person doing cognitive behavioral therapy for insomnia

What Is Cognitive Behavioral Therapy for Insomnia and Can It Help You Sleep Better?

by
/ February 7, 2022

Has sleep been hard to come by lately?  If so, then you're among the 30% of adults living with insomnia. It's frustrating not getting the sleep you need. And it's well documented that low-quality sleep is linked to health problems like high blood pressure and diabetes.     

To conquer insomnia, "having consolidated sleep at night is really the goal because you get those deeper stages of sleep," says Eve Rosenfeld, PhD, clinical psychology postdoctoral fellow, VA Palo Alto National Center for PTSD and Stanford University. 

Consolidated sleep means sleeping through the night, an almost impossibility for people with insomnia. Luckily, that's where cognitive behavioral therapy for insomnia, or CBT-I for short, comes in. Keep reading to find out whether CBT-I can help you sleep better. 

What is cognitive behavioral therapy for insomnia?

CBT-I teaches individuals to identify and replace dysfunctional beliefs about sleep with positive thoughts. CBT-I is directed by trained professionals  (psychologists, psychiatrists, or another medical doctor) with experience treating sleep disorders.  

How does CBT-I work?   

During CBT-I, individuals are taught habits that support improved sleep, such as:

  • Establishing a regular bedtime
  • Avoiding napping during the daytime
  • Limiting alcohol, caffeine, and nicotine before bed  

How long does it take for CBT-I to work?   

CBT-I is considered short-term therapy. The number of total sessions depends on the length of time it takes to learn the techniques. "I've seen it done as briefly as five weeks or 12 to 16 weeks, depending on how quickly somebody's implementing the skills and the amount of psychoeducation," says Rosenfeld.

How long does it take to learn CBT-I techniques? 

According to Adria Hagg, licensed clinical social worker, four to eight sessions are required to learn the techniques. Once individuals learn these techniques, the effects last a lifetime as long as the methods are continually implemented. In a way, these CBT-I techniques become a habit that replaces negative habits (thoughts and behaviors) that contribute to insomnia. 

Is CBT-I effective?  

So, can CBT help with sleep problems? Yes! Cognitive behavioral therapy for insomnia is "considered one of the most effective evidence-based treatments for sleep disorders," says Hagg.

Also, studies show this therapy is just as effective as sleep medications. This meta-analysis of randomized controlled trials focused on individuals suffering from both insomnia and depression. CBT-I was shown effective in treating both conditions, and the therapy was comparable to prescription anti-depressants and sleep aids.

Are there any risks to trying CBT-I?  

Cognitive behavioral therapy has been around since the 1960s and is considered safe and effective as it has helped many individuals with mental health conditions and various other issues.  

But might using CBT-I bring up painful or uncomfortable feelings or thoughts?  

There are many reasons why a person might experience difficulty sleeping, and sometimes those reasons involve previous trauma.  According to Rosenfeld, trauma should be explored with a trained therapist separately from CBT-I sessions.  

For some people, trouble sleeping can "be trauma-related, and that's when you would do some type of therapy that is also more trauma-focused," adds Hagg.

Can you do CBT-I online?  

Individuals can now access CBT-I through digital apps and online platforms.  But is digital delivery as effective as in-person therapy? 

One study assessed the pros and cons of using CBT-I digital platforms. The results showed that digital CBT-I provided better accessibility, instant support, and progress analysis. But without the presence of a human therapist, the programs can sometimes offer overgeneralized advice which can cause a person to be less interested in pursuing the program.   

"I have a lot of clients that have success with the applications out there," says Hagg.  "But a lot of times they begin with a therapy session, face to face or telehealth, because they want to be coached and learn the skillset."

How much does CBT for insomnia cost? 

Costs vary depending on a variety of factors, including the credentials your mental health professional holds and where you live. According to Choosing Therapy, an online therapy platform, weekly 50-minute cognitive behavioral therapy sessions usually run anywhere from $100-$200 per session. 

How do you find a CBT-I specialist?  

Finding a therapist specializing in CBT-I is as easy as consulting this list by the American Board of Sleep Medicine. You can also contact larger hospital groups and academic centers associated with major universities for information on CBT-I therapy personnel in your local area. 

Other tips for managing insomnia 

While CBT-I is proven effective for treating insomnia, it may not be suitable for everyone. Here are a few alternatives to CBT-I:

Mindfulness meditation  

Mindfulness meditation helps slow racing, negative thoughts to calm both body and mind by having you focus on a single action. Studies show mindfulness meditation can reduce stress, boost immunity, and improve sleep quality. You can practice mindfulness meditation anywhere, anytime. Try it when you brush your teeth, while doing the dishes, or working out.   

Deep breathing  

Doing breathing exercises before bed can help reduce anxiety and stress. There are several deep breathing exercises, such as abdominal breathing, which involves slowly breathing from the diaphragm into the abdomen instead of shallowly breathing in the chest. 

Another technique is called 4-7-8 breathing. Here's how to do it:

  • Inhale through your nose (while keeping your mouth closed), slowly counting to four.
  • Hold your breath for a count of seven.  
  • Exhale completely through your mouth while counting to eight.  
  • Repeat the cycle for a total of four breaths. 

Yoga

Studies show one of the best exercises to help you snooze is yoga. One meta-analysis concluded that yoga helps women who experience sleep problems. It can also help alleviate restless leg syndrome, which is associated with insomnia. 

Natural sleep solutions 

There are also plenty of natural sleep aids that may be able to help improve your insomnia. Always ask your doctor before adding any new supplements to your routine. 

Some of the most popular natural sleep solutions include: 

  • Melatonin
  • Valerian root
  • Magnesium
  • Lavender
  • Passionflower
  • Glycine
  • Tryptophan
  • Ginkgo Biloba
  • L-theanine

The bottom line: Cognitive behavioral therapy is a proven effective technique that has helped many people with insomnia regain their sleep. If you're looking for a 100% natural treatment for your sleep issues, consider giving CBT-I a try. 

Struggling with insomnia and looking for more ways to deal with it? We put together a list of nighttime activities to help you relax

theona layne, writer

Theona Layne

Theona Layne is an experienced Pittsburgh-based health writer. You can find her work popping up in places like Medical News Today, UPMC, Temple University Health System, and of course, Saatva. Connect with her on LinkedIn. Check out her website to learn more about her freelance writing services. 

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