Should You Consider CBT-I for Insomnia?

In a recent conversation with a friend who is a physician, she alerted me to the growing spike in cases of insomnia in her practice. Many of her patients, both young and old, increasingly struggle with sleep and are seeking primary care help in the form of medication. While medication can be helpful, my colleague mentioned that the preferred method of treatment is cognitive behavioral therapy for insomnia (CBT-I), which is an evidence-based treatment plan that is more effective than medication alone, with fewer negative side effects. More importantly, however, it was reported that there are few healthcare practitioners and therapists who practice CBT-I.

Motivated by this news, I began certification training in CBT-I and can share these insights with those who may be interested in this method of treatment.

Insomnia is difficulty initiating or maintaining sleep. Chronic insomnia is defined as having three disrupted nights in a week over the course of three months. The effects of insomnia include low energy and motivation, irritability, and withdrawal. There are also mental health risks associated with insomnia, including depression, anxiety, and substance use disorders.

When assessing (or self-assessing) for insomnia, you want to make sure that you rule out other sleep disorders such as apnea, restless leg syndrome, substance use, medications, and medical or psychiatric disorders.

What Is CBT-I?

CBT-I is a treatment approach that tackles insomnia from a cognitive and behavioral approach. It applies mental and activity strategies designed to facilitate the body's natural biological processes around sleep.

These are the 4 main parts of CBT-I treatment:

1. Sleep restriction. The first intervention uses a sleep diary to establish regular sleep routines. Aspects of this routine include restricting time in bed overall to build up "sleep drive." It also includes setting constant rise times to help stabilize your circadian rhythm.

2. Stimulus control. This is about creating mental associations between your bed and "good sleep." Strategies are discussed for leaving the bed when you are not sleepy, doing a set of relaxing activities, and returning to the bed only when sleepiness has returned. This creates more positive associations between the bed and a restful night.

3. Rebalancing negative thoughts. This cognitive approach explores the client's negative thoughts about sleep and lack of sleep. It works to reframe them in order to create positive de-arousal necessary for sleep. Common negative thoughts include:

• "I must get eight hours of sleep or else..."
• "I won't be able to function tomorrow without sleep"
• "I will get sick if my insomnia continues"

4. Relaxation techniques. These are a series of activities done outside the bed and the bedroom, including breathing, muscle relaxation, or visualization.

CBT-I is an evidenced-based approach that has proven successful in treating chronic insomnia and should be considered by sufferers of insomnia with the pairing of medication or without.