CBT-I, or How to cure insomnia
One of the most common reasons my clients consult me is to treat their insomnia, in certain cases a problem that has been troubling their sleep for over even decades.
In reality there are several different kinds of insomnia, which is the reason why an evaluation is important, including keeping a sleep journal; this gives me precious information for identifying bad habits and other factors contributing to the problem.
I use CBT-I, or Cognitive Behavioral Therapy for Insomnia, to help my clients. Research shows it helps subjects spend more time in slow-wave sleep, or deep sleep, than those treated with medication; moreover, six months later the benefits were still there, whereas sleep medication has no lasting benefits. CBT-I consists of several elements:
The first thing I do when I work with an insomniac client is to conduct an inventory of their sleep hygiene. I ask about the environment where the person sleeps, as well as what they do, eat and consume before trying to sleep. It seems obvious, but for example I recently helped a client improve her sleep simply by simply having her change her winter quilt for a summer one! Another client significantly improved her sleep by switching from caffeinated to decaffeinated coffee; studies have shown that for certain people even one small cup of caffeinated coffee in the morning can disturb their sleep that night.
I also teach my clients how to relax and reduce their stress with relaxation techniques, which are useful for those who have trouble falling asleep, but which also have proven very helpful for people who wake up in the middle of the night and can’t get back to sleep.
People who have insomnia often unknowingly condition their bodies to associate their bedroom or their bed with wakefulness. They also often over-stimulate their minds with television, video games or even YouTube videos. The body and the mind both need to be calm and prepared for sleep, and making a few adjustments in client routines and behaviors can often dramatically improve sleep.
For certain clients, they worry so much about their ability to sleep that it becomes a phobia, a kind of performance anxiety. Here the treatment method involves telling them to do exactly the opposite of what they’ve been doing: in other words, they should instead do their very best to stay awake all night, which takes their minds off the performance anxiety. Because they already know how to stay awake!
Sleep restriction is a counterintuitive but an extremely effective way to improve sleep quality, in my experience. Using the sleep journal, and after having eliminated other interfering factors, I work with the client to control the time they spend in bed; I have often found that my insomniac clients perpetuate their problem by trying to force their bodies to get too much sleep.
Cognitive Behavioral Therapy and ACT Therapy
Most commonly, when clients wake in the middle of the night and can’t get back to sleep, it’s because they start thinking – about problems, but also about Monday and things, such as what they’re going to do at work the next day or the groceries they need to buy for the weekend. CBT and ACT are therapies that help clients to have more distance from their thoughts and emotions and greater compassion for themselves, making it possible to stop the thought mill from working all night long, and improving mood as well.
Sleep Can be Improved
It must be accepted that for two or three weeks some uncomfortable changes may be necessary to make, and the client may feel quite tired as they adjust their sleep. But insomnia is not a fatality and in my experience can almost always be significantly improved, or cured.