Cognitive Behavioural Therapy for Insomnia (CBTi): What is it?

Insomnia can be a frustrating and exhausting experience, affecting millions of people worldwide. The inability to fall asleep, stay asleep, or wake up feeling refreshed can have huge impacts on your overall health, mood, and daily functioning. If you're one of the many struggling with insomnia, there is hope. Cognitive Behavioural Therapy for Insomnia (CBTi) is a highly effective, evidence-based treatment designed to help you regain control over your sleep.

What is Insomnia?

Insomnia is a common sleep disorder characterised by difficulty falling asleep, staying asleep, or waking up too early and not being able to go back to sleep. People with insomnia often feel fatigued, have low energy, difficulty concentrating, mood disturbances, and decreased performance in work or school. Insomnia can also make other health conditions worse, particularly around mental health.

What is CBTi?

Cognitive Behavioural Therapy for Insomnia (CBTi) is a structured, evidence-based program that helps individuals overcome insomnia by changing thoughts and behaviours that interfere with sleep. CBTi is often considered the first-line treatment for insomnia, recommended by sleep experts and psychologists. Unlike sleeping pills, CBTi addresses the underlying causes of insomnia rather than just the symptoms, providing long-lasting benefits.

How Does CBTi Work?

CBTi involves several components that work together to improve sleep:

1. Cognitive Therapy: This focuses on identifying and changing negative thoughts and beliefs about sleep. For example, you might believe that you’ll never be able to sleep without medication or that a single night of poor sleep will ruin your entire week. Cognitive therapy helps you challenge these unhelpful thoughts and replace them with more realistic and positive ones.

2. Behavioural Therapy: This includes techniques to change behaviours that contribute to insomnia. Common strategies include:

• Sleep Restriction Therapy: Limiting the time spent in bed to the actual amount of sleep you're getting, gradually increasing it as your sleep improves.

• Stimulus Control Therapy: Associating the bed and bedroom with sleep and establishing a consistent sleep-wake schedule.

• Relaxation Techniques: Using methods such as deep breathing, progressive muscle relaxation, or guided imagery to reduce anxiety and promote relaxation.

3. Sleep Hygiene Education: Teaching good sleep habits and creating an environment conducive to sleep. This might involve maintaining a regular sleep schedule, avoiding caffeine and alcohol close to bedtime, and creating a comfortable sleep environment.

4. Paradoxical Intention: Encouraging you to stay awake instead of trying to sleep, which can reduce the anxiety and pressure around falling asleep.

The CBTi Process: What to Expect

CBTi typically involves a series of sessions with a trained therapist, either in person or online. Here’s a step-by-step look at what you might expect:

Initial Assessment

Your therapist will start by conducting a comprehensive assessment to understand your sleep patterns, habits, and the specific issues contributing to your insomnia. This might involve keeping a sleep diary for a week or two, recording your bedtime, wake time, time taken to fall asleep, number of awakenings, and other relevant details.

Setting Goals

Based on the assessment, you and your therapist will set specific, realistic goals for your sleep. This could nclude goals like reducing the time it takes to fall asleep, increasing total sleep time, or improving sleep quality.

Developing a Treatment Plan

Your therapist will create a personalised treatment plan tailored to your specific needs. This plan will likely include a combination of cognitive and behavioural strategies, as well as sleep hygiene education.

Implementing Strategies

Throughout the course of CBTi, you’ll work on the strategies that you discussed with your therapist. This might involve challenging negative thoughts about sleep, sticking to a sleep schedule, practicing relaxation techniques, and making changes to your sleep environment.

Monitoring Progress

You’ll continue to keep a sleep diary and regularly review your progress with your therapist. This helps track improvements and make any necessary adjustments to your treatment plan.

Maintenance and Relapse Prevention

Once your sleep has improved, your therapist will help you develop a plan to maintain these gains and prevent relapse. This might include ongoing practice of the techniques you’ve learned, regular monitoring of your sleep, and strategies for dealing with any future sleep disturbances.

Core Components of CBTi

Let's dive deeper into the core components of CBTi:

Cognitive Restructuring

Cognitive restructuring involves identifying and challenging unhelpful thoughts about sleep. Common sleep-related thoughts might include:

• "I'll never be able to sleep without sleeping pills."

• "If I don't sleep well tonight, I'll be a wreck tomorrow."

• "I should be able to sleep perfectly every night."

These thoughts can create a cycle of worry and anxiety, making it even harder to sleep. Cognitive restructuring helps you develop a more balanced and realistic perspective. For example, you might challenge the thought "I'll never be able to sleep without sleeping pills" by reminding yourself that many people overcome insomnia with CBTi and that you have the tools and support to do the same.

Sleep Restriction Therapy

Sleep restriction therapy involves limiting the time you spend in bed This sounds counter-intuitive to getting more sleep. But the aim is to improve sleep efficiency - think, less hours lying in bed waiting to sleep, and more actual sleep.

Here's a brief rundown of how Sleep Restriction works:

1. Calculate Your Average Sleep Time: Using your sleep diary, calculate the average amount of time you spend asleep each night.

2. Set a Fixed Wake-Up Time: Choose a wake-up time that you can stick to consistently, even on weekends.

3. Determine Your Bedtime: Subtract your average sleep time from your wake-up time to determine your bedtime. For example, if you wake up at 7 a.m. and sleep an average of 5 hours, your bedtime would be 2 a.m (This sounds mad, but read the next point).

4. Gradually Increase Time in Bed: Once your sleep efficiency (time asleep divided by time in bed) improves, you can gradually increase your time in bed by 15-30 minutes each week.

Please note that Sleep Restriction should be done alongside a trained CBTi therapist as it is quite challenging. Your therapist will ensure that all safety requirements are met and that you are supported along the way.

Stimulus Control Therapy

Stimulus control therapy helps you associate your bed and bedroom with sleep, rather than with wakefulness and frustration. The key principles include:

• Go to Bed Only When Sleepy: If you're not sleepy at bedtime, get out of bed and do something relaxing until you feel sleepy.

• Use the Bed Only for Sleep and Intimacy: Avoid activities like reading, watching TV, or using electronic devices in bed.

• Get Out of Bed if Unable to Sleep: If you can't fall asleep within 20 minutes, get out of bed and engage in a quiet, relaxing activity until you feel sleepy.

• Maintain a Consistent Sleep Schedule: Go to bed and wake up at the same times every day, even on weekends.

Relaxation Techniques

Relaxation techniques can help reduce the physical and mental tension that interferes with sleep. Some effective techniques include:

• Deep Breathing: Focus on slow, deep breaths, inhaling through your nose and exhaling through your mouth. This helps activate the body's relaxation response.

• Progressive Muscle Relaxation: Gradually tense and relax different muscle groups in your body, starting with your toes and working your way up to your head.

• Guided Imagery: Visualise a peaceful and calming scene, such as a beach or a forest, to help your mind and body relax.

Sleep Hygiene

Good sleep hygiene involves making lifestyle and environmental changes to promote better sleep. Key sleep hygiene practices include:

• Keep a Consistent Sleep Schedule: Go to bed and wake up at the same times every day.

• Create a Relaxing Bedtime Routine: Develop a routine that helps signal to your body that it's time to wind down, such as reading a book or taking a warm bath.

• Make Your Sleep Environment Comfortable: Ensure your bedroom is cool, quiet, and dark. Consider using earplugs, an eye mask, or a white noise machine if necessary.

• Limit Stimulants: Avoid caffeine, nicotine, and alcohol close to bedtime, as they can interfere with your sleep.

• Avoid Heavy Meals and Exercise Before Bed: Eat light snacks if you're hungry and finish vigorous exercise at least a few hours before bedtime.

Benefits of CBTi

CBTi offers several significant benefits over other treatments for insomnia:

• Long-Lasting Results: Unlike sleeping pills, which often provide temporary relief, CBTi addresses the underlying causes of insomnia, leading to long-term improvements in sleep.

• No Side Effects: CBTi is a non-pharmacological treatment, so you won't have to worry about the side effects associated with sleep medications.

• Improved Overall Well-Being: Better sleep can lead to improvements in mood, energy levels, concentration, and overall quality of life.

Is CBTi Right for You?

CBTi is suitable for most people with chronic insomnia, including those with coexisting medical or psychiatric conditions. However, it's important to consult with a healthcare provider to determine if CBTi is the right choice for you. Your provider can help rule out any underlying medical conditions that might be contributing to your sleep problems and refer you to a qualified CBTi therapist.

Finding a CBTi Therapist

Great news! I am a trained CBTi therapist and am more than happy to assist you, either in person or via Telehealth. Head to the Consulations tab to book a session.

Other options:

• Try out some of the Sleep Hygeine and Relaxation options above. It might be all you need!

• Talk to your GP or Psychologist: Having your own trusted healthcare professional (who knows you) is a great place to start asking for advice.
  

• Explore Online Programs: Several online programs offer guided treatment, designed by sleep professionals, e.g. This Way Up is a free, self-guided resource.

Insomnia can take a toll on your physical and mental health, but it doesn't have to be a lifelong struggle. Cognitive Behavioural Therapy for Insomnia (CBTi) is a powerful, evidence-based treatment that can help you.