By: Jocelin Bailey, LICSW, LCSWC
Treatment for Insomnia: Cognitive Behavioral Therapy
Bedtime is approaching and you are dreading the night ahead. This feeling of dread is not because you aren’t exhausted from your very full day, it’s because you are worried about having another night of insomnia. As a therapist in the Washington, DC, Bethesda area, there are a number of overtired, under-rested adults suffering silently.
Insomnia is defined as insufficient, inadequate, or poor-quality sleep due to difficulty falling asleep, staying asleep during the night, waking up too early in the morning, then feeling overtired and unrefreshed in the morning. According to a poll conducted by the National Sleep Foundation, “more than half of people reported at least one symptom of insomnia (difficulty falling asleep, waking up a lot during the night, waking up too early and not being able to get back to sleep, or waking up feeling un-refreshed) at least a few nights per week within the past year. Thirty-three percent said they had at least one of these symptoms every night or almost every night in the past year.” The National Institute of Health reports that “roughly 30 percent of the general population complains of sleep disruption, and approximately 10 percent have associated symptoms of daytime functional impairment consistent with the diagnosis of insomnia.”
While the use of sleeping pills can improve sleep for a brief or occasional episode of insomnia, the use of sleep medicines in not recommended for the treatment of chronic insomnia. Sleeping pills are not recommended for the following reasons:
1) They are only moderately effective and lose their effectiveness with long-term use,
2) They have multiple side effects that can outweigh their benefits,
3) People can become dependent on the medication,
4) They do not treat the underlying causes of insomnia, and
5) Insomnia returns when the medications are discontinued.
Cognitive-Behavioral Therapy for Insomnia (CBT-I) is the treatment method most highly recommended by the Mayo Clinicc and The National Sleep Foundation for treatment of Insomnia in adults. A significant amount of research now suggests that CBT is more effective than sleeping pills. 75% of people with insomnia experience clinically significant improvement after CBT. Unlike sleeping pills, the improvements of CBT are maintained long after treatment has ended. As a trained provider using this model, I can say that I’ve seen great success firsthand, and there is truly hope if you are suffering from insomnia.
The following is an outline of the CBT-I process and how it achieves significant results:
• CBT-I is a short term treatment method, requiring just 5 sessions over a 6 week period. During treatment, the methods are both strengthening the sleep-system and managing the wakefulness-system. Small, structured goals are set each week. Patients are implementing small steps at home each week.
• Session 1 focuses on sleep education, teaching patients the helpful facts about sleep. This supports patients in developing more helpful thoughts about sleep, thus discrediting some of their negative thoughts about sleep. Session 1 supports understanding one’s own insomnia.
• Session 2 addresses sleep medications (if applicable) and begins teaching sleep scheduling techniques. The scheduling techniques work towards better sleep efficiency, meaning the ratio of time asleep compared to time spent in bed.
• Session 3’s focus includes improving relaxation techniques and controlling stimuli that tend to interfere with efficient, quality sleep.
• Session 4 includes strengthening a patient’s relaxation response, which is basically the opposite of our stress response system.
• Session 5 is the final session and supports patients in developing and maintaining good sleep hygiene.
If you are experiencing sleep problems and suspect insomnia, talk to your doctor about your symptoms and finding a therapist trained in Cognitive Behavioral Therapy for Insomnia.
Visit this website to find providers recently trained in your area: https://www.cbtforinsomnia.com/clinicians-recently-trained-by-dr-jacobs
To locate sleep centers in your area that may offer CBT for insomnia, go to the American Academy of Sleep Medicine website at http://sleepeducation.org/find-a-facility