Sleep

How CBT-I can help you conquer insomnia

By: Tralee Pearce

Getty Images Author: Canadian Living Credits: Getty Images

Sleep

How CBT-I can help you conquer insomnia

By: Tralee Pearce
You've tried warm milk, a bath and the no-screens rule, but insomnia keeps sneaking into your bed, tugging at the hem of your pajamas until you can't ignore it any longer. Before you beg your physician for a sleeping-pill prescription, you might want to consider an emerging insomnia treatment that can rejig your biological sleep patterns and redirect the pesky thoughts that run interference at night: It's called cognitive behavioural therapy for insomnia (CBT-I), and research has proven it to be very effective.
 
What is CBT-I?
CBT-I is a set of techniques based on a popular model of talk therapy that's designed to help people reframe disturbing thoughts, letting the air out of harmful thought bubbles, so to speak.

There are two processes that govern sleep: homeostatic regulation, which helps keep our bodies in balance by signalling that sleep is needed; and the circadian clock, a 24-hour cycle that tells us when to sleep and wake. Dr. Judith Davidson, psychologist and associate professor at Queen's University in Kingston, Ont., often prescribes patients an intense four- to six-week CBT-I treatment when the two processes aren't functioning properly.

If habits that can hamper a good night's sleep—excessive napping and caffeine and alcohol consumption—haven't already been curtailed, this is the patient's first step. Then, a sleep diary provides Dr. Davidson with insight into how many hours of nightly snooze time the patient is logging (as opposed to time spent in bed, tossing and turning while struggling to fall asleep, or falling back asleep after a disturbance).

Sleep-restriction therapy
Dr. Davidson implements a new bedtime based on the total number of hours the patient spends asleep each night. For example, a patient who wakes up for work at 6 a.m. and gets only five hours of total sleep per night will be asked to stay awake until 1 a.m. each night for about a week, no matter how sleepy she might feel. After a week of solid sleep, the patient is instructed to go to bed 15 to 30 minutes earlier every week until she is getting the duration and quality of sleep that leaves her feeling refreshed in the daytime.

Sleep-restriction therapy is often enough to quell the racing thoughts that patients blame for insomnia, but, if not, CBT-I has an arsenal of cognitive-restructuring tricks, too. The most effective technique combats the notion that you'll be a wreck on less than eight hours of sleep—a fear that, in itself, per​petuates insomnia. Contrary to the received wisdom, there is no ideal number of sleep hours; optimal duration varies from person to person and changes with age. Research shows that less than eight hours can be sufficient and that coworkers of sleep-deprived people don't notice a difference in their work after a poor night's sleep.

"They might actually be able to change the thought 'I'm not going to be able to function at work and it's going to be a disaster' to 'I'm not going to feel great, but I'm still going to function and get through the day,' " says Dr. Davidson. "That is a much less alerting thought. It's a calming thought. It's kind of boring as well. The more boring, the better."

Relax your mind
Mundanity is a constant theme in Dr. Davidson's work. She recommends visualizing ho-hum objects like the back of a chair.This takes our mind away from thinking and problem-solving, and it may allow the brain to shift to a state that's more conducive to sleep. In the case of the chair, Dr. Davidson says the mental picture taps into the brain's habit of flashing fleeting images before our eyes as we fall asleep.

While a clinical diagnosis of insomnia involves a month or more of interrupted sleeping and negative effects on daytime functioning, those plagued by occasional bouts of sleeplessness—Sunday-night sufferers, we're talking to you!—also may benefit from CBT-I.

Check out these eight ways to get better sleep.

This content is vetted by medical experts




This story was originally part of "Talk Yourself Into A Good Night's Sleep" in the May 2015 issue.
           
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How CBT-I can help you conquer insomnia

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