What is Cognitive Behavioral Therapy for Insomnia (CBT-I)?

CBT-I is a set of lessons and exercises that can treat insomnia by addressing the underlying behaviors and thoughts that are affecting your sleep. There are several different components that make up CBT-I, which are explained in detail below:

Sleep Hygiene

Sleep hygiene involves making changes to your lifestyle to reduce habits and behaviors that are interfering with sleep and increase actions that promote normal sleep.

One behavior to avoid is excessive smoking or drinking. While alcohol may make you fall asleep, your body will then break down the alcohol in your system, which can impact the quality of your sleep. On the other hand, cigarettes prevent you from sleeping because they contain the stimulant nicotine. Other stimulants like coffee as well as eating should also be avoided before going to sleep. The final thing to avoid is napping too much during the day. Though naps can be helpful in moderation, napping for too long or too often will interfere with your sleep cycle and won't make up for missing sleep during the night.

To promote sleep, there are several habits to keep in mind. It's important to have a bedtime routine and to wake up at the same time every day. The routine will help cue your body that it is time to sleep, while the wake time will help normalize your sleep schedule. You should also maintain your sleeping environment by getting rid of screens near your bed, and making sure your bedroom is dark, quiet and cool. Too much light and noise or a room that is too hot, can make it harder to fall asleep and stay asleep.

In addition, to the timing and environment, you should make sure you get enough natural light, as that is what your body uses to regulate your sleep cycle. A final improvement is to try and exercise for at least 10 minutes each day, which will help you feel tired when going to sleep, and will also improve the quality of your sleep.

Stimulus Control

The point of stimulus control is helping your mind associate your bed with sleep. The same way your mouth waters and you feel hungry when you smell food, getting in to bed should make you feel sleepy. To make this connection, you must first avoid using your bed for anything other than sleep and sex. This means activities like reading or watching TV should be done somewhere else, even in another room if possible. The next step is to only get into bed when you feel sleepy, and get out of bed if you can't sleep. Finally, don't take any naps during the day, only sleep in your bed.

Sleep Restriction

This is one of the most effective components of CBT-I, but can seem a little backwards when you first try it. First, you set a time limit on how long you can spend in bed, based on how long you are usually able to sleep. Once that time is up--- regardless of how much you slept--- get out of bed. Your time limit should never be less than 5 hours though, as any less than that would not be helpful.

Though you may get less sleep initially, eventually you will be able to sleep for the entire period. After a week of hitting that goal, you increase the time you are allowed to be in bed by half an hour, and that becomes your new goal. Using this method, you can work your way up to the amount of sleep you want.

In order to calculate your time limit, you need to figure out the average time you spend asleep each night. Not how long you spend in bed, but the time you spend actually sleeping. A sleep journal can be helpful for getting the numbers you need, and can also help you keep track of your sleep restriction goals and progress.

Once you have your average hours spent asleep, subtract that number from your wake up time to figure out your new bedtime. If your average is less than 5 hours, remember not to use it and instead make your bedtime 5 hours before your wake up time.

Citations

Psychological And Behavioral Treatment Of Insomnia: Update Of The Recent Evidence (1998-2004) https://stanfordhealthcare.org/medical-treatments/c/cognitive-behavioral-therapy-insomnia.html https://www.sleepfoundation.org/articles/cognitive-behavioral-therapy-insomnia https://www.mayoclinic.org/diseases-conditions/insomnia/in-depth/insomnia-treatment/art-20046677 http://sleepeducation.org/treatment-therapy/cognitive-behavioral-therapy