CBT for Insomnia and Sleep Disorders

You may be uncertain as to how a psychological approach, such as CBT, could improve your sleep. However, the great news is over 25 years of research has established CBT (CBT-I) as the treatment of choice for insomnia, and in my own practice I’ve used the approach to help countless clients reclaim their night’s rest. Whether you struggle to fall asleep, wake often or too early, CBT-I address the underlying causes.

“I've always envied people who sleep easily. Their brains must be cleaner, the floorboards of the skull well swept, all the little monsters closed up in a steamer trunk at the foot of the bed”

from 'City of Thieves' by David Benioff

How does CBT for insomnia (CBT-I) work?

An initial assessment of your personal insomnia problem will involve finding out how it shows itself day to day and its development over time. As CBT-I is a collaborative therapy, I will ask you to complete sleep diaries and think about sleep goals. We will look at the facts about sleep and probably bust a few myths in the process. Most importantly we will look at how you view your insomnia, is it perhaps from a position of defeat or panic? Whilst insomnia is frustrating and infuriating, we will endeavour to see it as a problem that can be solved.

How thoughts affect sleep

Many of my clients have full lives, and notice that their busy brains aren’t co-operating and switching off when it’s time to sleep. Perhaps you’ve noticed that familiar worries return as soon as your head touches the pillow. Plus when we’re sleep-deprived it’s really hard not to worry about the effects of poor sleep. CBT-I is a structured approach that teaches you to recognise and change negative beliefs and thoughts that contribute to your sleep problems. Common examples that may be addressed during treatment include anxiety about past experiences of insomnia, unrealistic expectations of sleep time and quality, and worry about daytime fatigue or other consequences of missed sleep.

There is a relationship between unhelpful beliefs and attitudes about sleep, and sleeping itself. A common example is “I should be able to sleep well every night like a normal person”. Other unhelpful thinking patterns include exaggerating (“I barely ever sleep”), hopelessness (“It will always be this way”) and catastrophising (“If don’t get some sleep tomorrow will be a disaster and I may lose my job!”). Changing to a more positive and realistic thinking style is associated with significant improvement in sleep, plus I’ll teach you how to calm a racing mind. 

How behaviours affect sleep

Unhelpful thoughts about sleep may lead to behaviors that make sleep more difficult, which then reinforce the unhelpful thoughts. CBT teaches you how to avoid behaviors that keep you awake at night and replace them with better sleep habits.

Depending on your needs, the behavioural aspect of treatment will combine the following:

  • Stimulus control: Many people with insomnia begin to dread their bedroom, associating it with wakefulness and frustration. They may also associate their bedroom with habits that make sleeping more difficult, like using their computer. Stimulus control removes factors that condition your mind to resist sleep.
  • Sleep restriction: You may feel like you’ve forgotten how to sleep well as it’s been so long. Lying in bed when you’re awake can become a habit that disrupts your body clock. CBT-I helps you learn how to fall asleep quickly using your natural sleep drive, limiting the time you spend laying awake. Once your sleep has improved, your time in bed is gradually increased. 
  • Plus some relaxation training: This helps you calm your mind and body using imagery and progressive muscle relaxation.

There’s always homework!

CBT-I is a collaborative process and the skills learned in sessions require practice. Assignments in-between sessions may involve keeping a sleep diary, thoughts challenging and improving sleep hygiene.

CBT-I can benefit nearly anyone with sleep problems, primary insomnia as well as people with physical problems, such as chronic pain, or mental health disorders, such as depression and anxiety. What’s more, the effects seem to last. And there is no evidence that CBT-I has negative side effects.

CBT for insomnia requires steady practice, and some approaches may cause you to lose sleep at first. But stick with it, and you’ll likely see lasting results.

CBT-I versus sleeping pills

Sleep medications can be an effective short-term treatment, for example, they can provide immediate relief during a period of high stress or grief. But they may not be the best long-term insomnia treatment due to issues of dependency, ineffectiveness and side effects.

A recent study at Harvard Medical School found that CBT-I was more effective at treating chronic insomnia than prescription sleep medication. CBT-I produced the greatest changes in patients’ ability to fall asleep and stay asleep, and the benefits remained even a year after treatment ended.

Unlike pills, CBT-I addresses the underlying causes of insomnia rather than just relieving symptoms. But it takes time, and effort, to make it work.

Get in touch

I’ve helped many insomnia sufferers learn how to get better sleep, use the contact details to make an appointment. 

Commuter sleeping on the train

Self help

In the meantime, make a commitment to integrating the key tips below that ‘good’ sleepers do naturally:

  • Be consistent: Maintaining a regular, predictable sleep schedule, including on weekends, can help your body sustain a rhythm and make it easier to fall asleep.
  • Don’t lie awake in bed: If you haven’t dropped off in 30 minutes, get out of bed and do something relaxing until you are sleepy-tired again. This means only going back to bed when you’re yawning and your eyes want to close.
  • Create a bedtime routine: Give yourself enough time to wind down while you get ready for bed. Get off your phone and computer 90 minutes beforehand and stick with activities that help you relax before sleep.
  • If you’re find it difficult to ‘switch off’ once your head hits the pillow, read Overcoming Stress to learn to manage your thinking and improve relaxation skills.
  • Consider your daytime activities: What you do during the day really counts. Even a small amount of exercise can help you sleep better.
  • Consider reducing or eliminating caffeine for a while, and avoid it for 4-6 hours before you want to go to sleep. Same goes for nicotine, try to cut down in the evening. Avoid large meals close to bedtime.
  • Alcohol might make you drop off quickly into a deep sleep, but actually it will affect the quality of the sleep you get overall. Avoid drinking for four hours before bedtime.

Recommended resources for insomnia

Overcoming Insomnia and Sleep Problems: A Self-Help Guide using CBT by Professor Colin Espie