Can Therapy Help My Insomnia?
Do you ever lay in bed, frustrated, wondering what stream of thought is going to capture your attention and keep you awake tonight? How people have wronged me, strange noises, diseases I probably have, my financial future, awkward things I did at that party, or an idea for a startup or novel?
If you have difficulty falling or staying asleep at least half of the nights of each week for at least three months, then you might have chronic insomnia. There is not a perfect quantitative way to diagnose it.
If you have this type of chronic insomnia, Cognitive Behavioral Therapy for Insomnia (CBT-I) could be an effective treatment option for you. The American Academy of Sleep Medicine says that CBT-I is the gold standard for first-line treatment of chronic insomnia. They gave it this recommendation over many FDA-approved sleep medicines because those medications sometimes lead to falls in older adults, interactions with other medications, tolerance over time, and parasomnias (sleepwalking, nightmares, etc.).
If you are like me, you are thinking, "Great, someone is going to tell me about not drinking coffee, spending more on a mattress, getting a sound machine, doing a sleep study, and getting EVEN better blackout curtains. Google can do that. And it does. That's the advice you get when you look up insomnia or sleep problems. You could imagine how all of the mattress companies, Amazon, Target, and melatonin supplement manufacturers are happy to push that message as well. Nothing is more frustrating to them than me telling you that you probably have an adequate sleep environment already, and you could probably start sleeping better after 3-4 sessions of implementing some new, somewhat counterintuitive, behavioral and cognitive strategies.
So, to convince you to consider it, let me give you an intro to just a few of the ideas and approaches you will learn in CBT-I. Remember, many of these things are relevant to you only if you meet the basic criteria for chronic insomnia: you have difficulty falling or staying asleep at least half of the nights of each week for at least three months.
The best way to make up for lack of sleep is to get more deep sleep the next night, not necessarily spend more hours in the bed or "asleep". This is an important distinction that will be discussed.
Your sleep schedule does matter, but that doesn't mean you have to go to bed early or get up early.
Taking naps and avoiding the gym, exercise, or anything strenuous when you are tired might be part of the problem.
The American Academy of Sleep Medicine advises against over-the-counter sleep aids such as Benadryl (diphenhydramine), melatonin, and valerian for those with chronic insomnia.
Pressuring yourself to get at least 8 hours of sleep each night might actually be causing your chronic insomnia.
CBT-I will introduce you to proven ways to make your bed a place where you want to go to sleep rather than a place where you dread tossing and turning.
It's normal to be afraid that starting this treatment will only make you even more anxious about sleep, but we will address that as well. Anxiety is often maintained or worsened by avoidance. Take proactive steps with an evidence-based approach.
Interested? Contact me or another CBT-I trained clinician to set up an appointment.
Carney, C. (2023). CBT for insomnia: Counselor’s choice award. Counselor’s Choice. https://www.counselorschoiceaward.com/cbti
DeAngelis, T. (2016, October). Behavioral therapy works best for insomnia. Monitor on Psychology. https://www.apa.org/monitor/2016/10/insomnia
