Fed up with tossing and turning instead of falling asleep? Exhausted from waking at 3 a.m. and not being able to get back to sleep? Help is available in a form that might surprise you: cognitive behavioral therapy or CBT.
CBT blends cognitive therapy and behavioral therapy. Cognitive therapy focuses on your thoughts and beliefs and how they affect your mood and behavior. Its goal is to help you change your thinking to be healthier and better able to adapt. Behavioral therapy focuses on your actions. Its goal is to help you change unhealthy behavior patterns. CBT, then, helps you focus on your current problems and develop coping skills to manage them.
Sleeping pills — if your doctor recommends them — may help if you experience insomnia only once in a while. But they aren't meant for long-term use. They may also interact with other medications or cause side effects like morning grogginess. They can also cause rebound insomnia when you stop taking them. CBT is free of side effects.
CBT involves meeting regularly with a therapist. As part of CBT, you may use a sleep diary to identify problems. The therapist then teaches you strategies to sleep better. The process can take eight weeks or more. You usually have time between sessions (two to three weeks) to test out techniques suggested and provide feedback to your therapist.
How CBT helps treat insomnia
Insomnia is a common sleep disorder. People with insomnia may take a long time to fall asleep. They may wake often in the night. Or they may wake up too early in the morning and not be able to return to sleep.
Cognitive therapy helps you address the anxiety and beliefs you have about sleep. For example, being unable to fall asleep may make you anxious. Those thoughts and beliefs make it even harder to get to sleep. The therapist will help you recognize these patterns and find ways to stop them.
Behavioral therapies often include the following:
- Stimulus control works on how you respond to your bedroom. If you have trouble falling asleep, you may associate your bed with being awake. Your goal is to relate your bedroom with sleep. For example, you should use your bed for sleeping and sex only. Watching TV, using technology devices, reading or working should be done in another room.
- Sleep restriction works by limiting time spent in bed to the amount of time you actually sleep. If you get only five hours of sleep a night, you will spend five hours in bed. This will make you more tired at first, but it is important not to sleep during the day. It may mean you get to sleep faster the next night. As sleep improves, the amount of time you spend sleeping gradually increases.
- Relaxation techniques aim to reduce physical or mental stress that disrupts sleep. Methods include muscle relaxation, meditation or guided imagery. You can use these at bedtime to prepare for sleep.
- Sleep hygiene is about creating habits that promote sleep. Keep your bedroom cool, dark and quiet. Avoid heavy meals, alcohol and caffeine (if you're sensitive) late in the day and at night. Some people may have to avoid any type of caffeine (included in many foods such as chocolate) after noon. Moderate exercise in the afternoon can foster better sleep.
Things to consider
- CBT for insomnia is not a quick fix. It may take a few weeks or months to start sleeping better. But CBT addresses the underlying issues causing sleep problems. This may make it a better long-term solution than medication.
- Insomnia may have a number of causes. These include depression and thyroid disorders or other medical conditions. Some medicines disrupt sleep, too. If you are having trouble sleeping, see your doctor.
- Online CBT may be an option. A few studies show positive results from online programs. But researchers are still examining this option. The National Institute of Mental Health has collaborated on one study and other clinical trials are in progress.
Emily A. King contributed to this report.
Created on 04/05/2005
Updated on 01/18/2013
- National Heart, Lung, and Blood Institute. What is insomnia?
- UpToDate.com. Insomnia treatments.
- National Heart, Lung, and Blood Institute. Your guide to healthy sleep.
- American Academy of Sleep Medicine. Internet intervention: Online cognitive behavioral therapy for insomnia.