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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 overall reduce the quality of your life. It is very common in India affecting almost 10 million people each year.
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 practiced to recover from insomnia.
Types of Insomnia
There are two main categories: Time and Cause which have two each subtypes.
Based on their duration.
1) Transient insomnia– 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–while 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.
Based on its reason of occurrence.
1)Primary insomnia–difficulty in 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 some 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:
- Non-rapid eye movement (NREM) sleep
- Rapid eye movement (REM) sleep
NREM occurs first during the sleep cycle and it further has 3 stages, whereas REM is the last stage of the sleep cycle.
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
- NREM Stage N1- Falling asleep. This is the first stage of sleep and if woken up from this sleep 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.
- NREM Stage N2- Light sleep. This is the second stage of sleep and you can awaken easily from this stage. Muscles are fully relaxed and eye movements are completely stopped. Heartbeat and body temperature goes 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 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- It is the dreaming stage of sleep. It occurs after about 80 minutes into a light sleep. There is a rapid outburst of eye movements and heart rate and body temperature increases. 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 is for about 10 minutes.
CBT for Insomnia: Treating Insomnia.
CBT is considered an effective treatment for insomniacs. It is highly important to understand and precisely record the causes, symptoms, and what exactly keeps you from staying asleep. And plan out cognitive behavioral therapy for individuals for the best treatment.
CBT is recognized as the first line of treatment in adult patients.
Dealing with Thoughts
These are the thoughts about daily life issues regarding school, work any upcoming events that give us pressure, stress, and anxiety which hinder our sleep. Address the thoughts earlier in the day and plan out how to tackle the obstacles long before your sleep. This can help you keep your mind calm and relaxed near the time of your sleep. It can help you to fall asleep faster.
One of the major causes of chronic insomnia is the thought of insomnia itself. Meaning that 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 sleep thoughts into positive sleep thoughts. This can be done by assuring yourself that staying awake late sometimes is not on its own unhealthy for you. People believe that a couple of 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 is used to promote healthy sleep habits. Good sleep hygiene includes learning to associate bed with sleeping only. Make sure not to spend time in your bed during you are awake for any other activity. Not using electronic devices such as laptops or mobile phones and avoiding problem-solving conversations in bed are good sleep habits.
It is also advised to not intake nicotine or alcohol just before your sleep time. Select your best place to be somewhere where it is cool and dark. Because this helps the body to enter into the first stage of sleep faster.
2. Stimulus Control
Cognitive behavior therapy for understanding when your body is feeling sleepy and only going to bed then. If 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 given 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 calculate how much time each night, on average you are sleeping.
Let’s say you sleep 7 hours a night and that your wake time is 8:00 AM. That would mean your bedtime should be working backward, 8:00 AM to 1:00 AM, and then added 30 minutes of grace. Your bedtime is the bedtime would be 12:30. But you can only sleep at that time or after it. What this does is restrict the amount of time that people are in their beds and the amount of time that they can sleep. And pretty quickly patients will start to get good quality sleep during that 7 1/2 hours.
And then 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. And 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 the person is asleep to the total time dedicated to sleep. That is adding the time spend in bed lying awake. 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% an average efficiency of a good sleeper.
For example, going to bed at midnight and setting the alarm for 8 am. That 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% of sleep efficiency, which would be 7 1/4 sleeping with an 8-hour allotment. Poor sleepers’ average efficiency is about 65%, which is 5.5/8.25 allotment.
5. Cognitive Restructuring
Cognitive restructuring is to change dysfunctional thoughts that create tension, damage sleep, and reinforce negative beliefs with positive thoughts.
Tips to get quality sleep
- 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 place your nap time during the afternoon anytime between 2-4 pm.
- Diet and Exercise-A healthy diet is necessary to live a healthy life. Make sure you are having your portions of protein, fiber, 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.
- Avoid taking stimulants like caffeine or nicotine before sleep time.
- Comfortable bedroom environment- Make sure your bed is comfortable and that your environment is cool.
- Only go to bed when you are feeling sleepy. Make sure you are drowsy or tired when you are lying on the bed. Associate the bed with sleeping only.
- If you are already struggling to sleep it would be informative to collect data on your sleeping pattern. Try to record your sleep time, sleep efficiency, the time taken to fall asleep, and at what time you wake up. You can maintain a sleep diary to be consistent. This would make your psychologist or sleep specialist understand your problems easier. And they can tell you what you should do to sleep better.
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 that are prescribed by sleep medicine specialists include Benzodiazepines-these are tranquilizers that are taken as sleep medications for chronic insomnia disorder and seizures usually for a short term. Melatonin-It is a supplement and is said to help 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 Ph.D. and Rachel Manber Ph.D.
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 behaviors 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.
- Thorpy, Michael J. “Classification of sleep disorders.” Neurotherapeutics 9.4 (2012): 687-701. ↩︎
- Foulkes, William David. “Dream reports from different stages of sleep.” The Journal of Abnormal and Social Psychology 65.1 (1962): 14. ↩︎
- 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. ↩︎
- Harvey, Allison G. “Insomnia: symptom or diagnosis?.” Clinical psychology review 21.7 (2001): 1037-1059. ↩︎