If you struggle to fall asleep, wake repeatedly during the night, wake too early, or find yourself worrying about whether you are going to sleep, you may be experiencing insomnia.
For some people, changing a few sleep habits is enough to help. But when insomnia continues for weeks or months, simply being told to “relax” or practise good sleep hygiene is often not enough.
This is where Cognitive Behavioural Therapy for Insomnia, or CBT-I, can help.
What is CBT-I?
CBT-I is a structured, evidence-based treatment specifically developed for insomnia.
Rather than simply trying to make you feel sleepy, CBT-I looks at the factors that may be keeping insomnia going.
After several difficult nights, it is very normal to start changing your behaviour around sleep. You might go to bed earlier, stay in bed for longer, nap during the day, monitor the clock, cancel activities because you are tired, or become increasingly anxious about the consequences of not sleeping.
Unfortunately, some of these attempts to get more sleep can unintentionally make sleeping more difficult.
CBT-I helps to break this cycle.
What happens during CBT-I treatment?
Treatment is individualised, but may include:
Understanding your sleep pattern
A sleep diary can help identify when you are sleeping, how much time you spend awake in bed and what may be influencing your sleep.
Strengthening your natural sleep drive
Your sleep and wake schedule may be adjusted so that the amount of time you spend in bed is more closely matched to the amount of sleep your body is currently able to produce.
Rebuilding the connection between bed and sleep
When you have experienced insomnia for a long time, your bed can become associated with wakefulness, frustration or worry. CBT-I uses behavioural strategies to gradually strengthen the association between bed and sleeping.
Reducing sleep-related worry
Thoughts such as “I have to sleep eight hours tonight” or “I won’t cope tomorrow if I don’t sleep” can increase pressure and physiological arousal at exactly the time your body needs to settle. CBT-I helps you develop a more helpful relationship with these thoughts.
Managing hyperarousal
For many people with insomnia, the problem is not simply being “not tired enough.” They describe feeling tired but wired — physically exhausted while their brain or nervous system remains highly alert. Treatment can therefore also include strategies to reduce cognitive, emotional and physiological arousal.
Is CBT-I the same as sleep hygiene?
No.
Sleep hygiene — such as considering caffeine, light exposure, exercise and your sleep environment — can be helpful, but sleep hygiene alone is usually not sufficient to treat persistent insomnia.
CBT-I is a more comprehensive treatment that addresses the behavioural and cognitive processes that can maintain insomnia over time.
Can insomnia improve?
Yes.
One of the most frustrating things about insomnia is the feeling that you have somehow “lost” your ability to sleep. CBT-I works from a very different assumption: your sleep system is still there.
Treatment focuses on creating the conditions that allow your natural sleep mechanisms to work more effectively again, while reducing the behaviours, worry and hyperarousal that may be interfering with them.
When should I get help for insomnia?
Consider seeking professional help if you regularly struggle with falling asleep, staying asleep or waking too early and it is beginning to affect your mood, concentration, energy or ability to function during the day.
A thorough sleep assessment is also important because not every sleep problem is insomnia. Conditions such as sleep apnoea, restless legs syndrome, circadian rhythm disorders and other medical or mental-health conditions can also disturb sleep.
If insomnia is the primary problem, CBT-I is one of the most well-established evidence-based treatments available.
If you would like help understanding your sleep difficulties or would like to explore CBT-I and insomnia treatment, you can contact me to arrange a sleep assessment or consultation.
Sleep OT provides sleep assessment and evidence-based insomnia treatment in Johannesburg, as well as online consultations for clients elsewhere in South Africa.
If you would like help understanding your sleep difficulties or would like to explore whether CBT-I may be appropriate for you, you are welcome to get in touch to arrange a sleep assessment.