Countless adults in the United States suffer from insomnia, the maddening inability to sleep when given the opportunity. Thankfully there are short-term, non-drug treatments that dramatically improve the sleep of most people with insomnia. The American Academy of Sleep Medicine recommends cognitive-behavioral therapy for insomnia, or CBT-I, as a first-line treatment.
When friends and family members find out that I treat insomnia, they often ask what the treatment involves. They’re not looking for a 90-minute lecture on CBT-I, of course: They want to know its essence.
In the end, the way to sleep well in general is to let go of how I sleep tonight. To understand why this is so important, you need to consider what leads to insomnia. A typical path goes like this:
The biggest factor that keeps insomnia going seems to be well-intentioned efforts to make up for the sleep you lost last night. A focus on how I’m sleeping tonight comes at the cost of how I’ll sleep in the long-term.
When our sleep is poor more nights than not, we’ll probably do things that we think will help us but that actually prolong our sleep problems:
Taken together, these factors keep the insomnia going. The role of CBT-I is to change these behaviors:
What all these instructions have in common is a long-view approach rather than a shortsighted focus on tonight’s sleep.
It’s important to point out that CBT-I is for people who have chronic insomnia. The average person who seeks out CBT-I has had insomnia for years. If you read this and think, “I take naps but I sleep great at night,” or, “I sleep in to make up for lost sleep and my sleep is generally good”—exactly. CBT-I is for people with frequent and persistent difficulty sleeping.
Countless nights’ sleep have been sacrificed to insomnia and the behaviors that maintain it. If you’re willing to risk having a few more bad nights’ sleep—for the right reasons—chances are that your sleep will be much better in pretty quick order.
The information in this post draws from a treatment manual by Michael Perlis and colleagues.