CBT for Insomnia

Insomnia is estimated to effect 6-10% of the adult population and can have a significant impact on your quality of life, long-term health outcomes, work performance and mood. While most individuals will be impacted by insomnia at some point in their lives, people who develop severe or chronic insomnia are often left feeling as though there is no solution to the problem despite trying their hardest to adhere to good sleep practices. Many times, people will have tried multiple sleep medications and find the medications either don't work, work only for a short period of time or have intolerable daytime side effects. For individuals who find themselves in this situation, having a thorough evaluation of their sleep and a comprehensive treatment plan can be the difference between feeling chronically sleepy and frustrated by insomnia and restoration of an improved sleep pattern that leaves them feeling refreshed. Cognitive behavioral therapy for insomnia (CBTi) is a short-term, symptom targeted treatment for patients with chronic insomnia. It is based on the idea that when we are unable to sleep, we often try to compensate by spending more time in bed. We think if we have more of a chance to sleep, we will get more sleep. Unfortunately, this can create a vicious cycle where we spend more time in bed, but we actually get less sleep and the sleep we do get is less refreshing. In order to reverse this cycle, we have to make some changes to how and when we sleep. Many of these changes may seem counter intuitive or difficult to adhere to, but they have been proven to work. If you chose to pursue CBTi as a treatment for your insomnia, your doctor will first work closely with you to rule out any medical, substance use related or psychiatric illnesses that could be contributing to your inability to sleep. Next, you will work together to figure out any environmental or behavioral changes you could make that might help facilitate a better night's sleep. The next step is keeping a careful sleep log to help figure out how much you are actually sleeping (total sleep time) versus how much time you are spending in bed (time in bed). These numbers are then used to come up with your "sleep prescription" which is the time you should go to bed each night and the time you should get out of be each morning. Initially, the "sleep prescription" will result in a mild sleep deficit that, overtime, improves the quality and duration of sleep. As sleep quality improves, the time in bed is lengthened to reflect a full night of sleep.