Alaska Sleep Education Center

Cognitive Behavioral Therapy for Insomnia: Treatment for Better Sleep

Posted by Dr. Angela Randazzo on Sep 23, 2019 1:10:00 PM

Stress affects your brain and sleep.

Insomnia is the most common sleep disorder, and it is estimated that 30-40% of adults have experienced some degree of insomnia, and as many as 10-15%% have experienced chronic insomnia at some point in their lives.

Insomnia is characterized by poor sleep quality as a result of patients having trouble initiating sleep, maintaining sleep, waking too early, or having sleep that is non-restorative, while having the adequate opportunity and circumstances to sleep.

up_at_night200Insomnia can be a debilitating condition that can wreak havoc on sufferers' day-to-day lives.  Sleep loss can lead to many daytime impairments including excessive daytime sleepiness; attention, concentration, and memory troubles; concerns or worries about sleep; mood disturbances and irritability; a general lack of energy; an increased chance of driving and work accidents; and poor performance at work and/or school.

When one's insomnia begins to interfere with their daily life, it's often a sign that treatment for the disorder should be sought out. Insomnia is rarely a primary disorder and is most often secondary to another medical condition, psychiatric condition, or a neurologic condition.

But there is hope for those suffering from insomnia. Treatments for insomnia include cognitive behavioral therapy, medications, or a combination of the two.

A lot of headway has been made into the successful treatment of insomnia through cognitive behavioral therapy (CBT), which is what we will be discussing here.

How Insomnia Can be Treated with CBT

There are five main components to treating insomnia with CBT: sleep hygiene, stimulus control, sleep restriction, relaxation training, and cognitive therapy.

Patients seeking treatment for insomnia should first discuss their symptoms with their primary care physician to see whether a sleep study may be necessary to rule out other sleep disorders, or whether a psychologist specializing in the treatment of sleep disorders through behavioral techniques is the best course of action.

When discussing treatment options for insomnia patients should do the following:

  • Keep a sleep diary that records information such as bedtime and rise time, time taken to fall asleep, the number of awakenings during the night, whether sleep was restorative or not, naps taken during the day, daytime mood, and any other sleep-related behavior during the day or night.

  • List of symptoms experiencing.

  • Health, social, or other problems that may be related to sleep difficulty.

  • List of current medications, vitamins, and supplements being taken regularly.

  • Any approach is already taken as self-treatment for insomnia.

The doctor's assessment along with the sleep diary will be helpful for sleep professionals to begin CBT for insomnia.

Sleep Hygiene

Man taking a nap.Sleep hygiene is comprised of practices, habits, and environmental factors that can be administered to help promote a healthy sleeping atmosphere and awareness to things that hinder one's sleep. They include simple changes to one's routine including:

  • Establishing a regular bedtime routine.

  • Getting regular exercise (but not within 2 hours of bedtime).

  • Avoiding caffeine and alcohol several hours prior to bedtime.

  • Avoiding daytime naps.

  • Abstaining from eating heavy or spicy meals close to bedtime as well as choosing better food for sleep.

  • Keeping the sleep environment cool, quiet, and dark.

Stimulus Control

Stimulus control therapy is comprised of learning to remove, or control, behaviors that contribute to the mind resisting sleep. Stimulus control therapy includes things like:

  • Going to bed only when sleepy.

  • Leaving the bedroom to pursue relaxing activities if sleep is taking longer than 20 minutes, and returning to bed when sleepy.

  • Setting a morning alarm and avoiding checking the clock at night.

  • Keeping electronics (phones, televisions, tablets, computers, portable gaming consoles, e-readers, etc) out of the room to help associate the bedroom with sleep and sex only, instead of being associated with stimulating activities.

  • Waking at the same time every morning, even on weekends.

  • Giving oneself adequate wind-down time by reading in dim light.

  • Eliminating stimulating activities or content engagement before bed.

Sleep Restriction

Sleep restriction can be challenging for patients, as it is aimed at spending less time in bed. It includes limiting the amount of time spent in bed initially by setting strict sleep/wake times. These times are often shorter than usually experienced initially but gradually allow for more time spent in bed once positive results are shown.

Sleep restriction works by causing mild sleep deprivation to make your assigned bedtimes allow you to achieve better quality sleep. It also leads to greater pressure to fall asleep and stay asleep; increases Slow Wae Sleep (Stage-3 sleep) and Rapid-Eye Movement (REM) sleep; decreases Stage-1 Non-REM sleep, and shortens the duration of nocturnal awakenings and frequency of awakenings.

Relaxation Training

Relaxation training is aimed at reducing physical tensions and intrusive thoughts or anxieties that may be interfering with sleep. They help a person to learn to quiet the mind and relax the body through:

  • Deep breathing/meditation as a form of cognitive distraction

  • Progressive muscle relaxation

  • Visual imagery training

Cognitive Therapy

The purpose of cognitive therapy is to help patients control or eliminate anxiety-producing thoughts or expectations. It includes:

  • Setting realistic expectations about sleep

  • Diffusing anxiety-provoking thoughts

  • Addressing irrational thoughts

  • Education about normal sleep

Methods of Cognitive Therapy

  • Cognitive re-framing (used at night)

    • Restating irrational or threatening thoughts in rational terms to diffuse fear or worry.
  • Thought stopping (used during the daytime)

    • Learning to replace negative thoughts about sleep with positive or productive thoughts.

  • Process time (used in the evening)
    • Journaling thoughts/feelings and coming to a proactive step to take the next day...then letting it go until the following day.

  • Addressing worries and anxieties such as the need to constantly check the time on the clock at night.
  • Other issues to address will arise during the process of implementing other techniques.

If you are suffering from restless nights and not feeling that the sleep you do get is restorative, it may be time to talk with your primary care physician or a sleep specialist about your treatment options. No one should have to suffer from a sleep disorder. At The Alaska Sleep Clinic, our goal is to help all Alaskans achieve regular, quality sleep every night of the week.

If you want to discuss your symptoms with one of our qualified staff members to see if a sleep study or cognitive behavioral therapy is right for you, click on the link below and one of our sleep educators will contact you shortly.

The Alaska Sleep Clinic would like to thank Dr. Angie Randazzo for her contributions to this article.

RandazzoAngie Randazzo, PhD, is a licensed clinical psychologist at St. Luke's Sleep Medicine and Research Center, St. Louis, MO. She received her doctorate from the University of Missouri-St. Louis and her master's from Southern Illinois University. She began her sleep medicine career in 1989 when she joined James K. Walsh, PhD, at the Sleep Disorders Center at the former Deaconess Hospital in St. Louis.

She began treating sleep-disordered patients at the Sleep Medicine and Research Center at St. Luke's Hospital in 1993. She has 25 years of experience treating all types of sleep disorders, including insomnia, delayed sleep phase, sleep apnea, shift work and daytime fatigue/sleepiness, using behavioral techniques. Behavioral interventions target behaviors and thinking that maintain or worsen sleep disturbances, and the techniques teach patients self-management skills to improve their sleep and resume healthy, normal sleep.

Dr. Randazzo's primary research interests include insomnia, clinical pharmacology, sleep deprivation and the relationship of sleep and behavior. She has conducted more than 100 clinical research trials, and she is the author of 18 publications on the topic of sleep, including sleep restriction in children, for which she received the 1997 American Sleep Disorders Association Young Investigator Award.

Impaired sleep can seriously affect your quality of life and productivity. Behavioral changes implemented under the guidance of an experienced clinician can improve sleep quality and help you feel more alert and functional on a regular basis. Sleep is a third of your life – make it count!

Alaska Sleep Clinic is the most comprehensive multisite sleep lab in Alaska with clinics in Anchorage, Wasilla, Fairbanks, and Soldotna and we continue to expand our services to those with sleep disorders. Angie Randazzo, PhD, is a specialist in cognitive behavioral therapy (CBT) with expertise in sleep disorders. No other CBT sleep specialist provides care in the state of Alaska. She is available to Alaska Sleep Clinic’s patients via telemedicine, through SleepTM.

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