Cognitive Behavioral Therapy (CBT) for Sleep

Cognitive Behavioral Therapy for sleep is a way to address sleep problems without resorting to pharmaceutical medications. CBT has even been shown to help treat insomnia.

By Nicole Gleichmann

Apr 27th, 2022

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One of the most common complaints that I hear from friends these days is that they feel tired during the day because of a lack of good, quality sleep. No matter whether you have trouble falling asleep, staying asleep, or sleeping enough hours each night, insufficient sleep can greatly hinder your health and quality of life.

If you’re someone who struggles with sleep, you might want to consider cognitive behavioral therapy (CBT) for sleep disorders like insomnia. CBT for sleep is a way to improve sleep and even treat insomnia without resorting to pharmaceutical drugs. The idea behind CBT is that you change your behaviors (with the help of a professional) in such a way as to improve your ability to fall asleep and sleep through the night.

Insomnia: Why Does it Happen, and How is It Treated?

Insomnia is a condition where you can’t fall asleep or stay asleep at night. While short bouts of insomnia, known as acute insomnia, aren’t always something that you need to worry about, chronic insomnia that lasts for months in a row is a serious condition that needs to be addressed.

There are many causes of insomnia, including underlying health conditions like sleep apnea, medications, shift work, hormonal changes from menopause, poor sleep habits, and environmental factors. Understanding the underlying cause of your insomnia is the first step toward finding an effective treatment.

Treating Insomnia with Cognitive Behavioral Therapy for Sleep

Many people don’t go to a sleep specialist for their insomnia symptoms in the fear that they will just be given sleeping pills that they’ll need to use indefinitely and that might cause unwanted side effects. But for some, cognitive behavioral therapy for insomnia (CBT-I) can successfully treat insomnia without the need for medications.

So, what exactly is cognitive behavioral therapy for sleep? It’s a customized plan devised by your sleep specialist that uses one of more of the following:

  • Education
  • Behavioral changes
  • Sleep training
  • Therapy

For a period of weeks of more, your doctor will tailor a plan to your needs. During this time, you’ll be asked to keep a sleep diary to track progress and uncover hidden insomnia contributors, all while working close with your doctor to determine next steps.

To understand a bit more as to what you can expect, we’ve compiled a list of the five common forms of cognitive behavioral therapy for insomnia.

1. Sleep Restriction

Often times CBT-I will begin with an extended period of time where you dramatically reduce the amount of sleep you get each night through a process known as sleep restriction.

From your visits and sleep study, your doctor will determine how much you actually sleep each night. For example, if you go to bed at 10 pm and wake up at 5 am, but it typically takes an hour to fall asleep and you experience an hour of waking each night, you actually get 5 hours of sleep each night.

In this example, you would be instructed to limit your time in bed to just 5 hours each night at a specific time (typically one that is later than your normal bedtime). So, you would only be allowed to be in bed from midnight to 5 am each night (during which you initially are unlikely to sleep the full five hours).

As you can imagine, over time, this sleep deprivation can lead to your falling asleep right away at midnight and sleeping soundly until 5 am, retraining your body and mind to sleep properly. Slowly, the length of time that you’re allowed to sleep is increased until you reach a healthy amount of nightly sleep.

2. Stimulus Control

Did you know that watching TV in bed in the middle of the day can make it harder to fall asleep in that same bed at nighttime, whether or not the TV is on? This is an example of a stimulus, or action, that could be hindering your sleep (watching TV in bed).

Stimulus control is used to help you associate sleep and positive emotions with your bed. It typically limits the bed for just sleeping, and sometimes your entire bedroom as well. Additionally, you’ll be instructed to leave your bed any time when you feel like you can’t sleep to avoid linking frustration or other negative emotions to your bed.

3. Sleep Hygiene

Sleep hygiene education will teach you the do’s and don’ts that you should keep in mind when you prepare for sleep. It includes things like:

  • Sleeping in a cool room
  • Wearing breathable clothing to bed
  • Reducing or eliminating alcohol and caffeine, particularly shortly before bedtime
  • Limiting nighttime light exposure
  • Using white noise to drown out distractions
  • Turning your phone to airplane mode when you sleep
  • Not exercising too late in the night

This is just a sample of the many things that can impact how well you sleep at night. Through your daily log and visits with your doctor, they can help you determine what you need to change in order to obtain healthy sleep hygiene.

4. Relaxation Training

Learning to relax your mind and body can help you get a good night’s rest. If repetitive thoughts or stressors are making it hard to fall asleep or waking you up in the middle of the night, your doctor is likely to help you learn how to relax.

This can include things like meditation, deep breathing, and focused muscle relaxation before bedtime. Sometimes biofeedback will be used to help you learn to control your heart rate, muscle tension, and brain waves. The idea is to find the best way for you to let go of tension before heading to bed.

5. Psychotherapy

Therapy sessions can be used to help improve your outlook and beliefs in such a way as to benefit your sleep. Things like worry, frustration, and anger can hinder your ability to sleep during the night, and therapy is a way to help you work towards a positive state of mind.

CBT for Insomnia in Kids with Autism

CBT for insomnia is a common treatment method used specifically for autism-related insomnia. A new study published in the official journal of the International Society for Autism Research offers hope for sleep-deprived children with autism and their exhausted parents.

As many as 86% of children on the autism spectrum struggle to fall asleep and stay asleep. In addition to the many negative impacts of sleep deprivation on neurotypical children, the severity of ASD-related symptoms in children with autism is strongly correlated with how well they sleep.

A New Study

The small study tracked the sleep of 17 children on the autism spectrum who were diagnosed with insomnia as well as at least one of their parents. A research team led by Christina McCrae, professor in the Department of Psychiatry at the University of Missouri School of Medicine, asked participants to keep sleep diaries to record how long it took them to fall asleep, their sleep duration, and other factors. They also wore wristbands that measure limb movement to provide an objective measure of sleep quality.

Baseline data was obtained for two weeks before eight, 50-minute cognitive behavioral therapy sessions that were specifically designed to target each family’s particular sleep concerns. After the CBT sessions, participants recorded their new sleep information in their diaries. The results were impressive.

The Results

After CBT, data collected from the wrist devices and diaries revealed that the children were sleeping much better, and their ASD-related behaviors improved. In fact, after one month, 85% of the children in the study no longer experienced insomnia. And their parents reported sleeping better and feeling less fatigued, an observation verified by their wrist monitors and their diaries.

But for children with autism who often struggle with communication, keeping sleep diaries and talking through irrational fears could pose a problem. Still, Dr. McCrae advocates CBT for disordered sleep. “In treating insomnia and other behavioral sleep issues among adults and children in general, I’ve found that there’s no substitute for cognitive behavioral therapy. Yet it’s still unclear how to best use such therapy for children with autism who struggle with communication.”

Final Thoughts

In order to fix your sleep problems long term, be sure to keep on top of your sleep schedule and behaviors. It’s easy to relapse following CBT, so you’ll want to practice what you’ve learned and stay in contact with your sleep specialist if you need them again in the future.