You may have heard of Cognitive Behavioural Therapy for Insomnia (CBT-I) as an effective treatment for sleep issues, but what does it actually involve?
In this post, we'll delve into the key techniques of CBT-I, explaining how they work and how they can help improve sleep. Whether you're new to CBT-I or looking to understand it better, this overview will guide you through the core elements of this effective solution for chronic insomnia.
An Introduction To CBT-I
Cognitive Behavioural Therapy for Insomnia (CBT-I) is a structured, evidence-based solution, designed to help individuals with long term insomnia. It is the first-line recommended treatment and focuses on identifying and altering negative thoughts and behaviours that contribute to sleep problems. Recommended by The National Institute for Health and Care Excellence (NICE), CBT-I is considered the “gold standard treatment for insomnia”.
What Exactly Does CBT-I Improve?
Through techniques like time in bed restriction, stimulus control, and cognitive restructuring, CBT-I aims to improve one or more of the following:
Insomnia severity
Subjective sleep quality
Time taken to fall asleep
Time spent awake during the night
Number of night time awakenings
Total sleep duration
Sleep efficiency (% of time in bed spent asleep)
What Is 'Chronic' Insomnia?
Chronic insomnia is defined as difficulty getting to sleep, staying asleep or waking too early in the morning for at least 3 nights per week, for 3 months or more. This is accompanied with sleep symptoms causing distress or impacting daytime functioning.
Is CBT-I Just The Same As Generalised CBT?
In short, no. While CBT-I shares foundational principles with general CBT, it is specifically tailored to address sleep-related issues. CBT-I focuses on the unique patterns and behaviours that contribute to insomnia. Unlike generalised CBT, which can address a wide range of psychological issues, CBT-I uses different techniques and is designed with a specialised framework to improve sleep quality and reduce insomnia symptoms.
Now let's get onto an overview of the main CBT-I techniques....
A Summary of CBT-I Techniques
1. Understanding Your Sleep (Sleep Education)
Sleep education involves learning about the science of sleep, including the stages of the sleep cycle, the importance of sleep for overall health, and the factors that affect sleep quality. It also addresses common misconceptions about sleep, such as the belief that everyone needs eight hours of sleep. By understanding sleep better, people can develop a more realistic, constructive and supportive approach to improving their sleep.
2. Stimulus Control
Stimulus control aims to create a strong association between the bed and sleep by establishing a consistent sleep-wake schedule and using the bed only for sleep and intimacy. It involves strategies like going to bed only when sleepy and getting out of bed if unable to sleep, which helps break the cycle of sleeplessness and anxiety. This technique helps condition the body and mind to expect sleep when in bed, thereby improving insomnia symptoms.
3. Time in Bed Restriction
Time in bed restriction, also known as sleep restriction therapy, involves temporarily reducing time spent in bed, rather than staying in bed for long periods trying to sleep. This technique helps improve sleep efficiency by consolidating sleep into a shorter, more restful period. Over time, as sleep quality improves, time in bed is gradually increased, helping to normalise sleep patterns.
4. Wind Down Period (Buffer Zone)
The wind-down period, or buffer zone, is a consistent, designated time before bedtime for activities that promote relaxation, such as reading, listening to calming music, or journaling etc. This period helps signal to the body and mind that it is time to prepare for sleep, making it easier to transition from wakefulness to rest. Reducing exposure to screens and stimulating activities during this time is also crucial for fostering a calm, sleep-friendly environment.
5. Cognitive Restructuring (Reframing Negative Thoughts)
Cognitive restructuring addresses the negative and irrational thoughts that can exacerbate anxiety about sleep, such as fears about not sleeping enough or worrying excessively about the consequences of insomnia. By identifying and challenging these thoughts, individuals can replace them with more balanced and realistic perspectives. This process helps reduce the emotional distress that often accompanies insomnia, promoting a more positive mindset towards sleep.
6. Counter Arousal (Dealing with Worries & Clearing the Mind)
Counter arousal techniques are designed to manage pre-sleep anxiety and intrusive thoughts that can interfere with the ability to fall asleep. Techniques such as journaling before bed, setting aside a specific "worry time" earlier in the day, and practicing relaxation exercises can help clear the mind. These strategies allow people to address their concerns in a structured way throughout the daytime, reducing their impact on sleep.
7. Relaxation & Mindfulness
Relaxation and mindfulness practices, such as deep breathing, progressive muscle relaxation, and meditation, help reduce physical and mental tension that can interfere with sleep. These techniques foster a state of calm and present-moment awareness, which is conducive to falling asleep and staying asleep. Regular practice can also improve overall stress management, making it easier to maintain a healthy sleep routine.
8. Sleep Hygiene
Sleep hygiene refers to habits and environmental factors that promote good sleep quality. This includes maintaining a regular sleep schedule, creating a comfortable and quiet sleep environment, avoiding stimulants like caffeine and nicotine close to bedtime, and limiting exposure to screens before bed. Good sleep hygiene supports the effectiveness of other CBT-I techniques by establishing a foundation of healthy sleep practices.
Will I need to do a sleep diary?
Completing a basic sleep diary is crucial in effective CBT-I as it provides detailed insights into sleep patterns, helping sleep experts identify specific issues contributing to insomnia. The sleep diary enables the tracking of progress, facilitates personalised adjustments to the sleep plan from data analysis, and reinforces self-awareness about behaviours and thoughts affecting sleep quality.
The importance of doing CBT-I with a sleep professional
Undertaking CBT-I with a trained sleep specialist is crucial for achieving the best outcomes when it comes to tackling insomnia. Sleep professionals who are trained in CBT-I have specialised knowledge and skills to customize the sleep plan to each individual's unique sleep challenges. They provide expert guidance, monitor progress, and adjust the sleep recommendations as needed to ensure effectiveness. Professional support also helps people stay committed to the techniques, overcoming challenges that might be difficult to achieve alone.
How does CBT-I fit into The Good Sleep Method?
When working with The Good Sleep Method, a holistic approach is taken to improving sleep, overall health and wellbeing to tackle to root causes of sleep disruption. A wide variety of different techniques and approaches will be considered, depending on what is most relevant and likely to be effective for the individual, so it isn't one size fits all. Some or all of the above CBT-I techniques maybe recommended for clients who they are deemed appropriate for. For those who may not respond well to CBT-I, strategies, adjustments or alternative approaches will be suggested.
How effective is CBT-I?
CBT-I is widely recognised as an effective treatment for insomnia, including both primary insomnia and insomnia that occurs alongside other conditions (known as comorbid insomnia). It has been shown to be effective in up to 80% of people, reducing time taken to fall to sleep, increasing sleep duration and decreasing the number of night time wakes. On top of this, results are often able to be sustained over long periods of time. Whilst results can often start to be seen within a couple of weeks, it can take time to work (depending on the individual) and requires some commitment and practice, so patience and consistency is key.
I hope you found this overview of CBT-I techniques helpful. If you're struggling with insomnia and are looking for a certified sleep practitioner trained in CBT-I, please book a call with me to get started today!
I'm Amy, a Holistic Sleep Coach and Certified Sleep Consultant Practitioner for adults & teens. I help people improve their sleep to feel and perform at their best, using The Good Sleep Method.
If you are looking for 1-1 tailored support to get a better night's sleep and tackle insomnia for good, book a call with me to get started.
You can read more about me here.
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