them (which is usually the case), you need to let them exist without judgment and without engaging in them. This teaches you to delay your response to worry and take a more objective look at it. The basic idea is that by becoming aware of your worry, you can do something to change it. During CBT-i, these principles are applied to the worry or anxiety you feel about sleep.
Relapse prevention is the last, but vital stage, of CBT-i. This entails ensuring you can use the tools you’ve learned through therapy in the long term, to prevent you from slipping back into unhealthy sleep habits which could lead to insomnia. This stage of the therapy recaps what you’ve learned and ensures you are prepared to move forward, feeling equipped to handle any bumps in the road.
You’ll be taught that if you have a few sleepless nights, instead of panicking or reverting to unhelpful coping strategies, you use the techniques you’ve learned. For example, you would check you’re sticking to good sleep hygiene habits. You would start utilizing relaxation techniques, using stimulus control, and sleep restriction if necessary. These skills will get you back on track and prevent your insomnia from continuing.
This article from the National Sleep Foundation explains that relapse prevention is vital and states that: “The patient needs to be reminded that lots of things may trigger a bout of insomnia and the main things one can do to protect against a new-onset episode of chronic insomnia.”
Where to Access CBT-i?
Now that we know how useful CBT-i can be and how it works, we’ll take a look at how and where you can access this useful therapy.
Through Your Doctor
If you are struggling with insomnia, you could go to see your GP. They may be able to refer to a sleep clinic or a therapist for CBT-i. This might involve being on a waiting list or needing to advocate for yourself depending on where you live. Again depending on your location, some local health services may allow you to self-refer for therapy.
Another option would be to access therapy privately. You can find a private sleep specialist through a search online to see what’s available in your area. This can be a costly option but allows you to get therapy when you want it without having to wait. This gives you more control and can be a good option if your resources allow it.
Another option is using an online insomnia treatment program or an app. This is often more cost-effective than private in-person therapy but still allows you to have that control. You can access therapy when you want it, and even in your own home. You can even use recorded relaxation sessions to help you fall asleep at night.
These choices give you the freedom to figure out which option will work best for your preferences, lifestyle, and budget. If you’re struggling with insomnia, ensure you do seek help: before you know it, you can be sleeping peacefully once again!
Some of the most popular apps and online CBT-i programs include:
- Sleep Tutor
- Somnus Therapy
What is the Somnus Therapy CBT-I Program?
Somnus Therapy offers a 6-step clinically-proven CBT-I therapy program, designed for anyone suffering from mild, moderate, or even severe sleep problems. This program is especially beneficial for those who struggle with chronic insomnia and who have had their lives negatively impacted by a lack of sound sleep.
How Does It Work?
This online CBT-I sleep program involves 6 steps, including:
- Step 1: Exploring
This step explores why you have a hard time falling asleep and introduces you to the CBT-I approach.
- Step 2: Understanding
This helps you identify your triggers and the factors that have led to your chronic insomnia or “sleeplessness.”
- Step 3: Learning
During this step, you learn positive bedroom habits that encourage sound sleep.
- Step 4: Challenging
This step teaches you how to challenge or question your negative sleep-related thoughts. During this time, you’ll also learn important CBT tools and strategies you can use to help you cope with your upsetting and continuous sleep-related thoughts and worries.
- Step 5: Quieting
This step involves learning techniques and strategies you can use to “quiet” your busty mind and racing thoughts, so you can fall asleep.
- Step 6: Building
The final step involves “revamping” your sleep pattern. This step involves helping you develop healthier and more positive sleep habits using CBT techniques, so you can combat your sleep problem.
Who Can Benefit from the Somnus Therapy CBT-i Program?
If you have a hard time falling asleep, tend to feel sluggish during the day, find yourself constantly waking up throughout the night, and/or experience anxiety right before bedtime – you will benefit from the Somnus Therapy CBT-I sleep program!
Is the Somnus Therapy CBT-I Program Effective?
In fact, 81% of Somnus users reported a significant improvement in sleep quality and a noticeable reduction in insomnia in as little as 6 weeks after beginning Somnus Therapy’s CBT-I Program. And, after 12 weeks, 93%
reported that they could fall and stay asleep throughout the night.
What are the Benefits of Using Somnus Therapy for Insomnia and Other Sleep Issues?
Science and personal testimonies have proven that Somnus Therapy’s CBT-I Program is extremely beneficial for people experiencing a wide range of sleep issues, due to stress, a diagnosed sleep disorder, depression, anxiety, aches, and pains, or any other health condition.
Some of the benefits of using Somnus Therapy’s CBT-I sleep program are listed below:
- A Deeper Understanding:
Somnus Therapy CBT-I sleep program helps you gain a deeper understanding of your thought processes, so you can identify and address triggers that may be preventing you from getting restful sleep.
- A Different Perspective:
Somnus Therapy CBT-I program also helps you gain a different perspective on your sleep issues. How? Through cognitive restructuring. Cognitive restructuring is a CBT-I technique that helps you identify and address irrational, harmful, or negative thoughts that have been keeping you awake, so you can peacefully fall and stay asleep. Somnus Therapy teaches you how to replace your unrealistic and maladaptive sleep thoughts with accurate and more positive ones.
- Awareness and Acceptance:
Somnus Therapy uses cognitive-behavioral therapy (CBT) to help you become more aware of your negative thoughts, so you can acknowledge and address them. Once you acknowledge and accept them, they no longer have power over you, freeing you to get the sleep you need.
- An Introduction to Mindfulness:
Have you ever heard of mindfulness? If not, Somnus Therapy’s CBT-I program can introduce this relaxation technique to you. Studies suggest that mindfulness can reduce insomnia and improve sleep. This CBT-I approach helps calm your busy mind, so you can relax and fall asleep.
- A Greater Insight:
Somnus Therapy’s CBT-I sleep program improves how you see your bed in relation to sleep. The aim is to foster a positive association between going to bed and sleeping, so you actually look forward to climbing in bed.
- Guided Meditations:
Studies suggest that guided meditations can help encourage healthy sleep habits. And, guess what? Somnus Therapy offers hundreds of meditations by expert meditation teachers and sleep specialists to help you sleep better at night.
- Relaxing Sounds:
Who doesn’t love soothing sounds while trying to relax? This CBT-I program offers you a wide range of relaxing sleep sounds, binaural recordings, and other enchanting audio experiences.
- An Extensive Library:
When you sign-up for Somnus Therapy’s CBT-I program, you get over 50 core CBT sessions and over 100 sessions of guided sleep meditations – all you need for a restful sleep!
- Accessibility and Affordability:
While some sleep programs cost an “arm and leg” and require frequent trips to a counseling office, Somnus Therapy’s sleep program is not only affordable but also accessible. You don’t even have to leave your home to get the tools you need to improve your quality of sleep.
- A Personal Sleep Coach:
Personal sleep coach anyone? With Somnus Therapy, you get a personal sleep coach! This coach not only offers you valuable support and advice – whenever you need it, he or she is also regularly available to answers your questions, address your concerns, and provide you with some much-needed guidance as you traverse through the program.
Insomnia is a common sleep condition that makes falling and staying asleep, throughout the night, feel like an impossible hurdle to overcome. Although it may feel as if you’re never going to get a good night’s rest, that is simply untrue. You can get the zzzs your body needs to function at an optimal level, but it will take time, effort, dedication, and persistence. There are also tools available to help you retrain your brain so you can drift into a restful sleep. One of the most effective tools is cognitive-behavioral therapy of insomnia (CBT-I).
Never heard of it? You’re not alone. While many may have heard of cognitive-behavioral therapy (CBT), not as many have probably heard of cognitive-behavioral therapy for insomnia (CBT-I). However, it is one of the best treatments for developing or regaining healthy and positive sleep habits and patterns. One of the best things about CBT-I is you can receive it in-person and/or online.
And, one of the best online CBT-I sleep programs on the market is Somnus Therapy. Somnus Therapy is a virtual sleep aid that can help you identify, address, and replace the disruptive thoughts and behaviors that are triggering or exacerbating your sleep problems.
And, guess what? Somnus Therapy’s CBT-I sleep program promotes sound sleep – all from the comfort of your home or wherever you are! And, unlike temporary sleep meds, Somnus Therapy actually helps correct the “problem” so you don’t have to worry about not being able to fall asleep every time you lie down. It is a more permanent solution to a chronic problem – without side effects like overdosing, mood swings, and addiction.
So, if you are tired of wrestling in bed, trying to fall asleep or awakening only to find out you are unable to drift back to sleep, Somnus Therapy may be the remedy you’ve been looking!