CBT for Insomnia: Treating Sleep Disorders

What is Insomnia?

Insomnia is a common sleep disorder¹, which makes it difficult to fall asleep and stay asleep. It breaks the body’s sleep cycle ( circadian rhythm) and disrupts your schedule.

Sleep deprivation can decrease your work performance and reduce your quality of life. It is very common in India, affecting almost 10 million people yearly.

Roughly 10-30% of the world’s adult population meets the criteria for some type of continued sleeping problems. Old age people, females, and people with other primary illnesses or chronic disorders seem to have a higher chance of having insomnia. CBT can be practised to recover from insomnia.

Types of Insomnia

There are two main categories: Time and Cause, which have two subtypes.

1. Time

Based on their duration.

1) Transient or short-term insomnia lasts for a short period, usually not more than a month. The underlying cause of this type is mainly stress or anxiety due to sudden changes in schedule or the occurrence of a traumatic event, and hence, it is quite common. It can also be due to stress regarding school, work, events, or gatherings.

2) Chronic insomnia – chronic or long-term insomnia occurs for a much longer period, ranging from 3 months to a lifetime if not given proper and effective treatment. It is quite difficult to pinpoint the cause of the chronic insomnia. It can be caused by multiple factors.

2. Cause

Based on its reason of occurrence.

1)Primary insomnia—difficulty initiating sleep is not a side effect or result of another already-existing cause, be it physical, mental, or environmental.

2) Secondary insomnia—where sleeplessness occurs as a side effect of other primary illnesses(respiratory diseases or chronic injury) of any sort or lifestyle (for example, medicines, drug usage, or alcohol consumption).

Types of Sleep

Different people need different amounts of sleep, both in quality and quantity. But every person needs to go through these 4 stages of sleep² to increase sleep quality.

There are two classified categories of sleep, namely:

1. Non-rapid eye movement (NREM) sleep
2. Rapid eye movement (REM) sleep

NREM occurs first during the sleep cycle, which has three stages, whereas REM is the last stage.

The first REM sleep duration is usually short and it gradually increases in time as the next cycle comes. This is the stage where you have dreams. One sleep cycle sustains for about 70-110 minutes and it is very subjective for different individuals and differs from night to night.

Stages of Sleep

1. NREM Stage N1—Falling asleep. This is the first stage of sleep, and if you are woken up from it, you may not even feel like you were asleep. Muscles begin to relax, including your eye movements and breathing, and your heart rate starts slowing down. It lasts for about 7-10 minutes.
2. NREM Stage N2—Light sleep. This is the second stage of sleep, and you can awaken easily from it. Muscles are fully relaxed, and eye movements are completely stopped. Heartbeat and body temperature go down further. Production of sleep spindles occurs. This stage lasts for 25 minutes.

3) NREM Stage N3- Slow-wave sleep. This is the stage where a person goes into a deep sleep, and it is difficult to wake him/her up.

During this stage, various actions inside the body, such as repairing and growth, take place. Cell regeneration is also done. Heartbeat is the lowest. At least 60-100 minutes of deep sleep is required for a whole night.

4) REM Stage R—This is the dreaming stage of sleep. It occurs after about 80 minutes of light sleep. There is a rapid outburst of eye movements, and heart rate and body temperature increase. Brain activity is remarkably increased. The duration of this stage is low in the first cycle and gradually increases overnight. The first cycle of REM lasts about 10 minutes.

CBT for Insomnia: Treating Insomnia

CBT is considered an effective treatment for insomnia. It is highly important to understand and precisely record the causes, symptoms, and what exactly keeps you from staying asleep. Then, to achieve the best treatment, cognitive behavioural therapy for individuals should be planned.

CBT is recognized as the first line of treatment in adult patients.

Dealing with Thoughts

Everyday Thoughts

These are thoughts about daily life issues, such as school, work, or upcoming events, that give us pressure, stress, and anxiety and hinder our sleep.

Address these thoughts earlier in the day and plan out how to tackle the obstacles long before sleep. This can help you keep your mind calm and relaxed near sleep time and help you fall asleep faster.

Insomnia THOUGHTS

One of the major causes of chronic insomnia is the thought of insomnia itself. While a person is in bed trying to sleep, the thought of not being able to sleep gives them more pressure and stress, preventing them from sleeping. These are called negative sleep thoughts.

Thoughts about sleep loss and not having a better sleep cycle make it harder to fall asleep. Hence, it is necessary to convert these negative thoughts into positive ones.

This can be done by assuring yourself that staying awake late sometimes is not on its own unhealthy for you. People believe that a few days of disrupted sleep will impact their daytime functioning when it’s not quite true.

How Does CBT-Insomnia Work?

The treatment of cognitive behavioral therapy for insomnia focuses on hygiene, stimulus control, sleep restriction, relaxation training, and cognitive techniques through a systematic review and structured program.

1. Sleep Hygiene Education

Sleep hygiene education promotes healthy sleep habits. Good sleep hygiene includes learning to associate bed with sleeping only. Do not spend time in your bed when you are awake for any other activity. Also, avoid using electronic devices such as laptops or mobile phones and having problem-solving conversations in bed.

It is also advised not to consume nicotine or alcohol just before sleep time. Select a cool and dark place to sleep because this helps the body enter the first stage of sleep faster.

2. Stimulus Control

Cognitive behaviour therapy for understanding when your body is sleepy and only going to bed. Suppose your mind is racing with negative sleep thoughts. Whether it is everyday thoughts or thoughts relating to insomnia, as discussed above.

It is well advised to learn to control your thoughts by using relaxation response tools. These can be calming and soothing music or reading a book to divert your mind from these negative sleep thoughts.

3. Sleep scheduling

Below is a technique that medical professionals usually use that insomniac people work with to get around a better sleep schedule.

The person can go back to sleep whenever they feel tired or sleepy. This continued for about a week. Then your trained medical professional calculates how much time each night, on average, you are sleeping.

Example

Let’s say you sleep 7 hours a night and that your wake time is 8:00 AM. That would mean your bedtime should work backwards, 8:00 AM to 1:00 AM, and then add 30 minutes of grace.

Your bedtime would be 12:30, but you can only sleep at that time or after. This restricts the amount of time that people are in their beds and the amount of time that they can sleep. Pretty quickly, patients will start to get good quality sleep during those 7 1/2 hours.

During treatment, it is extended back by 15 minutes a week as they demonstrate they keep their efficiency at least 85%. What is efficiency? The amount of time that you’re sleeping is divided by the total amount of time that you’re in bed. Patients are required to keep detailed sleep blogs about that for systematic review.

4. Sleep Efficiency

Sleep efficiency is the ratio between the total time a person is asleep and the total time dedicated to sleep, including the time spent lying awake in bed.

So, if you fall asleep the instant you lie on the bed, your sleep efficiency can be said to be 100%. But keep in mind that it is not an achievable goal. You can surely work to have a sleep efficiency of 90% to 98%, which is the average efficiency of a good sleeper.

For example, going to bed at midnight and setting the alarm for 8 a.m. is 8 hours allotted for sleep, and if your overall sleep time is 7, that is 7/8th efficiency or 87.5%.

The average person has about 90% sleep efficiency, which would be 7 1/4 sleeping with an 8-hour allotment. Poor sleepers’ average efficiency is about 65%, 5.5/8.25.

5. Cognitive Restructuring

Cognitive restructuring involves changing dysfunctional thoughts that create tension, damage sleep, and reinforce negative beliefs with positive thoughts.

Tips to get quality sleep

1. Napping- Yes, napping can help you complete your sleep debt in case of deprivation. But it is best to shorten it down to 30 minutes or so daily. It is also important to take your nap time in the afternoon between 2-4 pm.
2. Diet and Exercise- A healthy diet is necessary to live a healthy life. Ensure you have your portions of protein, fibre, and carbs regularly. Drink plenty of water, especially during summertime. Exercising daily will help you get tired by the time you have to sleep. It will also help to maintain a healthy body and mind which promotes better sleep³.
3. Avoid taking stimulants like caffeine or nicotine before sleep time.
4. Comfortable bedroom environment- Make sure your bed is comfortable and your environment is cool.
5. Only go to bed when you are feeling sleepy. Make sure you are drowsy or tired when lying on the bed. Associate the bed with sleeping only.
6. If you are already struggling to sleep, collecting data on your sleeping pattern would be informative. Try to record your sleep time, sleep efficiency, the time taken to fall asleep, and when you wake up. You can maintain a sleep diary to be consistent. This would help your psychologist or sleep specialist understand your problems better, and they can tell you what you should do to sleep better.

Be careful

If you think you suffer from insomnia it is best to consult a psychologist as soon as possible. Because sleep deprivation can be dangerous. Less sleep can get your body tired and you might feel sleepy during the day due to an unbalanced circadian rhythm. This might lead to accidents in vehicles or decrease your daily performance quality.

6. Medication for Insomnia

Some of the most common medications prescribed by sleep medicine specialists include Benzodiazepines, Which are tranquillizers taken as sleep medications for chronic insomnia disorder and seizures, usually for a short term. Melatonin, a supplement, is said to help people fall asleep slightly faster, though it has side effects such as dizziness and nausea.

For further deep knowledge and information about insomnia and its symptoms,⁴ causes, and behavioral therapy for insomnia, check out “Quiet your mind and get to sleep” by Colleen, E.Carney, PhD and Rachel Manber PhD.

Final Thoughts

Insomnia is a common sleep disorder in today’s time, and effective treatment options can help someone get the sleep they need. And CBT has shown effective results in treating long-term sleep disorders such as insomnia.

This is because CBT helps you find the root cause of your sleep problems. It helps you identify the behaviours or thoughts leading to insomnia and helps you learn how to tackle those thoughts. The therapy helps you control your thoughts and develop good sleeping habits.

1. Thorpy, Michael J. “Classification of sleep disorders.” Neurotherapeutics 9.4 (2012): 687-701. ↩︎
2. Foulkes, William David. “Dream reports from different stages of sleep.” The Journal of Abnormal and Social Psychology 65.1 (1962): 14. ↩︎
3. Tai, Daria, et al. “Can exercise training promote better sleep and reduced fatigue in people with chronic stroke? A systematic review.” Journal of Sleep Research 31.6 (2022): e13675. ↩︎
4. Harvey, Allison G. “Insomnia: symptom or diagnosis?.” Clinical psychology review 21.7 (2001): 1037-1059. ↩︎

Last Updated on July 23, 2024 by Sathi Chakraborty, MSc Biology